ALTCS Eligibility Requirements
To be eligible for the ALTCS program, you must be an Arizona resident over the age of 65 with a developmental disability. You must also be able to meet certain medical and financial criteria in order to be approved for long-term care in Arizona.
If the applicant is requiring hands on care to perform basic daily activities, they will most likely be medically eligible for ALTCS. Whereas some of the financial requirements for long-term care are much more complex and often require a bit of planning. For Example, the applicant must fall under a specific income limit and have a limited amount of liquid assets to be eligible for the ALTCS program.
Medical Eligibility Requirements
To qualify for the medical section of the ALTCS benefit, applicants must undergo a medical screening process known as the Pre-Admission Screen (PAS). Applicants begin by providing an assessor with personal information such as their age, date of birth, living arrangements, and physician information.
The assessor then evaluates the applicant’s health by examining aspects such as continence, behavior, and whether the applicant requires assistance with daily activities. Finally, ALTCS determines medical eligibility by assigning a numerical score based on the PAS evaluation and previous medical records.
Prior to the PAS, most ALTCS applicants will meet with a hospital discharge planner, social worker, or other health care professional who can give them insight as to whether they qualify medically for the ALTCS benefit. In addition to seeking guidance from one of these professionals, applicants should describe symptoms and behaviors that occur on their worst days when speaking with their PAS assessor, as this will best illustrate their need for assistance. As long as applicants genuinely need daily, hands-on assistance, they should not have difficulty meeting ALTCS medical requirements.
Financial Eligibility Requirements
The financial requirements for the ALTCS program are much more complex and it is not uncommon for applicants to struggle with this portion of the eligibility process. The financial assessment involves a close inspection of applicant’s income and assets, both of which must fall below a certain specified amount. ALTCS income and asset limits are also based on an applicant’s marital status, with the limits being quite different for married applicants compared to a single applicant.
An applicant must meet the following general criteria before starting the financial ALTCS assessment:
- Must be a U.S. citizen or a legal alien
- Must be an Arizona resident, with the intent to stay in Arizona
- Must have a Social Security number
- Must make an effort to secure potential primary benefits
- Must reside in their personal home, a medical institution or an approved home based community setting
- Must be cooperative and provide verifying documents to ALTCS
– ALTCS Monthly Income Limits
Whether an applicant is married or single determines the amount of income they can receive under the ALTCS program rules.
- A single applicant can have up to $2,250* in monthly income
- A married applicant applying for ALTCS alone is limited to $2,250* in monthly income and their spouse’s income is not considered.
- Married applicants applying together cannot have more than $4,500* in monthly income
*These limitations are effective for 2018 and are reviewed each year.
– Miller Trust Financial Options
The fear of being over the income limit shouldn’t keep individuals from applying for ALTCS. Individuals who would like to apply for the ALTCS benefit, but whose income is too high, might be able to establish a Miller/Income-only trust to help them qualify.
Like other types of trusts, the Miller/Income-only trusts must comply with strict legal formalities to be valid, so applicants who are looking for more information about this option should consult with an attorney about whether this strategy could potentially help them qualify or not.
– Personal Resources Allowed Through ALTCS
Whether applicants are married or single also determines the value of resources ALTCS allows them to have. Single applicants can have no more than $2,000* in countable resources, while married couples are allowed more.
It is important to remember that ALTCS only looks at countable resources when determining ones eligibility. Countable assets include all money and property that can be valued and converted into cash.
The following types of assets are excluded:
- One home: The home, located in Arizona, must be the applicant’s principal place of residence, and cannot have equity value exceeding $572,000* (Applicants living in a nursing home when they apply may have to demonstrate their intent to return home.)
- One vehicle: Applicants, married or single, are allowed to have one primary transportation vehicle of any value.
- Burial plots
- Irrevocable prepaid funeral plans
The following types of “Countable” assets include:
- Cash, checking and savings accounts
- Certificates of deposit
- S. savings bonds
- Retirement accounts, including IRA, 401K, and TSA
- Nursing home accounts
- Revocable prepaid funeral contracts
- Assets held in trust
- Real estate, other than the primary residence
- Additional cars
- Boats and recreational vehicles
- Stocks, bonds, and mutual funds
- Promissory notes
- Life Insurance, if face value of all policies owned by an individual exceeds $1,500
– Financial Relief Options For The Well Spouse
Married couples might be able to arrange their affairs to minimize their countable resources, doing so can help them keep more assets for the well spouse, while helping the other qualify for the ALTCS benefit. Spouses of ALTCS applicants obviously need to keep enough resources to remain financially secure.
Because of this, ALTCS allows for a Community Spouse Resource Deduction (CSRD), which essentially sets a portion of a couple’s assets aside for a well spouse. The CSRD allows the well spouses to keep one-half of the couple’s countable resources, up to a certain amount.
For Example, a couple with $100,000 in countable resources could keep about $50,000 for the well spouse. The CSRD has certain guarantees and limitations, as well as minimum and maximum thresholds. The minimum CSRD is $24,720*, meaning that a couple with $35,000 in countable resources could keep about $24,720* for the well spouse because half of $35,000 falls below the minimum threshold.
On the other hand, regardless of how many assets a couple has, the maximum CSRD is $123,600*. The rules state that the well spouse cannot keep more than this amount even if it is less than half of the couple’s total assets. An Elder Law attorney could help use policy and federal regulation to protect your family’s assets, keep in mind the time for couples to make these arrangements is before the ALTCS financial assessment, as this could minimize delays in eligibility.
Financial Spend Down Options
It is not uncommon for ALTCS to deny benefits to applicants on account of having too many resources. ALTCS applicants whose resources exceed the limit are not precluded from qualifying at a later date. Rather, they might be able to spend down their countable resources and qualify for the benefit once they satisfy the financial requirements.
Of course, prospective ALTCS applicants should never spend frivolously just to satisfy ALTCS requirements. ALTCS applicants can sometimes expedite their eligibility by spending excess countable resources on certain exempt resources, a process known as “spend down.” Because ALTCS penalizes applicants for making uncompensated transfers, however, they should be extremely cautious here.
ALTCS currently looks back five years from the date of application, and questions any transfers without value, or gifts. Applicants who make gifts within this five-year window are likely to be penalized with a period of ineligibility.
In short, applicants cannot simply give away excess resources in an effort to become eligible for the ALTCS benefit, Arizona Medicaid wants to be sure the applicant spends their money on their own needs, rather than giving it to family or friends. If an applicant is denied Medicaid benefits because they have too many resources financially, they can often “spend down” and re-apply at a later date.
What are ALTCS spend down exemptions?
- prepaid funeral plans
- care needs the applicant might have, paying for care is always allowable
- legal fees, including ALTCS Planning Attorneys
- personal items such as; clothing and home goods, hygiene and care items, over the counter medications
To learn more about ALTCS eligibility and requirements, call our Elder Care team today at (480) 405-0510.