ALTCS INFORMATION provided by
Senior Application Services
What is ALTCS?
ALTCS stands for the Arizona Long Term Care System. ALTCS is part of the Arizona Health Care Cost Containment System (AHCCCS). AHCCCS is the need based Arizona health care program which is funded by Medicaid, a federal program. ALTCS is the part of AHCCCS that provides Long Term Care Services to financially and medically eligible seniors and disabled persons.
My Family Member Needs ALTCS. Can I Work with SAS on Their Behalf? Do I Need Their Power of Attorney?
Most of the time we primarily work with a close family member or trusted friend of the applicant. You do not need to have their Power of Attorney to help them apply to ALTCS. You do need to have access to their personal information and records, and they will need to sign some forms. If they are medically unable to sign, we can deal with that in other ways.
Can I Apply for ALTCS Without Paid Help?
Yes. Most people do. Beware if ALTCS tells you to "reduce resources". ALTCS will not tell you there are better alternatives to just spending down all your money and coming back when you're broke, but we will. If you have very low income and assets it is easier, but still not easy. Sometimes applicants run into a lot of frustration and trouble, especially in cases involving trusts or married couples (community spouses). ALTCS is not going to be very helpful when you are exhausted and confused. If you miss a deadline they will deny your case and send you to the back of the line. Many people wind up being denied for small errors that could have been easily fixed because they did not understand or they just gave up. The advantages of having SAS apply for ALTCS as your Authorized Representative are many. We take the majority of the burden off exhausted spouses and family members. We know the ALTCS rules and procedures. If you go it alone you may wind up losing far more money from delayed or denied benefits than you would have paid SAS to help. When you hire SAS as your Authorized Representative, you avoid taking on what amounts to a new part-time second job for several months, and you avoid potentially costly errors in your application process.
How Much Does SAS Charge to Be the Authorized Representative for an ALTCS Application?
We handle cases on a flat fee basis. Simpler cases cost less, and complicated cases cost more. If SAS gets your ALTCS application approved even one month sooner, you will have saved a lot. Hiring SAS is a "no brainer" - unless you have endless patience, tons of free time, and are good with forms and following strict rules. The ALTCS application process is not always horrible, but for many people it is a frustrating and confusing hassle that ends with anger and disappointment. If your case is denied and we think ALTCS was wrong you may need to appeal. We usually charge an additional fee to be Authorized Representative for an appeal, but not always. We may reduce our fee in some cases for customers in need. Call us for more information.<
What Information Do You Need to Evaluate My ALTCS Eligibility?
For your first call we just need an overview of your age, residency, citizenship, marital status, assets, income, insurances, and medical situation. The call takes about five minutes. If you then think you might want us to help you, we will arrange to meet at our office or in your home for a more detailed conversation. If you then decide to work with us, we will request more specific information and copies of documents such as recent bank statements, pay stubs, etc. We will help you gather these things, but it is ultimately your responsibility to provide needed information and copies.
Do You Handle Developmentally Disabled (DD) ALTCS Applications?
Absolutely. Most of the people we help are seniors, but we are equally adept at DD applications.
What if I Have Already Been Denied?
We can still help. Call us and we will figure out if ALTCS made a mistake, or if there is a problem. If there is a problem, we will know how it can be fixed. Once we review your case, we will tell you if you need to request a Fair Hearing or reapply. It is always best to send us a copy of your Denial Notice right away, because the time allowed for filing a Hearing Request is short.
How are ALTCS Services Provided? Do They Pay Me Cash?
ALTCS services are provided by ALTCS Program Contractors. ALTCS does not pay you cash, but the Program Contractor may pay cash to a qualified caregiver who takes care of you if they meet certain requirements. ALTCS Program Contractors provide services through a Health Maintenance Organization (HMO) or managed care program. The ALTCS Program Contractors for each county are noted further down on this page.
How Much Can I Own in Assets?
ALTCS calls assets “resources”. The resource limit for single applicants is $2,000.00, not counting your home and one car in most cases. Community Spouse rules allow married applicants to own at least $26,180.00 and in some cases up to $120,900.00 in countable resources, typically not counting their home and up to two cars. It gets complicated, so ask us about your specific case for more information.
Will Assets Held in Trust be Counted?
