Arizona Medicaid (Arizona Health Care Cost Containment System) Long Term Care Programs, Benefits & Eligibility Requirements

Summary
Medicaid’s rules, benefits and name can all vary by state. In Arizona, Medicaid is called the Arizona Health Care Cost Containment System (AHCCCS). This article focuses on Arizona Medicaid Long Term Care for seniors, which will pay for care in a nursing home, a beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, the Arizona Long Term Care System or ABD Medicaid. This is different than regular Medicaid, which is for financially limited people of all ages.

Last Updated: Jan 29, 2024

Arizona Medicaid Long Term Care Programs Nursing Home Care Care at Home via ALTCS Care at Home via ABD Medicaid Eligibility Criteria Nursing Homes ALTCS ABD Medicaid How Medicaid Treats the Home Applying Choosing a Nursing Home

Arizona Medicaid Long Term Care Programs

Nursing Home / Institutional Medicaid

Arizona Nursing Home Medicaid will cover the cost of long-term care in a nursing home for financially limited Arizona seniors who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:

Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
Skilled nursing care
Physician’s visits
Prescription medication
Medication management
Mental health counseling
Social activities

Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.

Arizona Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover care expenses. They are only allowed to keep a “personal needs allowance” (PNA) of $141.15/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.

Arizona Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.

Arizona Nursing Home Medicaid is administered by the Arizona Long Term Care System, which will also provide long-term care benefits in the community, which is discussed in the next section.

Arizona Long Term Care System (ALTCS)

In addition to covering nursing home care, the Arizona Long Term Care System (ALTCS) will cover long-term care services and supports to assist Arizona seniors who require a Nursing Facility Level of Care but want to remain living in the community instead of moving to a nursing home. Living “in the community” can mean living in their home, the home of a loved one, an adult foster care home or an assisted living residence. While ALTCS can provide long-term care benefits in those settings, it will not cover room and board costs such as mortgage payments, rent, facility fees, utility bills or food expenses.

ALTCS, which is sometimes called the Elderly and Physical Disability (EPD) program, delivers its long-term care services and supports, as well as its medical and behavioral health benefits, through a single coverage plan. These plans are provided by managed care organizations, which have a network of care providers. ATLCS program participants can choose from multiple plans, and they can also self-direct their care with two options – Agency with Choice (AWC) and Self Directed Attendant Care (SDAC). These options allow ALTCS beneficiaries to hire caregivers from outside the managed care organization’s network, including friends and some family members, but not spouses. With SDAC, beneficiaries handles all the responsibilities of an employer, such as hiring, training, managing, paying and even firing the caregiver. With AWC, the state helps with some of those responsibilities.

ALTCS long-term care benefits can include adult day care, home modifications, medical equipment, meal delivery, housekeeping services, Personal Emergency Response Systems, transportation and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). Benefits will be made available depending on the needs and circumstances of each individual.

The ALTCS program is an entitlement. This means that all eligible applicants are guaranteed by law to receive the program benefits without any wait.

Aged, Blind, and Disabled (ABD) Medicaid

Arizona’s Aged, Blind, and Disabled (ABD) Medicaid provides healthcare coverage and long-term care services and supports to financially limited Arizona residents who are aged (65 and over), blind or disabled and live in the community. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for financially limited people of all ages. ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive healthcare coverage without any wait. Long-term care benefits are provided based on need and availability.

1. ABD Long Term Care Benefits
Eligible Arizona seniors who show a medical need for long-term care services can receive those services through ABD Medicaid. These benefits can include in-home personal care, adult day care, meal delivery, home modifications and Personal Emergency Response Systems (PERS). ABD Medicaid recipients qualify for these benefits one at a time. This is different from Nursing Home Medicaid, which makes all of its benefits immediately available for anyone who qualifies. Instead, Arizona seniors will be evaluated by the state to determine what kind of long-term care benefits they need and will receive.

