When Medicaid in Arizona Will Pay for a Nursing Home or Home Health Care

With the average monthly cost of a private room in a nursing home in Arizona over $7,600 in 2024, those who are likely to need long-term care will want to be sure they have a way to pay for that care. Medicare doesn't generally cover nursing home care.

Most people pay for long-term care with private funds, nursing home insurance (long-term care insurance), or Medicaid. If you can't afford to pay privately and don't have long-term care (LTC) insurance, Arizona's Medicaid program might pay for your care. In Arizona, Medicaid is called the Arizona Health Cost Containment System (AHCCCS).

Medicaid is a medical assistance program funded by the federal and state governments to pay for, among other things, long-term care for people who meet certain requirements, such as being over 65, disabled, or blind. Medicaid has different eligibility guidelines for covering long-term care services than other types of health care services.

The Arizona Long-Term Care System (ALTCS, pronounced "ALL-Tecs") provides health insurance for services in:

• an institution (like a nursing home)
• the Medicaid recipient's home, or
• a community-based setting (like an assisted living center).

Medicaid Coverage for Nursing Homes in Arizona

People who live in skilled nursing facilities, intermediate care facilities, or hospitals for 30 days or more and who Medicaid determines need this level of care can qualify for Medicaid benefits. To qualify for coverage, you must meet ALTCS income and resource limits and be 65 or older, blind, or disabled.

To get coverage for nursing home care, you must need the kind of care nursing homes provide, such as:

• 24-hour supervised nursing care
• nutrition management, or
• therapy

You can apply for Medicaid coverage for nursing home services online at Health-e-Arizona PLUS or you can 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 more information or to get help with your application.

Before you apply for ALTCS coverage, you'll want to know if you meet the income and asset eligibility criteria.

Medicaid Income Rules for Long-Term Care in Arizona

In Arizona, a single person can have a monthly income up to only $2,901 in 2025 (300% of the SSI payment level) and qualify for Medicaid-paid nursing home care. The LTC Medicaid income limit for a married couple, with both spouses applying, is $5,802 per month in 2025. The LTC income limits may be higher than those for other health care benefits from Medicaid.

AHCCCS considers virtually all income an applicant receives from any source when determining Medicaid eligibility. But you can deduct the amount you spend on medical insurance premiums or medical expenses not paid for by ALTCS, such as:

• eyeglasses
• dental care, and
• hearing aids.

Also, if you're married and you apply for Medicaid but your spouse doesn't, the income of your non-applicant spouse doesn't count. That's to ensure your spouse has enough funds to live on.

Additionally, under federal law, non-applicant spouses who don't have enough income of their own are entitled to a minimum monthly maintenance needs allowance (MMMNA)—a portion of the Medicaid recipient's income. (42 C.F.R. § 435.725(c)(2).) In Arizona, your spouse's MMMNA can range from $2,555 to $3,948.

If you qualify for Medicaid and live in a nursing home, you'll be expected to spend almost all your income on your care. Arizona allows nursing home residents receiving Medicaid to keep only $141.45 per month as a personal needs allowance.

Medicaid Asset Rules for Long-Term Care in Arizona

Medicaid for long-term care in Arizona has different resource rules than those for other AHCCCS (Medicaid) programs. Resources are assets like:

• real estate (real property)
• personal property (like jewelry and artwork)
• life insurance with a cash value
• vehicles, including motorhomes, and boats
• retirement accounts, like IRAs
• bank accounts, and
• cash.

You'll have to total up the values of all your assets to determine how much you have in resources.

If you're a single person, you can only have up to $2,000 in assets, with a few allowable exclusions such as a car and your home (with equity up to $730,000 in 2025). If you're married, your non-applicant spouse at home can keep up to $157,920 worth of joint assets.

For many people with long-term care insurance, Arizona offers a Long Term Care Partnership Program, under which ALTCS won't count certain assets to determine Medicaid eligibility. To participate in the program, you must buy an LTC insurance policy that meets program requirements. To determine your eligibility under this program, AHCCCS excludes resources equal to the LTC insurance benefits you received until the month before you applied. For example, if your LTC insurance company covered $60,000 of your long-term care costs, AHCCCS won't count the first $60,000 of your assets.

Plus, that same amount of assets will be protected from AHCCCS recovery under Arizona's estate recovery program. Contact your local ALTCS office for more information about the Long Term Care Partnership Program.

Home Health Care Through Arizona's ALTCS

Arizona's options for paid caregivers through ALTCS include programs that allow participants to be actively involved in choosing their attendant caregivers and other service providers in their homes or in alternative residential care settings (such as assisted living). These "member-directed" options allow participants to direct their at-home care to a greater degree than they would otherwise be able to. These programs include Arizona's:

• Agency with Choice (AWC) program, and
• Self-Directed Attendant Care (SDAC) program.

Arizona's Agency With Choice (AWC) Home Care Option

The Agency with Choice (AWC) program is an option available to ALTCS participants who live in their own homes. It's not available to those living in nursing facilities or other alternative residential settings (like group homes or assisted living centers). To receive AWC services, you must meet the functional and financial eligibility requirements for ALTCS.

AWC allows you and a program provider agency to share employer-based responsibilities for your paid in-home caregiver. This option allows you to choose your own caregiver through a provider agency, instead of having to accept any home health aide assigned to you by someone else.

In sharing responsibilities, the provider agency maintains hiring, firing, and training authority and oversight, and the program member (or your individual representative) can choose to assume certain employer-based responsibilities over the caregiver providing home-based services.

Through AWC, ALTCS members who prefer receiving care in their homes, as opposed to nursing homes or other LTC facilities, can receive self-directed home care without taking on all the responsibilities of an employer.

Self-Directed Attendant Care (SDAC) in Arizona

Arizona's Self-Directed Attendant Care (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 manage those caring for them at home, including:

• hiring
• firing, and
• training.

With this member-directed option, you or your guardian work with case managers to develop care plans that best meet your needs. SDAC pays the costs associated with the at-home services provided, as you get support from a fiscal employer agent that manages the:

• payroll withholding
• taxes, and
• actual payments to caregivers.

Under SDAC, you can hire a family member or friend as your caregiver, subject to certain program restrictions and provided all other requirements are met.

For more information on ALTCS member-directed options, visit the AHCCCS program.