ALTCS and Medicaid FAQ

1. Does Medicare cover long-term healthcare?
2. When is the best time to plan for long-term healthcare?
3. What is ALTCS?
4. Does the ALTCS benefit only apply to skilled nursing facilities?
5. Do ALTCS members receive the same quality of care as private pay residents in a skilled nursing or assisted living facility?
6. How are ALTCS services provided?
7. Can children or spouses receive payment from ALTCS for caring for their family member?
8. What happens after an ALTCS applicant is approved for the benefit?
9. What services are available through ALTCS?
10. Who determines what services ALTCS members need and where they should receive these services?
11. After getting approved for the benefit, can an ALTCS member ever change his mind and move to a different facility?
12. Do ALTCS benefits follow members who move to another county?
13. Can ALTCS members choose their own physician?
14. Can families pay privately for ALTCS members to receive additional services?
15. Do ALTCS members have to pay a portion of their cost of care?
16. What medical eligibility requirements must an ALTCS applicant pass to receive the benefit?
17. What are the financial requirements for ALTCS?
18. Can a single person protect any of his assets when applying for the ALTCS benefit, or is asset protection limited to married applicants?
19. How should ALTCS applicants prepare for the application process?
20. Can ALTCS members keep their Medicare Health Plan or private insurance while on ALTCS?
21. Does a family really need an Elder Law Attorney when applying for ALTCS?
22. Does an applicant who satisfies all of ALTCS financial requirements need a law firm to help with the application?
23. Why should an ALTCS applicant choose JacksonWhite to help with the ALTCS application?
24. Can JacksonWhite help a younger individual who was injured in an accident and now requires long-term healthcare?
25. Where do applicants submit their application for the ALTCS benefit?
26. List of AHCCCS insurance providers.

Does Medicare cover long-term healthcare?
Medicare covers healthcare costs associated with helping people recover from illness or injury.  However, Medicare does not pay for long-term custodial healthcare.  Long-term healthcare must be funded from private sources, long-term healthcare insurance or public benefit programs such as ALTCS or VA.

When is the best time to plan for long-term healthcare?
People should begin planning for long-term healthcare when they first suspect they will require it.  Somebody who is diagnosed with a degenerative disease such as Alzheimer’s or Parkinson’s, for example, would want to begin long-term healthcare planning.  Even those who require immediate healthcare could benefit from preparing for the future.  A long-term healthcare plan should help people preserve their assets and decide which types of medical treatment to pursue. 

What is ALTCS?
ALTCS stands for Arizona Long Term Care System.  It is part of the Arizona Healthcare Cost Containment System (AHCCCS) state healthcare program for low-income earners.  As a benefit program, ALTCS only provides long-term healthcare services to program applicants who meet eligibility requirements.

Does the ALTCS benefit only cover the costs of skilled nursing facilities?
ALTCS covers a continuum of care, including skilled nursing facilities, assisted living facilities, group homes and in-home care, so long as the care provider is contracted with ALTCS.  An ALTCS applicant may begin receiving benefits for care in the home, and continue receiving coverage as he moves to an assisted living facility or skilled nursing facility.  With proper foresight, ALTCS coverage follows members as their healthcare needs increase. 

Do ALTCS members receive the same quality of care as private pay residents in a skilled nursing or assisted living facility?
Healthcare providers are required by law to treat all of their patients equally, so ALTCS beneficiaries must be given the same treatment as private pay residents. 

How are ALTCS services provided?   
ALTCS Program Contractors work through managed care programs to provide ALTCS members with services.  Managed care programs are much like HMOs, in that ALTCS beneficiaries work with their Program Contractor to select from contracted healthcare providers.  Click here for a list of the ALTCS Program Contractors for each county.

Can children or spouses receive payment from ALTCS for caring for their family member?
An ALTCS benefit called attendant care allows family members and friends to become paid caregivers for an ALTCS beneficiary.  The person in need of care must first qualify for the ALTCS benefit.  Then, the family member or friend contracts with an ALTCS program contractor to become a paid caregiver.  Based on the beneficiary’s needs, ALTCS authorizes the number of hours the caregiver can be paid.  The Attendant Care program provides ALTCS members with the peace of mind that comes with having a caregiver they trust, while also compensating family members for their service.  Families that engage in ALTCS planning early on are best situated to take advantage of this program. 

What happens after an ALTCS applicant is approved for the benefit?
Upon approval for the benefit, new ALTCS members enroll with a Program Contractor, who assigns them a Case Manager.  ALTCS members then meet with their Case Manager to develop a specific healthcare plan.  Together with their Case Manager, ALTCS members choose healthcare providers in accordance with their healthcare plan.  ALTCS provides coverage for all services approved by a Case Manager and offered by a contracted provider.

