What is the difference between Medicare and ALTCS in Arizona?

Medicare covers the costs of short-term care, such as those associated with helping individuals recover from illness and injury.  This is a powerful resource indeed, but it does nothing to cover the costs of long-term health care.

ALTCS, on the other hand, is designed specifically to cover long-term health care costs.  As such, many individuals use ALTCS in conjunction with their Medicare benefits to receive the most coverage possible.  An Arizona Elder Law lawyer can help those who apply for Arizona Medicaid to coordinate their benefits appropriately.

Is ALTCS only for those who need care in a Arizona skilled nursing facility?

Many of those who are caring for elderly parents in Arizona believe that ALTCS only covers care in a skilled nursing facility.  The truth is, however, that Arizona Long-Term Care System covers a wide range of services.

In addition to skilled nursing care, ALTCS provides coverage for services including home health care, adult day care and assisted living.  So, whether or not an individual requires immediate attention in a skilled nursing facility, ALTCS planning with an Elder Law firm may be a good idea.

When should an individual begin preparing for ALTCS eligibility?

Anybody who suspects they may need long-term health care in Arizona in the future should consult with an Arizona elder law attorney about ALTCS planning.  Even those who already require medical attention, but do not qualify for the ALTCS benefit, can gain much from ALTCS Medicaid planning.

The general rule is that people who actively work towards Arizona Medicaid eligibility tend to obtain ALTCS eligibility sooner than those who do not.  An Elder Law lawyer in Arizona can evaluate an individual’s situation so that they may apply for Arizona Medicaid and begin receiving the benefit with as little delay as possible.

How does quality of medical care differ between those who pay privately for their health care and ALTCS members?

Arizona Long-Term Care System members receive the same courtesy and medical treatment as those who pay for health care out-of-pocket.  In fact, health care providers are legally required to treat their patients equally in Arizona, so ALTCS members are protected from discrimination by the force of law.

Thus, with ALTCS/Medicaid, individuals are eligible to receive quality health care, but are not burdened with overwhelming out-of-pocket expenses.

How does an ALTCS member begin receiving the benefit once she meets Medicaid qualifications?

Once a new member is approved for the ALTCS benefit, she may enroll with a Program Contractor, who assigns her a Case Manager.  Case Managers specialize in developing health care plans for members, and they do so with the input and feedback of the new member and her family.

In working with the Case Manager, new members select health care providers and services that are covered by ALTCS in order to minimize their out-of-pocket expenses.  In the end, Arizona Long-Term Care System covers all services that Case Managers approve, so long as a contracted provider offers them.

Must ALTCS members pay for any of their health care?

Once approved for Arizona Medicaid, ALTCS members are sometimes required to pay a share of cost.  The amount of a given member’s share of cost depends on her particular circumstances.  For instance, a member living at home may be responsible to pay for home-based services she receives before she meets Medicaid qualifications.

Likewise, a member living in an assisted living facility may be responsible for room and board charges, as ALTCS only covers this type of expense in certain nursing facilities.  Other members may be responsible for a portion of their medical care based on the amount of their monthly income and any dependents they may have.

Most times, ALTCS applicants learn of their share of cost when they apply for the benefit.  An ALTCS eligibility worker ordinarily explains the share of cost to new members, and notifies them how much, if any, they must pay.  Whether or not a share of cost is due, the ALTCS benefit relieves members of a substantial portion of long-term health care’s out-of-pocket costs.

Are ALTCS members allowed to keep their personal physician?

ALTCS members are limited to in-network physicians if they want ALTCS to pay for the visit.  Arizona Long-Term Care System members can, however, visit out-of-network physicians, provided they are willing to pay for the visit out-of-pocket.  Most members avoid this unnecessary expense, though, by selecting a contracted physician.  Case Managers can help new members find a new physician with whom they are comfortable.

Can an ALTCS member use private funds to supplement the care he receives from Arizona Medicaid?

While the ALTCS benefit is tremendously helpful by itself, members can sometimes improve their quality of life by supplementing the benefit with additional funds.  The catch here is that members who receive sudden increases in their income or resources can exceed Medicaid qualifications and thus lose their ALTCS eligibility.

Of course, with proper ALTCS planning, those who apply for Arizona Medicaid may supplement their care without triggering penalties.  For example, an ALTCS member may use a special needs trust to set money aside that will neither count as resources nor income for purposes of ALTCS eligibility.  There are strict rules surrounding these trusts, however, so ALTCS members should always consult with an Elder Law attorney about their creation and administration.

What specific financial requirements must ALTCS applicants meet?