Maybe. Typically assets in a Revocable Trust are counted and in an Irrevocable Trust they are not counted, but it depends whether the applicant is the Grantor, Beneficiary, and / or Trustee. Special Needs Trusts must meet certain requirements to be excluded. Call us for more information on how your trust will be treated.
What is the "Five Year Look Back Period" and a "Transfer Penalty"?
ALTCS will ask if you have given away, sold, or changed the name on the title or deed for any money or property in the past five years from the first day of the month the application was requested. They will also want to know if any such transfer was compensated. If not, they may still approve the application but assess a Transfer Penalty, unless the transfer falls within an exception. A Transfer Penalty means you would be approved but not receive the Long Term Care Services component of ALTCS for a period of months, just the Acute Care Services component (the medical insurance part). This penalty period is calculated by dividing the amount of the uncompensated transfer by the Private Pay Rate which is usually $6,905.11. It gets complicated, so ask us about your specific case for more information.
What Happens if I Sell My Home or Car While on ALTCS?
If you sell a resource after your are approved for ALTCS that was not counted (exempt) when you applied, like your house or your car, and you turn it into a counted resource (like cash), this could make you ineligible. Be careful! Call us first and we will let you know if you should worry about such a transfer impairing your eligibility.
How Much Income Can I Have?
The gross income limit for single applicants is $2,205.00 per month, double that for a married couple under Community Spouse rules. Some VA benefits and other forms of income may not be counted. Some applicants over the income limit can use an Income Only Trust to be income eligible. It gets complicated, so ask us about your specific case for more information.
I am a Veteran. Will That Affect My Application to ALTCS?
Maybe, but not in a bad way. Wartime veterans or their surviving spouses may be required to apply to the VA for a need-based pension as part of their ALTCS process. We will let you know if this affects you when we review your case. If you do need to apply for VA benefits, we will show you what you need to do to meet this requirement. It's no big deal, and you might get an additional cash benefit if you're eligible.
How Can I Know if I am Medically Eligible?
In addition to financial eligibility, ALTCS requires that an applicant need a “Nursing Home Level of Care” in order to be eligible. This is a high standard, and requires that the person needs a high level of assistance with many daily tasks of living such as dressing, toileting, bathing, medications, etc. A person from ALTCS called a PAS Assessor will come visit the applicant and do a PAS. "PAS" stands for pre-admission screening, and involves observing, questioning, and reviewing medical records of the applicant. An elderly person needs a EPD PAS score of 60 to be eligible. "EPD" stands for Elderly and Physically Disabled. If the score is 55 or higher but below 60, management will review the score. If it is then still below 60, or if the assessor thinks the score does not accurately reflect the applicant’s needs, a physician will review the case. The ALTCS physician can find an applicant to be medically eligible regardless of the score. Physician reviews often result in the applicant being found medically eligible, but not always. If the applicant is found medically ineligible, you can re-apply when ready. It gets complicated, so let us review your specific situation to advise you how this may apply to your case.
What If I am Married?
ALTCS uses different standards to determine whether married people are eligible. This is called “Community Spouse” policy. Community Spouse rules apply to married applicants unless both married spouses live in nursing homes (as opposed to living at home or in assisted living). Community Spouse rules allow married people to have more income or assets.
How Long Does it Take to Get Approved?
It takes about two months from the day we request the application to get a decision, but if you are approved then benefits are applied back to the first day of that month. Cases involving trusts or other complicated factors may take longer.
What Happens After I am Approved for ALTCS?
You will be enrolled with an ALTCS Program Contractor under contract in your county. The Program Contractor will then assign a Case Manager who will meet with you to develop a specific plan for your care. As of October 2017, for Maricopa, Gila and Pinal Counties the Program Contractors will be Banner-University Family Care, Mercy Care, and United Healthcare Community Plan. In Pima County you will be able to choose between Banner-University Family Care and Mercy Care Plan. For Cochise, Graham, Greenlee, La Paz, Santa Cruz, Yuma, Mohave, Coconino, Apache, Navajo, and Yavapai you will be assigned to Banner-University Family Care. If you have a choice and you are in a facility, ask the facility who they prefer to work with.
Does SAS Guarantee My ALTCS Application Will Be Approved?
No. There are lots of reasons an application could be denied that we do not control, such as medical eligibility. We do guarantee that we will work hard to make sure you get approved, and that you will not get denied do to any error on our part. That guarantee is in our fee agreement, which we both sign when you hire us as your Authorized Representative.