What services are available through ALTCS?
A continuum of care is available through ALTCS, including:

• AHCCS Acute Care Services, which include:  doctors, hospitalization, prescriptions, lab work, x-rays, tests and specialist treatments.
• Nursing Home Care, provided in a licensed nursing facility, Intermediate Care Facility for the Mentally Retarded (ICF-MR), a freestanding hospice, a residential treatment facility for persons under 21 or a psychiatric hospital for persons age 65 or older.
• Home and Community Based Services (HCBS) provided in the ALTCS beneficiary’s own home.  HCBS services may include:
  • Home Health Nursing
  • Habitation
  • Adult Day Care
  • Personal Care
  • Medical Transportation
  • Mental Health Services
  • Homemaker Services
  • Attendant Care
  • Respite Care
  • Home Health Aids
  • Home Delivered Meals
  • Hospice
• Home and Community Based Services may also be provided in a supervised alternative residential setting, such as an Adult Foster Care Home, Assisted Living Home, Group Home or a Level I, II or III Behavioral Health Center.

Who determines what services ALTCS members need, and where they should receive these services?
ALTCS members decide where they will receive services, so long as they are from a contracted provider.  However, Case Managers collaborate with ALTCS beneficiaries’ primary care physicians to make proper treatment and placement suggestions.  They also seek input from spouses and other representatives when coming up with healthcare options. 

After getting approved for the benefit, can an ALTCS member change his mind and move to a different facility?
ALTCS members can always change their mind about location of services.  Generally speaking, ALTCS members can move to another facility, provided that the facility is a contracted provider. 

Do ALTCS benefits follow members who move to another county?
ALTCS services do not automatically follow members who move to a different county.  By submitting a request to their program contractor, however, ALTCS members can switch the county in which they receive services. 

Can ALTCS members choose their own physician?
While there is no guarantee that ALTCS covers every physician, ALTCS members can seek treatment from an out-of-network physician.  Those who do must pay for the treatment they receive there.  Medicare or private insurance may provide this coverage, or the member may have an out-of-pocket expense.  Ideally, however, ALTCS members should select a physician who is contracted with their Program Contractor, as this will inevitably save them money.  

Can families pay privately for ALTCS members to receive additional services?
ALTCS members commonly use private pay dollars to supplement the care covered by ALTCS.  Special Needs Trusts are very effective tools in this regard because they help ALTCS members maintain the quality of life they are accustomed to without affecting their eligibility for the benefit.  

Do ALTCS members have to pay a portion of their cost of care?
ALTCS members sometimes must pay for a portion of their care, known as share of cost.  How much a member must pay depends on his particular circumstances:

• Members living in their home or in an alternative residential setting must pay for any Home and Community Based Services they receive before their ALTCS application is approved. 
• Members living in an alternative residential setting, such as an Assisted Living Home, must pay for room and board charges in the residential setting both before and after they are approved for benefits.  This cost is unavoidable, as ALTCS does not pay for room and board in alternative settings.
• Some ALTCS members are responsible for a share of cost of their medical care.  This amount is determined by their medical condition, their monthly income, and the needs of any dependents that they have. 

ALTCS applicants find out whether they must pay a share of cost during the application process.  Eligibility workers explain to applicants how ALTCS calculates the share of cost, and then notifies them how much, if any, they must pay.  Program contractors help remind ALTCS members of their responsibility to pay a share of cost by either collecting payment personally or explaining where payment is due and when it must be paid.

What medical eligibility requirements must ALTCS applicants pass to qualify for the benefit?
ALTCS uses a Pre-Admission Screening (PAS) to determine whether applicants qualify medically for the ALTCS benefit.  The PAS aims to accurately assess applicants’ medical condition, and only where it reveals a risk of institutionalization and a need for medical care do applicants qualify medically for the ALTCS benefit.  More specifically, applicants must require long-term care at a level comparable to that provided in a nursing facility, which is below hospitalization but above intermittent outpatient treatment in order to pass the screening process.  

Assessors perform the PAS by conducting a face-to-face interview with applicants, which consists of the following sections:

1. Intake Information
2. Demographic Information
3. Functional Information and Assessment
4. Medical Information and Assessment

The most important part of the PAS for applicants is how they answer the questions asked in the functional and medical assessment.  The assessor creates a numerical score based on the functional and medical assessment, which is used to determine how much medical care the applicant is eligible for. 

The functional assessment focuses on the following areas:

• Activities of Daily Living
  • Mobility – Purposeful movement within the applicant’s residence
  • Transfer – For example, moving from bed to a chair
  • Bathing – Washing, rinsing, drying body parts, transfer in/out of tub
  • Grooming – Tending to appearance of hair, teeth, face, hands, nails
  • Dressing
  • Eating
  • Toileting
• Continence
• Vision
• Orientation to person, place and time
• Behavior patterns such as wandering, aggression, self-injury and suicide attempts

The medical assessment focuses on the following areas:

• Medical condition – The assessor examines acute and chronic conditions, as well as medical history, and how these conditions impact activities of daily living.
• Services and treatment – The assessor identifies all services and treatments an applicant receives or requires. 

