Introduction
Are you wondering whether Medicaid covers long-term assisted living or nursing home care for dementia? Need to know if you can get help with treatment for a chronic illness, including prescriptions or doctor visits?
It’s no secret that medical care is expensive, so looking into aid is a good way to ease the financial burden a bit. But before you apply, there are some important rules you should be aware of. The more you learn about the process, the quicker you can gain access to the help you need.
What is ALTCS?
Federal law requires states to cover certain services for recipients of Medicaid, such as treatment in nursing facilities, behavioral health services, and more.
Arizona has a Medicaid program called ALTCS (Arizona Long-Term Care System) for aged, disabled, developmentally disabled, or blind residents of the state. The service offers long-term care services for those who are medically and financially eligible at little to no cost.
What Services are Available?
Once you apply, you’ll wait to hear back on whether or not you qualify for the benefits. If an associate finds you to be eligible for ALTCS, you’ll work with a case manager to put together a service plan. The program may cover the following:
- A combination of in-home and out-patient care
- Care in an institution, such as a nursing facility
- Doctor’s visits, prescriptions, and other medical services
- Behavioral health services
- Hospice care
Note that there are other services your ALTCS benefits may cover in addition to the ones listed above. Keep in mind that not all nursing homes or related services accept Medicaid benefits as payment, so you’ll have to ask.
What are the Eligibility Requirements for ALTCS?
We’ll cover financial information a little later in the article, but first, what are the non-financial requirements to get ALTCS assistance? You must:
- Be in need of a nursing home (or another type of institutional care)
- Be a United States citizen or qualified immigrant
- Be a resident of Arizona
- Have or apply for a Social Security Number
- Apply for benefits you qualify for such as VA benefits or Pensions
- Live in a nursing facility, your home, or another approved arrangement
Financial Requirements for ALTCS
How much does Medicaid (ALTCS) pay for long term care? This will depend on your financial situation and medical needs. As soon as you gain eligibility for ALTCS, an associate will determine how much (if any) you owe towards your community-based services or nursing home. This amount is called the Share of Cost.
For the purposes of the application, your income includes Social Security, wages, retirement pensions, and more. The gross monthly limit for income is $2,829 as of January 2024 for one person. If you need ALTCS services and you’re married, read through the program’s information on Community Spouse applicants.
If you make more than $2,829 per month, you might still qualify under special circumstances. Working with an Elder Law attorney is one good way to find out whether an exception applies to your situation.
Medical Eligibility
If you’re financially eligible for ALTCS, a social worker or nurse will give you an in-person interview to determine medical eligibility. To qualify, you must be at risk of institutionalization in an intermediate care or nursing facility. Keep in mind that this doesn’t mean you have to actually live in one, just that you must be in need of this level of care.
Resource Requirements for Eligibility
As a single applicant, your countable resources may not exceed $2,000 if you wish to receive Medicaid benefits. If you’re married, there may be an exception if your resources are set aside for your spouse. The following resources (among others) don’t count under these rules:
- Credit union, checking, or savings accounts
- The house you’re currently living in (some exceptions apply)
- Real property that you’re not living in
- Irrevocable burial plans or burial plots
- A single vehicle
- Non-exempt vehicles
- Cash, bonds, stocks
- Personal belongings
Can You Transfer Assets to Qualify for ALTCS?
Some people believe that they can qualify for ALTCS services by transferring their money or assets to their children. However, under Medicaid law, you may not transfer your assets unless you receive fair value for them in return.
The program imposes a penalty for people who break this rule. If you’re caught making transfers within the 5-year period before your Medicaid application, they will deem you ineligible for a period of time. This period will vary based on how much money you transferred. Some exceptions exist for this rule regarding the transfer of assets.
How Much Money can a Medicaid Recipient Keep?
ALTCS can deny their services to people who aren’t low enough on resources to qualify. As a single applicant, you can only have up to $2,000 in countable assets. As a married person who is applying for benefits with your partner, you may have up to $3,000.
What is Spending Down on Care?
If you have too much, you can “spend down” on care to help meet the financial requirements and receive benefits. This is a way to spend your extra resources on exempt items so you can reapply later. Note that you can’t give away your extra resources in order to qualify. ALTCS may look back five years to make sure you haven’t done this.
This rule is to ensure that applicants are using their money for their needs rather than giving it away. As mentioned, this rule applies only to countable assets such as bank accounts, retirement accounts, and other exempt items. If you wish to qualify for Medicaid even with multiple assets, speaking with an Elder Law attorney can help.
How to Prepare for ALTCS
If you need medical care and aren’t sure how you’ll cover the costs, ALTCS can be an invaluable resource. When should you start preparing to apply for ALTCS? If you suspect you may need long-term care in Arizona, you should start planning your application as soon as possible. The quicker you begin the process, the quicker you can potentially gain access to the program’s benefits.
If you have any further questions on how Medicaid works for long term care, or simply need help applying, schedule an ALTCS pre-screen today.
Contact the JacksonWhite ALTCS team today at (480)467-4337 and learn more your options for long term care.