Category - ALTCS

How Can ALTCS Help Me?

ALTCS stands for Arizona Long Term Care System and is Arizona’s branch of Medicaid. Applicants must qualify medically and financially in order to receive these benefits. If you do qualify for ALTCS this will cover the cost of acute care services, nursing home care, home and community based services, and services for developmentally disabled adults and children.

ALTCS does require quite a bit of planning. There are estate planning documents that can be put in to place before applying for ALTCS that will help increase the chances of qualifying. Each year 73% of all applicants are denied because they did not have prior proper planning.

It will take a minimum of 45 days to process the application. Many times they will come back and ask for more documentation. Before applying you must:

  • Meet the age and/or disability requirements
  • Verify citizenship status and identity
  • Verify your Social Security Number
  • Verify your marital status (if married)
  • Living in ALTCS qualified home or facility
  • Apply for all potential benefits
  • Assign your rights to health benefits to AHCCCS (Arizona Health Care Cost Containment System)
  • Pass the Pre-Admission Screening process
  • Meet the financial requirements
  • Have no transfer of assets in the past 5 years that would disqualify you for long term care

There is some pre-planning involved when applying for ALTCS. It would be best to meet with a consultant to give you guidance for your specific situation. Many who try to do this on their own are unaware of some of the penalties that could exist if their estate was managed incorrectly.

Why Seek Advice for ALTCS?

As life expectancies and long term care costs continue to rise, the challenge quickly becomes how to pay for these services. Many people cannot afford to pay $4,000 per month or more for the cost of a nursing home, and those who can pay may find their life savings wiped out in a matter of months, rather than years.

Fortunately, the ALTCS Program is there to help. In fact, in our lifetime, ALTCS has become the long term care insurance of the middle class. But the eligibility to receive ALTCS benefits requires that you pass certain tests on the amount of income and assets that you have. The reason for ALTCS planning is simple. First, you need to provide enough assets for the security of your loved ones. Second, the rules are extremely complicated and confusing. The result is that without planning and advice, many people spend more than they should and their family security is jeopardized.

Exempt Assets and Countable Assets: What Must Be Spent?

To qualify for ALTCS, applicants must pass some fairly strict tests on the amount of assets they can keep. To understand how ALTCS works, we first need to review what are known as exempt and non-exempt (or countable) assets. Exempt assets are those which Medicaid will not take into account (at least for the time being). In general, the following are primary exempt assets:

  • Home, no matter what its value. The home must be the principal place of residence. The nursing home resident may be required to show some “intent to return home” even if this never actually takes place.
  • Personal belongings and household goods
  • One car or truck
  • Burial spaces and certain related items for applicant and spouse
  • Up to $1,500 as a burial fund for applicant & spouse
  • Irrevocable prepaid funeral contract
  • Value of life insurance if face value is $1,500 or less. If it does exceed $1,500 in total face amount, then the cash value in these policies is countable.
  • Miller Trust (or Income Only Trust) – see our website for more information

All other assets are generally non-exempt, and are countable. Basically, all money and property, and any item that can be valued and turned into cash, is a countable asset unless it is one of those assets listed above as exempt. This includes:

  • Cash, savings, and checking accounts, credit union share and draft accounts
  • Certificates of deposit
  • Savings Bonds
  • Individual Retirement Accounts, (IRA), Keogh plans, (401K, 403B) (Exempt for the community spouse)
  • Nursing home accounts
  • Prepaid funeral contracts which can be canceled
  • Trust (depending on the terms of the trust)
  • Real estate (other than the residence)
  • More than one car
  • Boats or recreational vehicles
  • Stocks, bonds, or mutual funds
  • Land contracts or mortgages held on real estate sold

For assistance with qualifying for ALTCS please reach out to one of our specialists.

How To Pay For Nursing Home Care

One of the most difficult transitions people face is the change from independent living in their own home or apartment to living in a long term care facility or nursing home. There are many reasons why this transition is so difficult. One is the loss of a home…a home where the person lived for many years with a lifetime of memories. Another is the loss of independence. Still another is the loss of the level of privacy we enjoy at home, since nursing home living is often shared with a roommate.

Most people who make the decision to move to a nursing home do so during a time of great stress. Some have been hospitalized after a stroke, some have fallen and broken a hip, still others have progressive dementia, like Alzheimer’s disease, and can no longer be cared for in their own homes.

Whatever the reason, the spouse or relative who helps a person transition into a nursing home during a time of stress faces the immediate dilemma of how to find the right nursing home. The task is no small one, and a huge sigh of relief can be heard when the right home is found and the loved one is moved into the nursing home. For many, the most difficult task is just beginning; how to cope with nursing home bills that may total $2,500 to $6,000 per month or more?

