Components of Eligibility

As with all public benefits, an applicant must:

 

Be a U.S. Citizen or Qualified Alien

Have a Social Security Number

Be an Arizona Resident

There are four additional components to ALTCS eligibility:

 

Living Arrangements

Medical

Income

Resource Eligibility

 

Living Arrangements

 

An appropriate living arrangement is either the applicant’s home, apartment, or if they are living in or with a family member in their home or apartment. If they are living in a Group Home, Assisted Living Community, Skilled Nursing facility, or a 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.

Medical Eligibility

 

In order to qualify for the ALTCS program, a person has to require a level of care that places them “at risk” of 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.

These include: mobility, transfer, toileting, dressing, feeding, bathing, grooming, and meal preparation. An applicant must score 60 points or higher to be determined medically eligible for this program.

Financial Eligibility

 

The state looks at income and resources differently, depending on whether the person is married or single.

The eligibility for a single person is as follows:

 

Single Income: The single individual monthly income limit is $2,199. If a person’s monthly income is over $2,199 but below the average cost of care for the county in which he/she resides (as determined by AHCCCS, i.e. $6,726.48 for Maricopa County), the applicant could still potentially qualify with a Millers/Income Only Trust.

Single 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 $2,199, the applicant qualifies regardless of the spouse’s income.
  • If the applicant’s gross monthly income is greater than $2,199, but the combined income of the applicant and the spouse is less than $4,398, then the applicant can qualify.
  • If the applicant’s income is greater than $2,199 and the couple’s combined gross monthly income is greater than $4,398 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 $6,726.48 (for Maricopa County) and the couple limit to $13,452.96.
  • If the applicant’s income is greater than $6,726.48 and the couple’s combined gross monthly income exceeds $13,452.96, 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 have the applicant 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 $23,844. Otherwise, the total countable assets are divided in two with a maximum allowance for the community spouse of up to $119,220. For example, if the total combined assets are determined to be $150,000, then the spousal resource limit would be $75,000. In example two, if the total combined assets are determined to be $300,000, then the spousal resource limit would be the maximum of $119,220, 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.