The Arizona Long Term Care System (also known as ALTCS) is Arizona’s Medicaid-funded statewide health insurance program that provides coverage for Arizona residents who are 65 years of age or older and who have a disability or require nursing facility level of care. ALTCS is run and maintained by the Arizona Health Care Cost Containment System (AHCCCS), which is Arizona’s Medicaid agency that is responsible for offering Medicaid-funded healthcare programs to Arizona residents. Like many Medicaid-sponsored state health insurance programs around the country, ALTCS can provide coverage for care received either at home or in a community or institution setting. An Arizona senior does not need to live in a nursing facility to receive care under ALTCS, and many Arizona seniors who receive coverage for their care through ALTCS live at home or in an assisted living community. 

Before applying for any long term care insurance it’s important to speak with an Arizona elder law attorney or elder care expert to understand what programs you or your senior loved one may be eligible for, as well as what those programs cover. If you think that ALTCS coverage is right for you or your senior loved one, follow our guide below to learn how to apply for ALTCS coverage.

ALTCS Overview

Before explaining how to apply for ALTCS coverage, it’s helpful to do a quick refresher on what ALTCS is and who it covers. While the exact services covered by ALTCS will depend on each individual and the nature of their care-based needs, ALTCS coverage generally includes not only preventive and diagnostic care and treatments, but also things like surgeries or emergency medical care. ALTCS can also cover a variety of at-home care services for eligible Arizona seniors, including home healthcare services, home modifications, and at-home nursing care.

One thing to keep in mind is that ALTCS coverage is focused on paying for Arizona seniors’ care, meaning that ALTCS generally does not cover room and board for individuals in assisted living, and instead generally only covers the cost of the care that an individual receives while staying in an assisted living community. For residents of nursing homes, ALTCS will provide coverage for room and board provided that it is medically necessary.

Who is eligible for ALTCS

As is the case with many Medicaid-funded state health insurance programs around the country, eligibility for ALTCS is mainly focused on two main criteria: financial and medical necessity (along with being an Arizona resident who is age 65 or older, or who has a recognized disability such as blindness or a cognitive impairment like Alzheimer’s disease). 

ALTCS Medical Eligibility 

In order to qualify for ALTCS, a senior applicant must show that they have a need for a nursing home level of care. As described in more detail below, this assessment is made following a face-to-face interview between the senior ALTCS applicant and either a registered nurse or social worker. This assessment generally focuses on the senior applicant’s ability to complete the Activities of Daily living, as well as whether they suffer from any chronic conditions such as a cognitive disorder. In addition to looking at the senior applicant’s current condition, this assessment often also considers the applicant’s medical history and records. 

ALTCS Financial Eligibility

Because the financial eligibility requirements for ALTCS can be somewhat complicated depending on each individual’s circumstances, we cover them in greater detail elsewhere on the blog. But for the purposes of this article, the financial eligibility requirement for ALTCS focuses on two limits: income and assets. In 2023, the income limit for a single applicant is $2,742 per month and for married couples is $5,484. As for assets, in 2023 the asset limit for a single applicant is $2,000, and is $4,000 for a married couple (while these limits may seem low, it excludes many assets such as a primary residence or vehicle). 

If you are thinking about applying for ALTCS coverage, it’s important to consult a local Arizona elder law attorney as they will be able to advise you on whether you may still be eligible for ALTCS coverage even if you believe your assets or income to be over the ALTCS limit. Various methods exist to allow, for example, spouses to transfer income between one another in order to make sure that the applicant spouse does not exceed the income limit. Discussing your situation with an Arizona elder law attorney will help you explore the extent to which any of these strategies may help you qualify for ALTCS coverage.

How to apply for ALTCS

There are several ways that you can apply to ALTCS. Make sure to consult a local Arizona elder care attorney before applying, to ensure that your application is properly filed and has the greatest chance of success. In addition to consulting an Arizona elder care or senior health care specialist, we also suggest reviewing the helpful explainer resources provided by ALTCS, including this helpful information guide here. 

When you and your family decide that applying for ALTCS coverage is right for you, the Arizona Health Care Cost Containment System suggests starting the ALTCS application process by either calling their toll-free number at 888-621-6880 or visiting an Arizona Long Term Care System office in person. ALTCS has offices all across Arizona, and you can find a list of ALTCS offices on the AHCCCS website. Once you’ve contacted an ALTCS office, they will help you start your application process. This will often include filling out the DE-101 form. A senior can apply for themself, or have someone else such as an adult child apply for them on their behalf.

In addition to filling out the application paperwork, the senior applicant (or whoever is applying on their behalf) will also need to submit documentation showing that the senior applicant meets both the financial and medical eligibility requirements for ALTCS coverage. The financial documentation you will need to produce will include information on things like your bank accounts and property holdings in order to ensure that you qualify for the financial eligibility requirements laid out above. 

Once the senior applicant has been deemed financially eligible for ALTCS, the next step in the application process is for the senior applicant to have a face-to-face interview with a registered nurse or social worker in order to determine whether the senior applicant requires a nursing home level of care (an applicant may also need to provide medical documentation speaking to their need for nursing home level of care). In order to meet this requirement, the applicant must be at immediate risk of institutionalization in a nursing facility. While this assessment will be different for each ALTCS applicant, the medical eligibility requirement will generally focus on whether the senior applicant can accomplish all their Activities of Daily Living. Applications may be submitted in person to a local ALTCS office, mailed to the ALTCS main office (801 E Jefferson St, MD 3900, Phoenix Arizona, 85034), or emailed to altcsregistration@azahcccs.gov. Because contact information, as well as the application process itself, can always change, make sure to consult a local Arizona elder law attorney before submitting any ALTCS applications to make sure your information is as current as possible. 

To learn more about how Sunbound can help make paying for senior living and senior care more affordable for you or your senior loved one, send us an email at info@sunboundhomes.com or request more information on Sunbound. Sunbound is the best way to pay for senior living and senior care, and we’re on a mission to make senior living and senior care more affordable for everyone.