With the average monthly cost of a private room in a nursing home in Arizona approaching $8,000 in 2019, those who are likely to need long-term care should pay serious attention to ensure they have a way to pay for that care. Long-term care is usually paid for by private funds, nursing home insurance, or Medicaid. If a patient cannot afford to pay privately and does not have long-term care (LTC) insurance, Arizona's Medicaid program might pay for his or her care.
Medicaid is a medical assistance program funded by the federal and state governments to pay for, among other things, long-term care for persons who meet certain requirements, such as being over 65, disabled, or blind. Long-term care Medicaid services have different eligibility guidelines than the rules for other types of services covered by Medicaid.
In Arizona, Medicaid is called the Arizona Health Cost Containment System (AHCCCS), and the Arizona Long-Term Care System (ALTCS, pronounced "ALL-Tecs") provides LTC insurance for services in an institution, home, or community-based setting.
Patients who live in skilled nursing facilities, intermediate care facilities, or hospitals for 30 days or more and are determined by Medicaid to need this care may qualify for Medicaid benefits, if they meet ALTCS income and resource qualifications (and are age 65 or older, blind, or disabled).
To obtain coverage for nursing home care, you must need the kind of care nursing homes provide. Nursing homes provide 24-hour supervised nursing care, nutrition management, therapy, personal care, organized activities, and other services.
For more information and to apply for Medicaid coverage for nursing home services, you can seek assistance from the state's ALTCS web page or call ALTCS at (888) 621-6880. Typically, your nursing care facility can assist you with the Medicaid application process. You can also contact your local ALTCS office for assistance.
Before you apply for ALTCS coverage, make sure that to the best of your knowledge you meet the income and asset eligibility criteria.
In Arizona, a single person can have a monthly income up to only $2,313 in 2019 and qualify for Medicare-paid nursing home care. (This is 300% of the SSI payment level.) The Medicaid income limit for a married couple, with both spouses applying, is $4,626 per month in 2019. These LTC income limits may be higher than the income limit for those applying for other health care benefits from Medicaid.
For purposes of determining Medicaid eligibility, virtually all income an applicant receives, from any source, is considered. You may, however, deduct the amount you spend on medical insurance premiums or medical expenses not paid for by ALTCS, such as eye glasses, dental care, and hearing aids. Also, when only one spouse of a married couple applies for Medicaid, the income of the non-applicant spouse is not counted, so that he or she has enough funds on which to live. Additionally, if the non-applicant spouse doesn't have enough income on his or her own, he or she is entitled to a minimum monthly needs allowance, which may range from $2,113.75 to $3,160.50.
If you qualify for Medicaid and live in a nursing home, you will be expected to spend almost all income on your care. Arizona allows nursing home residents receiving Medicaid to keep only $116.65 per month as a personal needs allowance.
Medicaid for long-term care in Arizona has different resource rules than those for other AHCCCS programs. Resources are assets like real property, personal property, life insurance with a cash value, vehicles, motorhomes, boats, IRAs, bank accounts and cash. You will have to total up all of these to determine how much you have in resources.
If you are a single person, you can have only up to $2,000 in assets, with a few allowable exclusions such as a car and your home (up to a value of $585,000 in 2019). If you are married, your non-applicant spouse at home can keep up to $126,420 worth of joint assets.
For those with long-term care insurance, Arizona offers a Long Term Care Partnership Program, under which ALTCS will not count certain of an applicant's assets to determine Medicaid eligibility, provided the applicant's LTC insurance policy meets program requirements. To calculate whether an individual is eligible for ALTCS, AHCCCS will not count the individual's resources in an amount equal to the LTC insurance benefits received through the month before the person applied for ALTCS. Furthermore, that same amount will be protected from AHCCCS recovery under the Arizona Estate Recovery Program. Contact your local ALTCS office for more information about the Long Term Care Partnership Program.
Arizona's options for paid caregivers though ALTCS include programs allowing elderly participants to be actively involved in choosing their attendant caregivers and other service providers in the home or in an alternative residential care setting (such as assisted living). These "member-directed" options, which allow participants to direct the provision of their at-home care to a greater degree than they would otherwise be able, include Arizona's Agency with Choice (AWC) and Self-Directed Attendant Care (SDAC) programs.
The AWC program is an option available to ALTCS participants who live in their own homes. Not available to program members who live in nursing facilities or other alternative residential settings, AWC allows a program provider agency and an ALTCS member to share employer-based responsibilities for the paid home caregiver. Through this option, elderly participants can choose their own caregivers, through a provider agency, instead of having to accept an assigned home health aide.
AWC applicants must meet ALTCS functional and financial eligibility requirements. In sharing responsibilities, the provider agency maintains hiring, firing, and training authority and oversight, and the program member (or his or her individual representative) may choose to assume certain employer-based responsibilities over the caregiver providing home-based services. Through AWC, ALTCS members who prefer receiving care in their home, as opposed to a nursing home or other LTC facility, can receive self-directed home care.
The SDAC program allows members, or their legal guardians, to serve as legal employers of paid home caregivers and assume all employment responsibilities for those caregivers.Under this model, participants gain flexibility to decide which services they need and to hire, fire, train, and manage those caring for them at home.
Utilizing this variation of member-directed option, the member or his or her guardian works with case managers to develop care plans that best meet the member's needs. SDAC pays the costs associated with the at-home services provided, as the member receives support from a Fiscal Employer Agent that manages taxes, payroll withholding, and actual payment to caregivers. Under SDAC, family members and friends can also be hired as caregivers, subject to certain program restrictions and provided all requirements are met.
For more information on ALTCS member-directed options, visit the AHCCCS program web page.