2. Program of All-Inclusive Care for the Elderly (PACE)
PACE coordinates medical, social service and long-term care coverages into one comprehensive plan and delivery system for ABD Medicaid recipients, including Medicare benefits for those who are “dual eligible.” PACE also administers vision and dental care, and PACE day centers provide adult day care, meals, social activities and regular health checkups. PACE program participants are required to need a Nursing Facility Level of Care, but they must live in their home or somewhere else in the community. Although Arizona does not have a PACE program of its own as of Jan. 1, 2024, there are programs in neighboring California and New Mexico. While seniors can not use PACE programs (or receive any kind of Medicaid benefits) in other states, or transfer their Medicaid coverage from state to state, they can re-apply for Medicaid in a new state without any waiting period if they relocate. To learn more about PACE, click here.

Eligibility Criteria For Arizona Medicaid Long Term Care Programs

To be eligible for Arizona Medicaid, which is called the Arizona Health Care Cost Containment System (AHCCCS), a person has to meet certain financial requirements and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home Medicaid, Arizona Long Term Care System (ALTCS) or Aged, Blind, and Disabled (ABD) Medicaid.

Just For You: The easiest way to find the most current Arizona Medicaid eligibility criteria for your specific situation is to use our Medicaid Eligibility Requirements Finder tool.

Arizona Nursing Home Medicaid Eligibility Criteria

Financial Requirements
Arizona residents have to meet an asset limit and an income limit in order to be financially eligible for Arizona Nursing Home Medicaid, which is administered by the Arizona Long Term Care System (ALTCS). For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for Arizona Nursing Home Medicaid for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, Arizona Medicaid beneficiaries who reside in nursing homes must give most of their income to the state to help pay for the cost of care. They are only allowed to keep $141.15/month of their income as a “personal needs allowance,” and they are allowed to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy, non-applicant spouses.

For married applicants with both spouses applying, the 2024 asset limit for Arizona Nursing Home Medicaid is a combined $4,000, and the income limit is $2,829/month per spouse. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

Plan Ahead: There are alternative pathways to eligibility for Arizona Nursing Home Medicaid applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Arizona has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for Arizona Nursing Home Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with a nursing home. Arizona uses the Pre-Admission Screening tool to determine level of care requirements for Medicaid purposes. This tool takes into consideration an applicant’s ability to complete the Activities of Daily Living, as well as their cognitive abilities.

Arizona Long Term Care System (ALTCS) In-Home Care Eligibility Criteria

Financial Requirements
In order to receive long-term care services and supports in their home, the home of a loved one, an adult foster care home or an assisted living residence through the Arizona Long Term Care System (ALTCS), Arizona seniors have to meet an asset limit and an income limit. For a single ALTCS applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Counts the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for in-home care via ALTCS for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants with both spouses applying, the 2024 asset limit for receiving in-home, long-term care benefits through ALTCS is a combined $4,000, and the income limit is $2,829/month per spouse. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

Plan Ahead: There are alternative pathways to eligibility for ALTCS applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Arizona has a Look-Back Period of five years. This means the state will look back into the previous five years of the LTSS applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for receiving in-home, long-term care benefits through the Arizona Long Term Care System is needing a Nursing Facility Level of Care, which means the applicant requires the kind of full-time care that is normally associated with a nursing home. Arizona uses the Pre-Admission Screening tool to determine level of care requirements for Medicaid purposes. This tool takes into consideration an applicant’s ability to complete the Activities of Daily Living, as well as their cognitive abilities.

Arizona Aged, Blind, and Disabled Medicaid Eligibility Criteria

Financial Requirements
Arizona residents have to meet an income limit in order to be financially eligible for Aged Blind and Disabled (ABD) Medicaid. There are no asset limits when it comes to ABD Medicaid in Arizona. The income limit for a single applicant from Feb. 2024 to Jan. 2025 is $1,255/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants, the income limit for Arizona ABD Medicaid from Feb. 2024 to Jan. 2025 is a combined $1,704/month. This limit is used for both married couples with both spouses applying for ABD Medicaid and married couples with only one spouse applying.

Plan Ahead: There are alternative pathways to eligibility for Arizona ABD Medicaid applicants who are over the asset limit and/or the income limit, such as Medicaid Planning. While Arizona has a Look-Back Period of five years for nursing home coverage or in-home services through the ALTCS, there is no Look-Back Period or asset limits for Arizona ABD Medicaid applicants. However, ABD applicants should be cautious about giving away their assets. They might eventually need nursing home coverage or in-home long term care through ALTCS, and they will be denied that coverage for giving away their assets.

