What Are The AHCCCS Income Limits to Received Medicaid in Arizona?

Table of Contents

·         1 Points to Keep in Mind on Medicaid Eligibility

·         2 How Working With an Attorney Can Help

·         3 FAQs on Medicaid in Arizona

·         4 What to Do if You Need Help

·         5 Need Help Applying for ALTCS in Arizona?

The Medicaid program in Arizona is called AHCCCS (the Arizona Health Care Cost Containment System). AHCCCS is jointly federal and state funded and helps to support low-income individuals who are younger than 65 (though some who are older might be eligible). You might qualify for benefits through this program if you earn 138 percent of the FPL (Federal Poverty Level) or less. As of 2019, this is $35,535 for a household with four family members and $17,236 for an individual.

If you’re over 65, you’ll need to apply for Medicaid benefits through the ALTCS (Arizona Long Term Care System). Unlike other Medicaid services, which place a limit on how many participants can enroll, ALTCS offers benefits as an entitlement. In other words, if you meet the requirements for eligibility, you can access services.

The income and asset limits for ALTCS is can be tricky to navigate. We’ll go into detail on that soon, in addition to ways you can qualify even if you don’t meet the requirements.

Points to Keep in Mind on Medicaid Eligibility

·         AHCCCS typically covers state residents who are younger than 65

·         Residents who are older than 65 or disabled should apply for ALTCS

·         If you have children, they may be entitled to Medicaid services, too

·         The application processing period is usually between 60 and 90 days

·         If you don’t meet the financial requirements for ALTCS, a lawyer might be able to help

AHCCCS for Arizona Residents

When you apply to receive AHCCCS benefits, an associate will review your application and help you figure out which Medicaid coverage is best for your situation. To qualify for AHCCCS, you usually must be younger than 65 (though you can be 65 or older if you’re the caretaker or parent of a child). You must be either on Medicare as a pregnant woman or caretaker/parent of a child or be ineligible for Medicare services. You also need to earn below a certain limit and be a citizen of the U.S. or a qualified noncitizen.

Income-based AHCCCS will count most of the unearned and earned income you have. Some income doesn’t count, though, such as Supplemental Security Income. 

Medicaid for Disabled and Elderly Residents

ALTCS is a state Medicaid program that can help certain individuals afford their medical care. This system provides specifically for the long-term medical needs of qualifying disabled, blind, or aged residents in the state. This program pays for the services you require once you’ve already exhausted your savings. To qualify, you must undergo a financial assessment to determine whether you are able to cover the costs yourself. The next component is a functional assessment to determine your current medical state and care needs.

The financial eligibility requirements to receive ALTCS benefits can be complicated and will be affected by whether or not you’re married. As a single applicant, you can earn $2,313 or less in monthly income to qualify. If you’re married and applying for benefits on your own, your income is limited to the same amount and your spouse’s income doesn’t count. If you and your spouse are applying for ALTCS together, you may not earn more than $4,626 monthly.

If your income is higher than these numbers, don’t let that deter you from pursuing ALTCS services. You might still be able to qualify for benefits by using a Miller Trust. Like other trusts, this type of trust must be legally sound in order to be considered valid.

How Working With an Attorney Can Help

Getting approved for AHCCCS benefits can prove tricky for some people. Many residents are denied ALTCS benefits because they have too many resources to meet the eligibility requirements. Fortunately, this doesn’t mean that you can’t qualify later once you do. You may be able to get around being over the resource limit by “spending down” on your assets in order to meet the financial requirements. 

However, the way you go about this is extremely important. Working with a lawyer can ensure that you spend down in the way that will increase your odds of approval.

FAQs on Medicaid in Arizona

Here are some common queries that applicants may have about Medicaid services in the state:

Q: Will I owe any costs if I get Medicaid services?

For most of your needed medical services, you’ll either cover a small copayment when you visit a medical professional or pay nothing. In most cases, you’ll just have to show your coverage card to prove you have Medicaid and the state will pay your doctor for the costs.

Q: Can I get coverage for my children’s medical needs?

Medicaid and a program called CHIP (the Children’s Health Insurance Program) work together to offer low-cost coverage to Arizona residents with children. If your income meets the eligibility requirements, your children can access these services. If you give birth while you’re covered by Medicaid, your child will also automatically be enrolled for the first year of their life.

Q: What factors can slow down the processing period for my application?

