The Arizona Long Term Care System (ALTCS) is one of the most important programs available for seniors and adults with disabilities who need long-term care and have limited income or resources. Many Arizona Medicare beneficiaries do not realize they may qualify for ALTCS, or how it works alongside Medicare to reduce or eliminate long-term care costs.
This guide explains everything you need to know about ALTCS, including eligibility, coverage details, how it interacts with Medicare, and how to apply.
What Is ALTCS?
ALTCS stands for the Arizona Long Term Care System.
It is Arizona’s version of Medicaid long-term care and is administered by AHCCCS (Arizona Health Care Cost Containment System).
ALTCS is designed for individuals who:
- Need long-term care services such as assisted living or nursing home care
- Want to receive in-home care instead of entering a facility
- Have limited income or financial resources
- Are elderly or have a disability that requires daily support
While Medicare covers medical care, it does not cover long-term custodial care. ALTCS fills this critical gap.
What ALTCS Pays For
ALTCS provides a wide range of services that help individuals remain independent or receive appropriate long-term care.
ALTCS typically pays for:
- Nursing home care
- Assisted living
- In-home caregivers
- Memory care
- Adult day health care
- Medical transportation
- Medical equipment and supplies
- Hospice care
- Case management
- Behavioral health services
- Home modifications (in certain cases)
- Personal care services
- Respite care for caregivers
Because long-term care is extremely expensive in Arizona, ALTCS is often one of the only ways seniors can afford the support they need.
How ALTCS Works with Medicare
Many ALTCS applicants already have Medicare.
ALTCS does not replace Medicare; instead, the two programs coordinate benefits.
Here is how coverage typically works:
- Medicare pays for medical services, doctor visits, hospital stays, and short-term skilled nursing.
- ALTCS pays for long-term care services, custodial care, and support services Medicare does not cover.
- ALTCS may help pay Medicare deductibles and coinsurance for eligible members.
- Individuals on ALTCS may also qualify for a Dual-Eligible Special Needs Plan (D-SNP), which often includes extra benefits.
This combination of Medicare plus ALTCS provides comprehensive coverage that minimizes out-of-pocket costs.
Who Qualifies for ALTCS in Arizona
To qualify for ALTCS, applicants must meet both medical and financial requirements.
1. Medical Eligibility
Applicants must need a nursing home level of care.
To determine this, ALTCS uses a functional and medical assessment that looks at:
- Ability to perform activities of daily living (bathing, dressing, eating, etc.)
- Mobility and balance issues
- Cognitive impairments such as dementia or Alzheimer’s
- Chronic medical conditions
- Behavioral health needs
- Frequency of falls
- Need for ongoing supervision
If an individual requires significant assistance or supervision, they may meet the ALTCS medical criteria.
2. Financial Eligibility
ALTCS has strict income and asset requirements.
These limits change annually.
Income Limit
Arizona typically uses a limit tied to the Federal Benefit Rate or a percentage of the Federal Poverty Level. Applicants receiving income above the limit may still qualify by setting up a Miller Trust (also called an Income-Only Trust).
Asset Limit
ALTCS reviews:
- Bank accounts
- Investments
- Retirement accounts (varies by case)
- Cash on hand
- Real estate other than a primary residence
Assets not counted often include:
- Primary residence (with limitations)
- One vehicle
- Personal belongings
- Household goods
- Irrevocable burial funds
Couples have different, more flexible asset rules designed to protect the spouse who is not applying.
What ALTCS Costs
Most ALTCS members pay little or nothing for services, depending on their income and living situation.
Costs may include:
- Share of cost (similar to a monthly copayment)
- Room and board in some assisted living settings
- Small personal contributions for certain services
However, for individuals with low income, many services end up being fully covered. ALTCS is designed to make long-term care affordable for those who cannot pay privately.
How to Apply for ALTCS
Applying for ALTCS involves multiple steps and can take several weeks. Accuracy is important to avoid delays or denials.
Step 1: Submit Your Application
Applications are submitted through the Arizona ALTCS office.
You can apply:
- Online
- By phone
- By mail
- In person
Step 2: Financial Review
ALTCS will request documents such as:
- Bank statements
- Proof of income
- Social Security award letters
- Medicare details
- Resource verification
- Living situation documentation
Step 3: Medical Evaluation
A nurse or assessor will conduct an in-person or virtual evaluation to determine whether the applicant meets medical criteria.
Step 4: Determination
If approved, coverage usually begins the first day of the month after approval.
Common Reasons People Are Denied ALTCS
Many Arizonans who should qualify are denied because:
- They did not provide complete financial documentation
- They have excess income but did not set up a Miller Trust
- Assets were not properly structured
- They did not meet the medical benchmark initially
- Errors were made during the application
- They applied too early or too late
Often, these issues can be corrected with guidance.
How ALTCS Helps Arizona Medicare Beneficiaries
ALTCS is especially important for:
- Seniors who can no longer live independently
- Individuals with dementia or Alzheimer’s
- Adults with physical disabilities
- People who want to avoid a nursing home
- Caregivers who need support or respite
- Individuals who cannot afford long-term care privately
Since the average monthly cost of assisted living in Arizona is over $4,000 per month (and nursing homes much higher), ALTCS can be life-changing.
How ALTCS Connects with Medicare Advantage D-SNP Plans
Many ALTCS members also enroll in a Dual-Eligible Special Needs Plan (D-SNP).
These plans often include:
- Dental
- Vision
- Hearing
- Transportation
- Over-the-counter allowances
- Care coordination
- Prescription drug coverage
ALTCS pays certain medical costs, while the Medicare Advantage plan wraps in additional benefits.
How a Local Medicare and ALTCS Specialist Can Help
A licensed agent familiar with Arizona Medicare and ALTCS can:
- Determine whether you meet income and medical criteria
- Help review the financial requirements
- Explain how ALTCS will coordinate with existing Medicare coverage
- Guide families through the application process
- Recommend D-SNP plans that work well with ALTCS
- Help seniors and families plan for long-term care needs
Navigating ALTCS alone can be overwhelming. Expert guidance makes the process far easier.
Conclusion
ALTCS is one of the most important long-term care resources available to Arizona seniors and adults with disabilities. It fills the critical gap left by Medicare, providing coverage for assisted living, nursing home care, in-home support, and other long-term care services.
If you or a loved one may need long-term care in the future and have limited income or resources, applying for ALTCS could significantly reduce or eliminate care costs. With the right help, many Arizona residents qualify without realizing it.