ALTCS & Medicaid Long-Term Care Planning Attorney in Chandler

The Arizona Long-Term Care System, commonly known as ALTCS, is a pivotal part of Arizona's healthcare infrastructure, designed to provide long-term care services to eligible residents. As the complexities of life progress, one may find themselves needing long-term care. Whether due to advancing age, illness, or disability, navigating this process can seem daunting. That's where ALTCS steps in to provide much-needed support and resources.

If you or a loved one needs ALTCS assistance, it is important that you consult with an experienced attorney who can guide you through this challenging process. Applying for ALTCS independently often results in denial. With our seasoned elder law attorney, the Law Williams Law Office streamlines the application and approval process, ensuring smooth transitions and saving you time, money, and stress. We offer consultations to help you understand what your next steps need to be.

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Understanding ALTCS (Long-Term Care Planning)

The Arizona Long-Term Care System (ALTCS) is a testament to Arizona's commitment to providing healthcare for its vulnerable residents. Designed as a segment of Arizona's Medicaid program, ALTCS primarily focuses on offering long-term health coverage. But what does "long-term" mean in this context, and who benefits from such a program? Let's explore further.

ALTCS is about more than just providing health coverage in the traditional sense. Its primary focus is on individuals who require assistance due to age, illness, or disability over prolonged periods. This might encompass the following:

  • Facility Care: This includes nursing homes where individuals receive around-the-clock care, assisted living facilities that provide a mix of independence and care, and rehabilitation facilities that help individuals regain physical or cognitive functions.

  • At-Home Care: Some individuals, despite needing care, prefer to stay in their homes. ALTCS can cover the costs associated with healthcare professionals providing care within the home environment.

  • Acute Care Services: These are the more traditional healthcare services we think of, such as doctor visits, medical testing, surgeries, and treatments.

  • Specialized Services: ALTCS extends its coverage to mentally disabled children and adults, recognizing the unique care they require.

  • Community Services and Support: This includes crucial support mechanisms like senior transportation (to medical appointments or community centers) and home food deliveries, ensuring nutritional needs are met.

The Difference Between Medicare and Medicaid

Medicare and Medicaid, though often used interchangeably, serve distinct purposes. While both are government healthcare programs, Medicare primarily caters to seniors, irrespective of their financial situation. Medicaid, on the other hand, is designed to assist individuals based on financial need. It's a public assistance initiative to alleviate healthcare costs for those with limited income and assets. To qualify for Medicaid, you must meet specific income and asset requirements to be eligible.

What are the ALTCS Eligibility and Requirements?

ALTCS, being a part of Arizona's Medicaid program, adheres to stringent eligibility criteria. Prospective beneficiaries must meet both medical and financial requirements. Essentially, they must prove long-term care's medical necessity while demonstrating limited income and assets. Applicants must meet requirements spread across the following categories:

1. General Requirements: To be eligible for ALTCS, an individual must be:

  • A U.S. citizen.
  • Possess a Social Security Number.
  • Be a current resident of Arizona.

2. Living Arrangements: ALTCS beneficiaries or their representatives have the autonomy to decide their living conditions. Options encompass:

  • Living independently at home.
  • Residing with a family member and receiving in-home care.
  • Staying in an assisted living facility. However, the facility must be affiliated with the ALTCS program.

3. Medical Eligibility Requirements: Pre-Admission Screen (PAS): A point-based, in-person screening process determines medical eligibility.

  • Applicants undergo a comprehensive health examination.
  • Their Activities of Daily Living (ADLs) – like bathing, dressing, eating, transferring, etc. – are assessed.
  • Scoring: Post PAS and review of medical records, a numerical score is assigned. Although most applicants easily satisfy the medical prerequisites, ALTCS must ascertain their daily aid needs. Diagnoses like Alzheimer's confer additional weightage for eligibility.
  • Family and Physician Input: It's beneficial for primary physicians or family members to participate in the process, given that some applicants might hesitate to share intimate details with strangers.

4. Financial Eligibility Requirements: Given the expensive nature of long-term care in the U.S. and the lack of a comprehensive health insurance system covering it, ALTCS has stringent financial criteria with the following income limits:

  • Single Applicants: Must not surpass a gross monthly income of $2,523.
  • Married Applicants: Their combined income shouldn't exceed $5,046/month.
  • The applicant becomes ineligible if the income surpasses these thresholds, even by a cent. However, a Miller Trust (or Income Only Trust) can be employed to navigate around these restrictions. Through this trust, one can assign their rights to receive specific income, bringing them within the ALTCS eligibility parameters. Setting up such trusts requires expert assistance.
  • The Minimum Monthly Maintenance Needs Allowance is designated for the non-institutionalized spouse. If this spouse earns below $2,177.50, they can retain a portion of the institutionalized spouse's income, with the maximum allowance capped at $3,435.
  • Single Applicants: Must have assets below $2,000.
  • Married Applicants: Asset calculations get intricate. The Community Spouse Resource Assessment (CSRA) signifies the amount the non-institutionalized spouse can retain. To determine the CSRA, the couple's total assets are halved. The CSRA varies between $29,724 and $148,620. The institutionalized applicant can additionally retain $2,000.
  • Exemptions: Certain assets, like the primary home, one vehicle, burial funds, specific insurance policies, household items, and tools used for income, are exempt from consideration.

ALTCS also conducts a five-year look-back period, scrutinizing any transfers of assets. Any non-equivalent exchanges result in a penalty period, which is calculated by dividing the given amount by the prevailing rate for a private facility. This quotient indicates when applicants must self-finance their care before ALTCS begins coverage. Considering the intricate nature of ALTCS qualifications, seeking the guidance of a knowledgeable Medicaid attorney, especially in Chandler, can be invaluable.

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Legal Disclaimer

The information you obtain at this site is not, nor is it intended to be, legal advice. The Attorneys Office's legal team is licensed to practice law in Arizona. We invite you to contact us, but please be aware that contacting us does not establish an attorney-client relationship. Please do not send any confidential information to us until an attorney-client relationship has been established.

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