Arizona Medicaid Definition
In Arizona, Medicaid is called the Arizona Health Care Cost Containment System (AHCCCS), and the program that 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, with a focus on 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) Home and Community Based Services (HCBS) – although Arizona has previously offered HCBS Medicaid waivers for its elderly population, the state no longer does. With waivers, the number of participant slots was limited, and wait lists could exist to receive services. Currently, long-term care services are provided at home, adult day care, adult foster care homes, or in assisted living residences via a managed care system. This allows program participants to receive all needed services via one administering agency. Unlike with waivers, the managed care program does not have enrollment caps, which means there are no waiting lists to receive benefits.
3) Regular Medicaid / Aged Blind and Disabled – is an entitlement (anyone who meets eligibility requirements is able to get benefits) and is provided at home or adult day care.
The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long term care from an Arizona Medicaid program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT: Not meeting all of the criteria below does not mean one is ineligible or cannot become eligible for Medicaid in Arizona. More.
|2021 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||$2,382 / month**||$2,000||Nursing Home||$4,764 / month (Each spouse can have up to $2,382 / month)**||$4,000 (Each spouse can have up to $2,000 in assets)||Nursing Home||$2,382 / month for applicant**||$2,000 for applicant & $130,380 for non-applicant||Nursing Home|
|Home and Community Based Services||$2,382 / month||$2,000||At Risk of Institutionalization||$4,764 / month (Each spouse can have up to $2,382 / month)||$4,000 (Each spouse can have up to $2,000 in assets)||At Risk of Institutionalization||$2,382 / month for applicant||$2,000 for applicant & $130,380 for non-applicant||At Risk of Institutionalization|
|Regular Medicaid / Aged Blind and Disabled||$1,073 / month||No limit||None||$1,452 / month||No limit||None||$1,452 / month||No limit||None|
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted towards the income limit. 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. An exception does exist for Covid-19 stimulus checks (initial and subsequent), which do not count as income, and therefore, do not impact one’s eligibility for Medicaid.
When only one spouse of a married couple is applying for nursing home Medicaid or long-term home and community based services, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded. In the case where just one spouse is applying for regular Medicaid, the income of both spouses (applicant and non-applicant) is counted towards the income eligibility of the applicant spouse. Learn more about how Medicaid counts income here.
There is also a Minimum Monthly Maintenance Needs Allowance (MMMNA) for non-applicant spouses of those applying for nursing home Medicaid or long-term home and community based services. (This rule does not extend to married couples in which one spouse is applying for regular Medicaid). The MMMNA is the minimum amount of monthly income to which the non-applicant spouse is entitled and is intended to ensure he / she has sufficient funds from which to live. From July 1, 2020 – June 30, 2021, the MMMNA is $2,155.00 / month. Simply put, the applicant spouse can transfer his or her income to the non-applicant spouse to bring his / her monthly income up to $2,155.00. The non-applicant spouse is entitled to an even greater spousal allowance if his or her mortgage/rent and utilities are greater than this figure. In 2021, the maximum spousal income allowance is $3,259.50 / month.
**Please note that although the income limit for Medicaid nursing home care is $2,382 / month (in 2021), all of a beneficiary’s monthly income, minus a personal needs allowance of $119.10 / month, and possibly a monthly maintenance needs allowance for a non-applicant spouse, must go towards the cost of nursing home care.
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 purposes, 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 lives in the home or has “intent” to return to the home, and his / her equity interest in the home is not greater than $603,000 (in 2021). (Equity interest is the amount of the home’s value the Medicaid applicant owns). If a non-applicant spouse lives in the home, it is exempt regardless of where the applicant lives or the applicant’s equity interest in the home.
For married couples, as of 2021, the community spouse (the non-applicant spouse of an institutional Medicaid applicant or long-term HCBS applicant) can retain up to half of the couple’s joint assets, up to a maximum of $130,380, as the chart indicates above. That said, there is also a minimum amount to which the community spouse is entitled, and as of 2021, this amount is $26,076. Stated differently, the non-applicant spouse is entitled to 100% of the couple’s joint assets up to $26,076. This, in Medicaid speak, is often referred to as the Community Spouse Resource Allowance (CSRA), but in Arizona, it is called the Community Spouse Resource Deduction (CSRD). As with the spousal income allowance, this rule does not apply to married couples in which one spouse is an applicant for regular Medicaid.
Notice from the chart above, both Institutional / Nursing Home Medicaid and 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 immediately precedes 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 penalty 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) – Also referred to as Miller Trusts, QITs 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 offers 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 the 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 for long term care services / medical expenses accrued by the Medicaid enrollee. While the income in this account is exempt from Medicaid’s income limit. 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 help reduce assets over Medicaid’s limit. 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, as well as to protect their home from Medicaid’s estate recovery program. Read more or connect with a Medicaid planner.
Specific Arizona Medicaid Programs
1. Arizona LTC Services (ALTCS) – This is an AZ general Medicaid program for those with long term care needs. The ALTCS program, sometimes called the Elderly and Physical Disability (EPD) program, will pay for nursing home care, but also for some care in beneficiaries’ homes, adult foster care homes, or in assisted living residences.
2. 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. This includes hiring family members, even spouses.
3. Self Directed Attendant Care (SDAC) – SDAC is very similar to the AWC option in that program participants can select their own personal caregivers. With this option, program participants work with a fiscal employer agency.
How to Apply for Arizona Medicaid
For more information or to apply for nursing home Medicaid or long-term care home and community based services, persons should contact their local Arizona Long Term Care System (ALTCS) Office. At the time of this writing, there is not an online application for these programs. However, seniors who are strictly applying for medical assistance, rather than long-term care, and do not have a nursing home level of care need, can apply online on the Arizona Health Care Cost Containment System website.
For non-state specific information about the application process for Medicaid, click here.