To qualify for the program, you must submit your application, which can take up to 90 days to get approved. Your application processing period might take longer than average if your income is too high for eligibility in the month you apply and the month after but might be low enough during the third month. If more proof is needed to determine your eligibility, or you request extra time to gather the necessary documents, your processing period might also be longer than 90 days.

What to Do if You Need Help

The Medicaid application process can be complex, and many applicants are denied coverage each year. Thankfully, even if you’ve been denied before, all hope is not lost. Give us a call so we can work with you to apply and give you a better shot at approval for AHCCCS benefits. We also might be able to help you appeal the decision if your application for help with medical coverage was previously denied. Speak with one of our Elder Law attorneys today.

Need Help Applying for ALTCS in Arizona?

If you need help setting up Medicaid, speaking with a lawyer is a good place to start. The application process itself can be complex and confusing, and making mistakes can set you back in attaining benefits and services. If your situation is complicated or you need help meeting the eligibility requirements, one of our attorneys can answer your questions.
 

Contact the JacksonWhite Elder Law team today at (480)467-4337 and learn how we can help to ensure you receive the maximum ALTCS benefits available, while preserving as many of your assets as possible.

ALTCS Enforces Travel Limitations

Q: My husband and I live in Arizona, but most of our family lives out-of-state.  Like many other couples of our age, we like to spend our summers in cooler climates, so we typically stay with our son, who lives in another state, for about four months of the year.  If I apply for the ALTCS program, will ALTCS have any problems with me maintaining this type of a travel schedule?

I should preface this response by reminding you that ALTCS imposes a very strict medical requirement on its members.  As such, if you are healthy enough to maintain a rigorous travel schedule, even spending summers out of state, it could be that you are also too healthy to qualify for the ALTCS benefit.  Of course, being too healthy for ALTCS implies that you do not need long-term care, and will thus not have the associated expenses.  All in all, then, being too healthy for ALTCS should not be too distressing.

As to the question on hand, ALTCS does have a limit on the number of days for which its members can leave the state without losing eligibility, and this limit is 60 days.  The rationale here is certainly not to prevent interstate travel; so much as it is to ensure that ALTCS members are receiving the care that they presumably require.  Again, ALTCS provides long-term care coverage only to those individuals who actually require long-term care.  At least to all outward appearances, an individual who is well enough to forego care for months on end while out-of-state is presumably without a genuine need for long-term care.  At a certain point in time, then, for coverage reasons as well as for general well-being reasons, it will make sense for you and your husband to settle upon one state of residence.

Aging and the Law is authored by the attorneys at JacksonWhite and addresses legal issues that arise for the elderly and their families.  Questions can be sent to firm@jacksonwhitelaw.com.

Click to view all of our Aging and the Law columns.

When To Start Planning for ALTCS?

Our latest Arizona Republic article in the weekly Aging and the Law column can be found below. Our column runs every Friday in select Arizona cities.

Q: A couple of weeks ago, my father suffered a fairly severe stroke.  After a brief hospitalization, he was transferred to a skilled nursing facility for rehabilitation.  He is making strides in his therapy, but we don’t know if he will fully recover.  Without this knowledge, how can I determine when to prepare for the ALTCS program?

I am assuming that your father’s care is currently covered by Medicare.  By design, however, Medicare covers only acute care, or that care which is rehabilitative in nature.  For as long as your father is showing marked improvements, then, his Medicare coverage could remain in effect for up to 100 days.  More specifically, Medicare could cover the first 20 days without co-payment, and days 21-100 for a co-payment of just over $150 per day.  Importantly, once it is determined that your father’s health has plateaued, and that he has transitioned from acute care into long-term care, Medicare coverage will end.

Once Medicare coverage ends, your father will have a few options.  If he is well enough, he can return home and resume his previous way of life.  If his health has not returned by this point in time, however, he will have to pay privately or seek an alternative payer source.  If your father has substantial long-term care insurance, then this could provide a solution, but without such coverage, ALTCS might be his only viable option.

Given the huge expenses associated with long-term care, it makes most sense to hope for the best, but plan for the worst.  By this, I am suggesting that the time to begin considering the ALTCS program for your father is now.  Each application process is fact-dependent, but it can sometimes take several months or more to gain access to the benefit, so planning while Medicare is still in effect can be very advantageous.

Aging and the Law is authored by the attorneys at JacksonWhite and addresses legal issues that arise for the elderly and their families.  Questions can be sent to firm@jacksonwhitelaw.com.

Click to view all of our Aging and the Law columns.

For additional information visit our website at www.arizonaseniorlaw.com