What Services are Available Through ALTCS?
ALTCS Long Term Care Services include nursing home care provided in a licensed Skilled Nursing Facility (SNF), an Intermediate Care Facility for the Mentally Retarded (ICF-MR), a free-standing hospice, a residential treatment facility for persons under 21, or a psychiatric hospital for people age 65 or older. Home and Community-Based Services (HCBS) are provided in your home or in a supervised alternative residential setting such as an Assisted Living Home, Group Home, Adult Foster Care Home, or a Level I, II, or III Behavioral Health Center. In-home services are intended to help you to remain in your home. They include, but are not limited to Home Health Nursing, Personal Care, Homemaker Services, Home Health Aids, Habilitation, Medical Transportation, Attendant Care, Home Delivered Meals, Adult Day Care Mental Health Services, Respite Care, and Hospice. To receive ALTCS care in a facility it must be certified with ALTCS. AHCCCS Acute Care Services include doctors, hospitalization, prescriptions (limited for people who have Medicare), lab work, x-rays, tests, and specialist treatments. Once you are approved, you receive acute care services even during a penalty period.
Can I Choose My Own Physician?
Your ALTCS Program Contractor will give you an opportunity to pick your own primary care physician from an approved listing, or will pick one for you if you do not make a choice. Your ALTCS Program Contractor will only pay for services authorized by ALTCS contracting physicians. If you choose to see a non-contracting physician, you will be responsible for the payment for that medical service.
Is This an Official ALTCS Website? Is This Company Affiliated with ALTCS?
No. This is a private company that helps people apply for ALTCS as their Authorized Representative. We are not affiliated with ALTCS, although our eligibility specialists used to work at ALTCS.
Is Senior Application Services a Law Firm? Are You Attorneys? Do You Give Legal Advice?
No. This is not a law firm, we are not attorneys in Arizona, and we do not give out legal advice. We help people apply for ALTCS, and we use our knowledge of ALTCS rules and procedures to make sure the job gets done right. If you need legal help as part of your ALTCS application process, we know some great Arizona lawyers who are happy to work with us when you need them. We will let you know when that is the case.
ALTCS stands for the Arizona Long Term Care System. ALTCS is part of the Arizona Health Care Cost Containment System (AHCCCS). AHCCCS is the need based Arizona health care program which is funded by Medicaid, a federal program. ALTCS is the part of AHCCCS that provides Long Term Care Services to financially and medically eligible seniors and disabled persons.
My Family Member Needs ALTCS. Can I Work with SAS on Their Behalf? Do I Need Their Power of Attorney?
Most of the time we primarily work with a close family member or trusted friend of the applicant. You do not need to have their Power of Attorney to help them apply to ALTCS. You do need to have access to their personal information and records, and they will need to sign some forms. If they are medically unable to sign, we can deal with that in other ways.
Can I Apply for ALTCS Without Paid Help?
Yes. Most people do. Beware if ALTCS tells you to "reduce resources". ALTCS will not tell you there are better alternatives to just spending down all your money and coming back when you're broke, but we will. If you have very low income and assets it is easier, but still not easy. Sometimes applicants run into a lot of frustration and trouble, especially in cases involving trusts or married couples (community spouses). ALTCS is not going to be very helpful when you are exhausted and confused. If you miss a deadline they will deny your case and send you to the back of the line. Many people wind up being denied for small errors that could have been easily fixed because they did not understand or they just gave up. The advantages of having SAS apply for ALTCS as your Authorized Representative are many. We take the majority of the burden off exhausted spouses and family members. We know the ALTCS rules and procedures. If you go it alone you may wind up losing far more money from delayed or denied benefits than you would have paid SAS to help. When you hire SAS as your Authorized Representative, you avoid taking on what amounts to a new part-time second job for several months, and you avoid potentially costly errors in your application process.
How Much Does SAS Charge to Be the Authorized Representative for an ALTCS Application?