One of the things that concerns people most about nursing home care is how to pay for that care. There are basically four ways that you can pay the cost of a nursing home:

  1. Long Term Care Insurance – If you are fortunate enough to have this type of coverage, it may go a long way toward paying the cost of the nursing home. Unfortunately, long term care insurance has only started to become popular in the last few years and most people facing a nursing home stay do not have this coverage.
  2. Pay with Your Own Funds – This is the method many people are required to use at first. Quite simply, it means paying for the cost of a nursing home out of your own pocket. Unfortunately, with nursing home bills averaging between $4,000 and $6,000 per month in our own area, few people can afford a long term stay in a nursing home.
  3. Medicare – This is the national health insurance program primarily for people 65 years of age and older, certain younger disabled people, or people with kidney failure. Medicare provides short term assistance with nursing home costs, but only if you meet the strict qualification rules.
  4. ALTCS (Arizona Long Term Care System) – This is a federal & state funded and state administered medical benefit program which can pay for the cost of the nursing home if certain asset and income tests are met.

If you are looking for assistance in qualifying for ALTCS please reach out to one of our specialists at Legal Awareness for Seniors.

 

ALTCS 5 Most Common Questions

1. Is ALTCS only for those who require to be in a skilled nursing facility in Arizona?
ALTCS (Arizona Long-Term Care System) provides a wide array of care for those that would like home care, adult day care, assisted living and more. So, even if you don’t need immediate skilled attention, you can apply to receive ALTCS to assist you.

2. Does the care you receive through ALTCS differ from the care you would receive if you paid privately?
Those that receive care through ALTCS receive the same wonderful care and medical treatment as they would if they paid for it out of their own pocket. Health care providers are legally required to give the same level of care to each patient no matter how it is paid for.

3. Are you allowed to keep your personal physician once you are on ALTCS?
ALTCS has a limited network of doctors that they work with. If you want ALTCS to pay for the doctor visits you will be required to see a doctor that is on their list. You may continue to see your doctor if they are out-of-network only if you pay for it yourself. But, don’t worry, case managers are available to assist you in finding the right doctor.

4. Are there any medical costs that ALTCS members must pay on their own?
Each person has different circumstances. Sometimes members are asked to pay a share of the cost while other members are fully covered. For example, a member living in Assisted Living may be required to pay for their room and board while ALTCS pays for the medical expenses. Most of the time members will learn what their share of the costs will be at the time of their qualification process.

5. If I have too many financial resources can I give them away in order to qualify for ALTCS?
No, you may not give them away. ALTCS looks back 5 years to see if you have gifted any of your resources. However, if you speak with one of our qualified ALTCS representatives we can help you to establish strategies in order to qualify for ALTCS without ‘spending down’ your resources.

What is Spend Down for ALTCS

When qualifying for ALTCS (Arizona Long Term Care System) otherwise known as Medicaid many applicants will come to learn the term “spend down”. If you have too many assets when you apply ALTCS will deny you. In order to qualify you will need to spend down your assets.

The assets you have cannot be given away, but they can be spent on certain exempt resources. ALTCS looks back five years to check for gifting. They want to assure that you are spending your money on your own needs and not the needs of family or friends.

Some of these qualifying exemptions are:

  • Funeral trust
  • House
  • Car
  • Personal items (clothing, medications, appliances, etc.)
  • Care needs
  • Legal fees, such as estate planning
  • Miller Trust (or Income Only Trusts)

There are means to avoiding spend down. You will want to be sure to get quality legal advice or speak to one of our knowledgeable estate planners to help assure ALTCS will accept you.

Creating A Trust for Your Spouse or Child With Special Needs

Preparing to leave your loved one an inheritance when they have special needs must be done with care. Most individuals that have some sort of ailment or impairment are usually on government assistance. Leaving them any sort of inheritance can disqualify them from continuing to receive that assistance.

There are ways to prevent the loss of this assistance. With a Miller Trust (also known as an Income Only Trust) you will rest assured that their Medicaid won’t be taken away from them.

Setting up this trust has a few steps:

  1. Have the Miller Trust prepared by an Estate Planner such as with Legal Awareness for Seniors. We will have the correct wording drawn up as to maintain any financial assistance they are currently on or will be receiving through any programs.
  2. Open a bank account in the name of the newly acquired trust. The tricky part is that when you open the account you cannot have an opening balance. Most banks will give you a hard time about this, but there are banks out there that are familiar with and will accommodate this request.
  3. Reach out to social security, pensions, and any other income resources your loved one is receiving. Have them deposit their funds directly into the newly set up bank account.

Once everything is set up the funds can be used towards your loved one. However, there are some stipulations. These funds cannot be used directly to purchase shelter, clothing, food or any of the services that the government benefits will normally provide. The funds are commonly used to pay for vacations, home furnishings, personal care attendance, education, recreation, vehicles, physical rehabilitation and so on.

The reason this type of trust works is because Medicaid (in Arizona it is called ALTCS) sees the income being received by the Trust and not the individual. To accurately set up this type of document and received guidance you will want to work closely with us at Legal Awareness for Seniors.