Generally speaking, PAS assessors recognize a combination of the following needs and impairments in medically eligible ALTCS applicants:

• Requires nursing care on a daily basis
• Requires regular medical monitoring
• Exhibits impaired cognitive functioning
• Exhibits difficulty with activities of daily living
• Exhibits impaired continence
• Displays psychosocial problems

What are the financial requirements for ALTCS?
The financial requirements for the ALTCS benefit change annually, but these figures are effective for 2010:

• ALTCS Income Eligibility Cap – $2,022
• Resources for Individual – $2,000
• Maximum Monthly Community Spouse Resource Allowance – $109,560
• Minimum Monthly Community Spouse Resource Allowance – $21,912
• Maximum Monthly Maintenance Needs Allowance – $2,739
• Minimum Monthly Maintenance Needs Allowance – $1,822
• Personal Needs Allowance - $101.10

Can a single person protect any of his assets when applying for the ALTCS benefit, or is asset protection limited to married applicants?
ALTCS has special eligibility requirements for married applicants that protect spouses’ financial wellbeing.  With certain exceptions, applicants’ spouses can keep one-half of the married couple’s countable resources.  Single applicants, on the other hand have to spend down their countable resources or make other preparations to preserve their assets.    

How should ALTCS applicants prepare for the application process?
Applicants who satisfy all of ALTCS eligibility requirements are likely to qualify for the benefit without much ado.  However, many applicants must prepare well in advance to qualify for the benefit, and an Elder Law Attorney can help these applicants prepare.  Those who answer YES on any of the following questions should visit an Elder Law Attorney before applying for the ALTCS benefit. 

• Is monthly income over $2,022?
• If single, are assets over $2,000?
• If married, are assets over $21,912?
• Is car value over $4,500?
• Is the primary house in a trust?
• Do applicant’s assets include a trust?
• Have there been transfers of cash or assets within the past 60 months? (i.e. charity, gifts, name changed on property)
• Does the primary home have more than $500,000 in equity?
• Is there more than one home/property?
• Is there more than one car?

Can ALTCS members keep their Medicare Health Plan or private insurance while on ALTCS?
Medicare and ALTCS cover different services.  To ensure full coverage of medical expenses, ALTCS members keep their Medicare Health Plan or private insurance while receiving the ALTCS benefit, and choose which Medicare plan to enroll in.  As a payer of last resort, ALTCS covers only those services that other insurances do not cover.   

Does a family really need an Elder Law Attorney to apply for ALTCS?
Recent legislation made qualifying for ALTCS even more difficult than in the past.  Applicants can now be denied benefits for any transfer of assets, whether or not it was made with consideration of future healthcare needs.  A denial can be quite devastating not only to applicants, but to their families and spouses.  Consulting with an Elder Law Attorney educates applicants on their options and prepares them to qualify for the benefit. 

Does an applicant who satisfies all of ALTCS financial requirements need a law firm to help with the application?
Anybody can apply directly with the state ALTCS office for the ALTCS benefit. ALTCS representatives take applications over the phone and help applicants with the process.  Applicants who satisfy all of the financial requirements do not require a law firm to help with this.  For ALTCS contact information and office locations please click here.   

Why should an ALTCS applicant choose JacksonWhite to help with the ALTCS application?
Over the years, the Elder Law team at JacksonWhite has guided thousands of families through the ALTCS application process and helped them understand their healthcare options.  Through this experience, JacksonWhite Elder Law has developed a thorough understanding of the ALTCS system and its rules.  In addition, the Elder Care Consultants, Social Workers, and Elder Care Benefit Specialists are experienced in all of the issues surrounding long-term healthcare.  The JacksonWhite Elder Law team works collaboratively to answer all of the questions families have about public benefits and securing assets. 

Can JacksonWhite help a younger individual who was injured in an accident and now requires long-term healthcare?
JacksonWhite’s Elder Law Attorneys can help anybody who needs long-term healthcare, regardless of their age.  In addition to long-term healthcare concerns, accident victims are confronted with a variety of issues that JacksonWhite can help them resolve.  The Attorneys at JacksonWhite work collaboratively to provide every client with individualized attention.

Where do applicants submit their application for the ALTCS benefit?
ALTCS applicants should mail or fax their ALTCS application to the Long-Term Care Office listed below that is nearest to their residence:

List of AHCCCS insurance providers:
Arizona Healthcare Cost Containment System Insurance Providers:

Acute Care Health Plans
Please note while this is a complete list for the state, health plans are not broken down by county. Please contact JacksonWhite or your counties long-term care office for your counties specific information.

Long-Term Care Program Contractors
Please note while this is a complete list for the state, health plans are not broken down by county. Please contact JacksonWhite or your counties long-term care office for your counties specific information.

Behavioral Health Plans
Please note while this is a complete list for the state, health plans are not broken down by county. Please contact JacksonWhite or your counties long-term care office for your counties specific information.

*Health Plans are listed in random order