Staying In-network for Long-term Care
Question: I filed an Arizona Long Term Care System application for my wife nearly a year ago, and I have had a horrible time trying to manage and understand the process on my own. After many months of working on this process, I am now being told that my wife has to move to a different facility in order to qualify for the benefit. Can ALTCS really tell me where my wife has to live?
Answer: ALTCS will never decide where your wife will live — this is your decision to make. Before ALTCS will approve your wife’s case, however, she must reside in an approved setting.
To clarify, ALTCS is just like any other insurance provider insofar as it will only provide coverage to its members who seek care from an in-network provider. Just like with any other insurer, ALTCS has a network of providers with which it is contracted to provide care.
As long as the setting in which you place your wife has an ALTCS contract, she will be eligible for coverage if she is otherwise eligible for the benefit.
It is worth mentioning that ALTCS contracts with care providers all along the healthcare continuum. There are approved in-home care providers, group homes, day care centers, assisted living facilities and skilled nursing facilities. Further, it is not as if there is a clear demarcation between ALTCS and non-ALTCS facilities — all ALTCS facilities also have non-ALTCS residents; and ALTCS members are given the same level of treatment and care as others.
If the only thing preventing your wife from qualifying for ALTCS is this setting requirement, it would certainly be worth considering moving to an approved setting to help facilitate eligibility. You have many good options available to you, and this benefit is too valuable to forgo.
Richard White is an elder law attorney at JacksonWhite Attorneys at Law. For more information on Elder Law at JacksonWhite, please visit www.ArizonaSeniorLaw.com.
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