What Are Residential Care Homes?

Residential Care Homes are located in a local neighborhood and are run by caregivers (not necessarily nurses) to assist your loved one. These homes can have a specialty care, such as Alzheimer’s, or a more broad care for your elderly family member. The owner sometimes lives in the home and is one of the caregivers for the residents, other homes hire caregivers to take shifts and run it more like a business.

Some homes are fancy with chandeliers and granite counter tops while others have more of a country home feel. It is always best to place your parent in a home that they are accustomed to and would feel most comfortable living in.  No matter the style of the home they all will provide:

  • A room, either private or shared
  • Meals
  • Custodial care such as housekeeping, laundry, doctors appointments, and possibly transportation services
  • Different levels of assistance for daily living activities such as bathing, dressing, moving around, and incontinence care
  • Reminders for medication

However, if you are looking for medical care, you will need to look into nursing homes. Residential Care Homes are for those that can’t live independently, but do not like the idea of living in a large institution. These homes usually are in residential areas, have a porch and a patio for residents to enjoy, and home cooked meals. Your loved one will still have the freedom to continue living the way they are use to, but in a community that can care for them easily.

Have you been told you make too much to qualify for ALTCS?

2-6-17-too-much-for-altcsArizona is one of the states that has an “income-cap”, which means there is a limited amount of money that a beneficiary may receive in order to qualify for ALTCS. This cap is adjusted yearly. If you have been previously told that your income is too high in order to receive benefits there are steps you can take in order to qualify. The most common step is to re-direct some or all of your income to an Income Only Trust (otherwise known as a Miller Trust).

It has been known that even though the Miller Trust holds all the income only the monthly allotted amount given to the beneficiary will be counted as their income. This may let the individual that once had too much income to now qualify to receive ALTCS benefits.

Re-directing the income is simply having the source of income (for example your Social Security check) to be deposited into a checking account that is in the name of the trust. The Miller Trust can only be used when the applicant resides in a long term care living arrangement.

In order for the Miller Trust to work it must meet specific rules. Some of those rules are:

  • The full amount of any source of income (such as Social Security) must be deposited into the trust account.
  • The income and interest earned once the trust is created can accumulate but will not be counted as a resource.
  • The trust must be established by the ALTCS applicant or by someone he names to act on his behalf.
  • The account must be opened with a portion of the applicant’s monthly income or with a $0 balance.
  • Anything received prior to setting up the Miller Trust cannot be put into the account and will be claimed as the applicant’s income.
  • The income disbursed to the beneficiary is only allowed to go towards personal needs, food, shelter, medical expenses, clothing, and other allowable disbursements in order for the beneficiary to live on.

In addition to these rules when you pass away the state will receive the amount remaining in the trust. They will receive only the amount up to the total costs they covered through ALTCS, if there is anything remaining it will be disbursed to your named beneficiary.

What Options Do I Have for Long Term Care Through ALTCS?

ALTCS (Arizona Long Term Care System) is Arizona’s version of Medicaid. Applying for Medicaid can be confusing with their strict qualification standards. Legal Awareness for Seniors specializes in helping you through the system because we understand it. Elderly and disabled residents are provided with long term care without causing financial strain.

Besides medical care the qualified recipient can also receive the following services:

  • Assisted Living Care
  • Adult Day Care
  • Home Nursing CareMeasure a patients blood pressure a sphygmomanometer
  • Hospice Care
  • Personal Care
  • Transportation Services
  • Respite Care
  • Home Health Care
  • Housekeeping Services
  • Meal Preparation and Delivery
  • Home Modifications
  • Homemaker Services
  • Behavioral Care
  • Care Coordination Assistance
  • Personal Emergency Response Services

You may notice the room and board are not listed above. Those services are not considered medical care and, thus, are not paid by ALTCS.

If you have attempted to receive ALTCS and were told that you have too much money, there are a few things we can do to help assist you in qualifying for ALTCS. Contact us to learn more and find out what we can do for you.

Why Should I Apply for ALTCS If I Already Have Medicare?

altcs-vs-medicareMedicare is a great program for seniors who need medical insurance and prescription drugs. However, Medicare does not cover the cost for assisting living. It may cover very short term (average of 27 days, but can be up to 100 days) in a nursing home facility.  They also do not cover the cost for non-skilled services which include assistance with activities that are done daily which include grooming, meals, etc.

Medicare is beneficial for the times before needing Assisted Living. It is immensely helpful for preventative measures and rehabilitation if you were to slip and fall. What happens when rehabilitation doesn’t work and you need constant assistance? That is when Medicaid, otherwise known in Arizona as ALTCS, will come into play.

If you are worried you have too much money to qualify for ALTCS you may want to speak to a knowledgeable advisor. At Legal Awareness for Seniors we specialize in qualifying individuals for ALTCS through different means. If you or someone you love is in need of Assisted Living – applying for ALTCS is the most affordable way.