Those who apply for Arizona Medicaid must meet Medicaid qualifications, which include financial requirements.  Preparing for ALTCS eligibility with an Elder Law attorney may help ALTCS applicants meet these requirements.  While these Medicaid qualifications change annually, the following figures are effective January 1, 2017:

  • Income limit:  $2,205
  • Resource limit: $2,000
  • Maximum monthly community spouse resource allowance:  $120,900
  • Minimum monthly community spouse resource allowance:  $24,180
  • Maximum monthly maintenance needs allowance:  $3,023
  • Minimum monthly maintenance needs allowance:  $2,003
  • Personal needs allowance:  $110.25

May an ALTCS applicant spend down her resources to meet the ALTCS resource limit?

Many of those who apply for Arizona Medicaid have more resources than Medicaid qualifications permit, but still not enough to cover long-term health care for the remainder of their life.

For these applicants, ALTCS planning with an Elder Law lawyer may be instrumental.  One strategy for obtaining ALTCS eligibility in such a situation is spending countable resources on exempt resources.  Because Arizona Long-Term Care System penalizes certain transfers with a period of ineligibility, however, applicants should only use this method under the advisement of an Arizona Elder Law attorney.

By working with an Elder Law firm, applicants may arrange their affairs such that they avoid penalties and unnecessary delays in eligibility.

Can an ALTCS applicant give away excess resources to become eligible for the benefit?

While Arizona Medicaid rules permit ALTCS planning, those who apply for Arizona Medicaid cannot give their resources away to obtain ALTCS eligibility.  To prevent this, Arizona Long-Term Care System has implemented a policy penalizing transfers without value.

ALTCS/Medicaid applicants who give away assets for any reason must wait for a period of time before becoming eligible for the benefit.  The larger the uncompensated transfer, the longer the applicant must wait before becoming eligible.  While gifting may play a role in ALTCS planning, Arizona Medicaid applicants should never do so without the assistance of an Elder Law firm.  With the guidance of an Elder Law attorney, applicants can set out on the quickest path to meet Medicaid qualifications without accruing unnecessary penalties.

How far back does Arizona Long Term Care System look to see if an applicant transferred any assets?

Arizona Long Term Care System imposes penalties on transfers without value, or gifts, to prevent applicants from transferring their assets just to obtain ALTCS eligibility.  At the present time, ALTCS looks back five years from the application date and questions every transfer an applicant has made.

Applicants who transferred assets within the five-year window may be penalized with a period of ineligibility, the length of which is determined by the value of the transfer.  The bottom line here is that applicants cannot become eligible for the ALTCS benefit by simply giving away their assets.  Before giving any property away, ALTCS applicants should discuss their situation with an Arizona Medicaid lawyer.

How are spouses affected when their husband or wife must spend down resources to qualify for the ALTCS benefit?

Sometimes those who apply for Arizona Medicaid spend down their resources so that they may obtain ALTCS eligibility.  A married applicant, however, could deprive the well spouse of the means to care for herself if he is not careful with this strategy.  To prevent such a result, Arizona Long Term Care System protects well spouses by allowing married applicants to take what is called a Community Spouse Resource Deduction (CSRD).

The CSRD ensures that a well spouse’s needs are met and that she is able to maintain her quality of life.  With certain exceptions, the well spouse may keep one-half of the couple’s countable resources.  For instance, the minimum CSRD is $24,180.  This means that a couple with $35,000 in countable resources could keep the minimum CSRD of $24,180 for the well spouse because half of $35,000 falls below the minimum CSRD.

Likewise, a couple with $100,000 in countable resources could keep $50,000 for the well spouse, as this is one-half of the couple’s total resources.  On the other hand, the maximum CSRD is $120,900, which means that a couple with $300,000 could only keep $120,900 for the well spouse, even though this amount is less than half of the couple’s total assets.  The minimum and maximum amounts provided here are effective for January 2017, and are reviewed each calendar year.

Because quality of life is just as important to well spouses as it is those who apply for Arizona Medicaid, it is particularly important for married individuals to consult with an Elder Law attorney about ALTCS planning.  Contrary to what many people believe, Arizona Long Term Care System does not require married couples to spend down all of their resources when applying for Arizona Medicaid.  Rather, the CSRD protects well spouses who engage in proper ALTCS planning from impoverishment.

Who is eligible for ALTCS?

Due to strict ALTCS eligibility requirements, not everybody qualifies for the ALTCS benefit – in fact, 79% of applicants are denied each year.  As such, it is many times best for those who apply for Arizona Medicaid to make advance preparations with an Elder Law lawyer before submitting an application.  While some applicants qualify immediately for the benefit, others must prepare to meet ALTCS eligibility criteria.

A bar-certified Elder Law attorney is best suited to help applicants make these preparations.  To discuss the ALTCS application process with an Arizona Elder Law attorney, enter your name and email below, and somebody from the Elder Law firm, JacksonWhite, will contact you within one business day.

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