We handle cases on a flat fee basis. Simpler cases cost less, and complicated cases cost more. If SAS gets your ALTCS application approved even one month sooner, you will have saved a lot. Hiring SAS is a "no brainer" - unless you have endless patience, tons of free time, and are good with forms and following strict rules. The ALTCS application process is not always horrible, but for many people it is a frustrating and confusing hassle that ends with anger and disappointment. If your case is denied and we think ALTCS was wrong you may need to appeal. We usually charge an additional fee to be Authorized Representative for an appeal, but not always. We may reduce our fee in some cases for customers in need. Call us for more information.<
What Information Do You Need to Evaluate My ALTCS Eligibility?
For your first call we just need an overview of your age, residency, citizenship, marital status, assets, income, insurances, and medical situation. The call takes about five minutes. If you then think you might want us to help you, we will arrange to meet at our office or in your home for a more detailed conversation. If you then decide to work with us, we will request more specific information and copies of documents such as recent bank statements, pay stubs, etc. We will help you gather these things, but it is ultimately your responsibility to provide needed information and copies.
Do You Handle Developmentally Disabled (DD) ALTCS Applications?
Absolutely. Most of the people we help are seniors, but we are equally adept at DD applications.
What if I Have Already Been Denied?
We can still help. Call us and we will figure out if ALTCS made a mistake, or if there is a problem. If there is a problem, we will know how it can be fixed. Once we review your case, we will tell you if you need to request a Fair Hearing or reapply. It is always best to send us a copy of your Denial Notice right away, because the time allowed for filing a Hearing Request is short.
How are ALTCS Services Provided? Do They Pay Me Cash?
ALTCS services are provided by ALTCS Program Contractors. ALTCS does not pay you cash, but the Program Contractor may pay cash to a qualified caregiver who takes care of you if they meet certain requirements. ALTCS Program Contractors provide services through a Health Maintenance Organization (HMO) or managed care program. The ALTCS Program Contractors for each county are noted further down on this page.
How Much Can I Own in Assets?
ALTCS calls assets “resources”. The resource limit for single applicants is $2,000.00, not counting your home and one car in most cases. Community Spouse rules allow married applicants to own at least $26,180.00 and in some cases up to $120,900.00 in countable resources, typically not counting their home and up to two cars. It gets complicated, so ask us about your specific case for more information.
Will Assets Held in Trust be Counted?
Maybe. Typically assets in a Revocable Trust are counted and in an Irrevocable Trust they are not counted, but it depends whether the applicant is the Grantor, Beneficiary, and / or Trustee. Special Needs Trusts must meet certain requirements to be excluded. Call us for more information on how your trust will be treated.
What is the "Five Year Look Back Period" and a "Transfer Penalty"?
ALTCS will ask if you have given away, sold, or changed the name on the title or deed for any money or property in the past five years from the first day of the month the application was requested. They will also want to know if any such transfer was compensated. If not, they may still approve the application but assess a Transfer Penalty, unless the transfer falls within an exception. A Transfer Penalty means you would be approved but not receive the Long Term Care Services component of ALTCS for a period of months, just the Acute Care Services component (the medical insurance part). This penalty period is calculated by dividing the amount of the uncompensated transfer by the Private Pay Rate which is usually $6,905.11. It gets complicated, so ask us about your specific case for more information.
What Happens if I Sell My Home or Car While on ALTCS?
If you sell a resource after your are approved for ALTCS that was not counted (exempt) when you applied, like your house or your car, and you turn it into a counted resource (like cash), this could make you ineligible. Be careful! Call us first and we will let you know if you should worry about such a transfer impairing your eligibility.
How Much Income Can I Have?
The gross income limit for single applicants is $2,205.00 per month, double that for a married couple under Community Spouse rules. Some VA benefits and other forms of income may not be counted. Some applicants over the income limit can use an Income Only Trust to be income eligible. It gets complicated, so ask us about your specific case for more information.
I am a Veteran. Will That Affect My Application to ALTCS?
Maybe, but not in a bad way. Wartime veterans or their surviving spouses may be required to apply to the VA for a need-based pension as part of their ALTCS process. We will let you know if this affects you when we review your case. If you do need to apply for VA benefits, we will show you what you need to do to meet this requirement. It's no big deal, and you might get an additional cash benefit if you're eligible.
How Can I Know if I am Medically Eligible?