Functional Requirements
The only functional requirement to receive basic healthcare coverage through Arizona’s ABD Medicaid is being aged (65 and over), blind or disabled. For ABD applicants and beneficiaries who require long-term care services and supports, the state will administer an assessment of their ability to perform Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and Instrumental Activities of Daily Living (which include shopping, cooking, housekeeping and medication management) to determine the kind of long-term care benefits the state will cover.

How Arizona Medicaid Treats the Home for Eligibility Purposes

One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:

If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage/debt) is less than $713,000 (as of 2024) then the home is exempt.
If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives.
If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $713,000.

These rules apply to all three types of Medicaid, with one important exception – ABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. To learn more about the impact of home ownership on Medicaid eligibility, click here.

Arizona Medicaid Long Term Care applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in Arizona and how you can protect your home from it, click here.

Applying For Arizona Medicaid Long Term Care Programs

The first step in applying for the Arizona Health Care Cost Containment System (Arizona Medicaid) Long Term Care programs is deciding which of the three programs discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Arizona Long Term Care System “in the community” coverage or Aged Blind and Disabled (ABD) Medicaid / Regular Medicaid.

The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for the Arizona Health Care Cost Containment System (Arizona Medicaid) when not financially eligible will result in the application, and benefits, being denied.

During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Arizona Health Care Cost Containment System applicant. These documents will be needed for the official Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.

After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Arizona residents can apply for long term care through the Arizona Health Care Cost Containment System by contacting their local Arizona Long Term Care System office.

For step-by-step guides to applying for each of the 3 types of Medicaid Long Term Care, just click on the name: 1) Nursing Home Medicaid 2) HCBS Waivers 3) ABD Medicaid.

Professional Help: Many seniors need support when it comes to Medicaid Long Term Care’s rules, benefits and application process. These are all complicated, constantly changing and vary by state. The best place to get help with Medicaid Long Term Care is through a professional like a Certified Medicaid Planner or an Elder Law Attorney.

Choosing an Arizona Medicaid Nursing Home

After being approved for nursing home coverage through the Arizona Long Term Care System (ALTCS), seniors need to choose which Medicaid-accepting nursing home best suits their needs. Even though Nursing Home Medicaid is an entitlement, not all nursing homes take Medicaid, and those that do may not have available space. Finding the right nursing home can be a task, especially if you want to stay within a certain geographic area.

There are roughly 110 nursing homes that accept Medicaid in Arizona, and about half of them are in the Phoenix area. There are roughly 20 more in and around Tucson. Otherwise, the facilities are spread thinly across the state – there are only four in Yuma and just three in Flagstaff, for example.

TOOLS: Arizona residents can use this Arizona Health Care Association (AHCA) facility finder to help them locate a nursing home. They can also use Nursing Home Compare, which is a search tool administered by the Centers for Medicare & Medicaid Services (CMS) that has information about more than 15,000 nursing homes across the country.

After finding nursing homes in your area that accept Medicaid, you can start comparing them, if there are multiple options. The Nursing Home Compare search can be filtered by overall rating, health inspections, staffing and quality measures, so that can be a good place to start. You can also get information on nursing homes by contacting your local Area Agency on Aging.

Once you’ve done the research and narrowed down your options, you or someone you trust should visit potential options before making a final decision. Call first to make an appointment for the visit, and arrive prepared with a list of questions. Some things you might ask are: Does the residence organize social activities? Does it offer transportation for medical and non-medical purposes? How does it facilitate oral and eye care? Who are the staff doctors? What’s the food like? CMS has a thorough “Nursing home checklist” you can use to evaluate a nursing home while visiting.

According to data collected by the CMS, Arizona nursing homes averaged 22.9 health deficiencies resulting in citations from 2019-2022, which is lower than the national average of 25.7. Arizona nursing homes also had a lower number of fire safety deficiencies than the national average, 9.3 compared to 13.5. The CMS data showed the percentage of Arizona nursing home residents who reported depressive symptoms (3.9%) was less than half the national average (8.1%).