Arizona Medicaid Definition
In Arizona, Medicaid is called the Arizona Health Care Cost Containment System (AHCCCS), and the program that specifically provides long term care for the aged, blind, and disabled is called the Arizona Long Term Care System (ALTCS).
Medicaid is a wide-ranging, jointly funded state and federal health care program for low-income individuals of all ages. However, this page is focused on Medicaid eligibility, specifically for Arizona residents, aged 65 and over, and specifically for long term care, whether that be at home, in a nursing home, or in an assisted living facility.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which Arizona seniors may be eligible. These programs have slightly different financial and medical eligibility requirements, as well as benefits. Further complicating eligibility are the facts that the criteria vary with marital status and that Arizona offers multiple pathways towards eligibility.
1) Institutional / Nursing Home Medicaid – is an entitlement (anyone who is eligible will receive assistance) & is provided only in nursing homes.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – Limited number of participants. Therefore, wait lists may exist. Provided at home, adult day care, or in assisted living.
3) Regular Medicaid / Aged Blind and Disabled – is an entitlement and is provided at home or adult day care.
The table below provides a quick reference to allow seniors to determine if they are immediately eligible for long term care from an Arizona Medicaid program. Alternatively, take the Medicaid Eligibility Test. IMPORTANT, not meeting all the criteria below does not mean one is not eligible or cannot become eligible. More.
|2018 Arizona Medicaid Long Term Care Eligibility for Seniors|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||$2,250 / month||$2,000||Nursing Home||$3,375 / month||$3,000||Nursing Home||$2,250 / month for applicant||$2,000 for applicant & $123,600 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,250 / month||$2,000||Nursing Home||$3,375 / month||$3,000||Nursing Home||$2,250 / month for applicant||$2,000 for applicant & $123,600 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$1,005 / month||No limit||None||$1,354/ month||No limit||None||$1,005 / month||No limit||None|
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. To clarify, this income can come from any source. Examples include employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. However, when only one spouse of a married couple is applying for Medicaid, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded. There is also a Minimum Monthly Maintenance Needs Allowance (MMMNA), which is the minimum amount of monthly income to which the non-applicant spouse is entitled. (As of July 2018, this figure falls between $2,057.50 / month and $3,090 / month). This rule allows the Medicaid applicant to transfer income to the non-applicant spouse to ensure he or she has sufficient funds with which to live.
What Defines “Assets”
Countable assets include cash, stocks, bonds, investments, credit union, savings, and checking accounts, and real estate in which one does not reside. However, for Medicaid eligibility, there are many assets that are considered exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts, and one’s primary home, given the Medicaid applicant or their spouse lives in the home and the home is valued under $572,000 (in 2018). For married couples, as of 2018, the community spouse (the non-applicant spouse) can retain up to a maximum of $123,600 of the couple’s joint assets, as the chart indicates above. This, in Medicaid speak, is referred to as the Community Spouse Resource Allowance (CSRA).
Notice from the chart above, both Institutional / Nursing Home Medicaid and Medicaid Waivers / Home and Community Based Services have asset limits. On the other hand, Regular Medicaid / Aged, Blind, and Disabled does not have an asset limit. Arizona is extremely unique in that it is the only state with no asset limit for the Aged, Blind, and Disabled pathway. One should be aware that Arizona has a Medicaid Look-Back Period, which is a period of 60 months that dates back from one’s Medicaid application date. During this time frame, Medicaid checks to ensure no assets were sold or given away under fair market value. If one is found to be in violation of the look-back period, a period of Medicaid ineligibility will ensue.
Qualifying When Over the Limits
For Arizona elderly residents (65 and over), who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.
1) Qualified Income Trusts (QIT’s) – QIT’s, also referred to as Miller Trusts, are a type of Special Treatment Trusts (STT’s) for Medicaid applicants who are over the income limit, but still cannot afford to pay for their long-term care. (For Arizona Medicaid purposes, a Miller Trust is often called an Income-Only Trust.) This type of trust offer a way for individuals over the Medicaid income limit to still qualify for long-term care Medicaid, as money deposited into a QIT does not count towards Medicaid’s income limit. In simple terms, one’s excess income (over the Medicaid limit) is directly deposited into a trust, in which a trustee is named, giving that individual legal control of the money. The account must be irreversible, meaning once it has been established, it cannot be changed or canceled, and must have Arizona Health Care Cost Containment System (AHCCCS) listed as the remainder beneficiary. In addition, the money in the account can only be used for very specific purposes, such as paying long term care services / medical expenses accrued by the Medicaid enrollee. As previously stated, the income in this account is exempt from Medicaid’s income limit. However, the deposited income is counted towards calculating one’s “Share of Cost”, which is the amount towards medical expenses in which a Medicaid applicant must contribute. In most cases, there is only a share of cost if one resides in a nursing home facility.
Unfortunately, Income Only Trusts do not assist one with extra assets in qualifying for Medicaid. Said another way, if one meets the income requirements for Medicaid eligibility, but not the asset requirement, the above option cannot assist one in reducing their extra assets. However, one can “spend down” assets by spending excess assets on non-countable assets, such as home modifications (wheelchair ramps, roll-in showers, and stair lifts), vehicle modifications (wheelchair lifts, adaptive control devices, and floor modifications to allow one to drive from a wheelchair) prepaying funeral and burial expenses, and paying off debt.
2) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, but still cannot afford their cost of care. For persons in this situation, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible. Read more or connect with a Medicaid planner.
Specific Arizona Medicaid Programs
1. Arizona LTC Services – This is AZ general Medicaid program for those with long term care needs. The program will pay for nursing home care but also for some care in beneficiaries’ homes or in assisted living residences.
2. Arizona Agency With Choice (AWC) – AWC is less a Medicaid program and more a way to receive care from AZ Medicaid. This option allows participants to choose their own attendant / personal care providers rather than the state Medicaid program assigning a caregiver to them.
3. Arizona Self Directed Attendant Care (SDAC) – SDAC is very similar to the AWC in the program participant can select their own personal caregivers. However, interested parties may incur wait-lists to participate.