In addition to financial eligibility, ALTCS requires that an applicant need a “Nursing Home Level of Care” in order to be eligible. This is a high standard, and requires that the person needs a high level of assistance with many daily tasks of living such as dressing, toileting, bathing, medications, etc. A person from ALTCS called a PAS Assessor will come visit the applicant and do a PAS. "PAS" stands for pre-admission screening, and involves observing, questioning, and reviewing medical records of the applicant. An elderly person needs a EPD PAS score of 60 to be eligible. "EPD" stands for Elderly and Physically Disabled. If the score is 55 or higher but below 60, management will review the score. If it is then still below 60, or if the assessor thinks the score does not accurately reflect the applicant’s needs, a physician will review the case. The ALTCS physician can find an applicant to be medically eligible regardless of the score. Physician reviews often result in the applicant being found medically eligible, but not always. If the applicant is found medically ineligible, you can re-apply when ready. It gets complicated, so let us review your specific situation to advise you how this may apply to your case.
What If I am Married?
ALTCS uses different standards to determine whether married people are eligible. This is called “Community Spouse” policy. Community Spouse rules apply to married applicants unless both married spouses live in nursing homes (as opposed to living at home or in assisted living). Community Spouse rules allow married people to have more income or assets.
How Long Does it Take to Get Approved?
It takes about two months from the day we request the application to get a decision, but if you are approved then benefits are applied back to the first day of that month. Cases involving trusts or other complicated factors may take longer.
What Happens After I am Approved for ALTCS?
You will be enrolled with an ALTCS Program Contractor under contract in your county. The Program Contractor will then assign a Case Manager who will meet with you to develop a specific plan for your care. As of October 2017, for Maricopa, Gila and Pinal Counties the Program Contractors will be Banner-University Family Care, Mercy Care, and United Healthcare Community Plan. In Pima County you will be able to choose between Banner-University Family Care and Mercy Care Plan. For Cochise, Graham, Greenlee, La Paz, Santa Cruz, Yuma, Mohave, Coconino, Apache, Navajo, and Yavapai you will be assigned to Banner-University Family Care. If you have a choice and you are in a facility, ask the facility who they prefer to work with.
Does SAS Guarantee My ALTCS Application Will Be Approved?
No. There are lots of reasons an application could be denied that we do not control, such as medical eligibility. We do guarantee that we will work hard to make sure you get approved, and that you will not get denied do to any error on our part. That guarantee is in our fee agreement, which we both sign when you hire us as your Authorized Representative.
What Services are Available Through ALTCS?
ALTCS Long Term Care Services include nursing home care provided in a licensed Skilled Nursing Facility (SNF), an Intermediate Care Facility for the Mentally Retarded (ICF-MR), a free-standing hospice, a residential treatment facility for persons under 21, or a psychiatric hospital for people age 65 or older. Home and Community-Based Services (HCBS) are provided in your home or in a supervised alternative residential setting such as an Assisted Living Home, Group Home, Adult Foster Care Home, or a Level I, II, or III Behavioral Health Center. In-home services are intended to help you to remain in your home. They include, but are not limited to Home Health Nursing, Personal Care, Homemaker Services, Home Health Aids, Habilitation, Medical Transportation, Attendant Care, Home Delivered Meals, Adult Day Care Mental Health Services, Respite Care, and Hospice. To receive ALTCS care in a facility it must be certified with ALTCS. AHCCCS Acute Care Services include doctors, hospitalization, prescriptions (limited for people who have Medicare), lab work, x-rays, tests, and specialist treatments. Once you are approved, you receive acute care services even during a penalty period.
Can I Choose My Own Physician?
Your ALTCS Program Contractor will give you an opportunity to pick your own primary care physician from an approved listing, or will pick one for you if you do not make a choice. Your ALTCS Program Contractor will only pay for services authorized by ALTCS contracting physicians. If you choose to see a non-contracting physician, you will be responsible for the payment for that medical service.
Is This an Official ALTCS Website? Is This Company Affiliated with ALTCS?
No. This is a private company that helps people apply for ALTCS as their Authorized Representative. We are not affiliated with ALTCS, although our eligibility specialists used to work at ALTCS.
Is Senior Application Services a Law Firm? Are You Attorneys? Do You Give Legal Advice?
No. This is not a law firm, we are not attorneys in Arizona, and we do not give out legal advice. We help people apply for ALTCS, and we use our knowledge of ALTCS rules and procedures to make sure the job gets done right. If you need legal help as part of your ALTCS application process, we know some great Arizona lawyers who are happy to work with us when you need them. We will let you know when that is the case.