As with all public benefits, an applicant must meet certain criteria to qualify for the program. These requirements include proving that you:
- Are a U.S. Citizen or Qualified Alien
- Have a Social Security Number
- Are an Arizona Resident
There are four additional components to ALTCS eligibility, which we’ll explore in more detail below:
In order to qualify for the ALTCS program, a person has to require a level of care that places him or her “at risk” requiring nursing home care. This determination is done through a survey tool known as the Pre-Admission Screening (P.A.S.). This tool assesses the applicant’s ability to perform his/her activities of daily living.
Daily activities taken into consideration include mobility, transfer, toileting, dressing, feeding, bathing, grooming and meal preparation. All of these components are then quantified, and an applicant must score 60 points or higher to be considered medically eligible for this program.
An appropriate living arrangement is either the applicant’s home or apartment, or living in or with a family member in their home or apartment. If the applicant is living in a Group Home, Assisted Living Community, Skilled Nursing facility, or Memory Care Unit, the facility must participate with ALTCS and have contracts in place with at least one of the Program Contractors to be considered an appropriate living arrangement.
The state looks at income and resources differently, depending on whether the person is married or single.
The numbers below are current as of January 2018.
Single Person Income – The single individual monthly income limit is $2,250. If a person’s monthly income is over $2,250 but below the average cost of care for the county in which he/she resides (as determined by AHCCCS, i.e. $7,134.44 for Maricopa County), the applicant could still potentially qualify with a Miller’s/Income Only Trust.
Single Person Resources – The resource limit for a single individual is $2,000 in “countable” assets. In order to qualify for ALTCS benefits, an individual must have less than $2,000 of liquid assets in cash, property, life insurance policies or other assets.
Married Couples are treated differently because the state does not want to impoverish the healthy spouse. The eligibility for married persons is as follows:
Married Couples Income – The income limit for a married couple is determined in several ways.
- If the applicant’s gross monthly income is less than $2,250, the applicant qualifies regardless of the spouse’s income.
- If the applicant’s gross monthly income is greater than $2,250, but the combined income of the applicant and the spouse is less than $4,500, then the applicant can qualify.
- If the applicant’s income is greater than $2,250 and the couple’s combined gross monthly income is greater than $4,500, then a Miller’s/Income Only Trust can be used in some cases to qualify, which solves the problem of too much income when a person is applying for ALTCS.
- An Income Only Trust raises the applicant’s income limit to $7,134.44 (for Maricopa County) and the couple limit to $14,268.88.
- If the applicant’s income is greater than $7,134.44 and the couple’s combined gross monthly income exceeds $14,268.88, the applicant will not qualify.
Married Couples Resources – A Resource Assessment is required only in the case of a married person. The Resource Assessment is the process by which the state determines how much the Community Spouse is entitled to have in countable resources and still allow the applicant to qualify for benefits. The Resource Assessment looks at the first period of continuous institutionalization or when the individual first began receiving home health services that prevented institutionalization for at least 30 consecutive days. Through the Resource Assessment, the state will total the combined countable marital assets as of the first period of continuous institutionalization. The minimum that all Community Spouses are entitled to is $24,720. Otherwise, the total countable assets are divided in two with a maximum allowance for the community spouse of up to $123,600. For example, if the total combined assets are determined to be $150,000, then the spousal resource limit would be $75,000 – half the countable assets. Conversely, if the total combined assets are determined to be $300,000, then the spousal resource limit would be set at the maximum of $123,600, not $150,000. Additionally, the applicant is entitled to have up to $2,000 in his/her name at the time of application.
All components of eligibility must be met before the state will grant approval; a person cannot apply before they are eligible and obtain approval. Note: Different limits apply if both spouses are seeking benefits.