Arizona Long Term Care System
​
ALTCS Financial Requirements

Financial Eligibility
ALTCS applicants must meet the following general criteria before ALTCS will begin the financial assessment:

• Applicants must be a U.S. citizen or a legal alien.
• Applicants must be an Arizona resident, with intent to stay in Arizona.
• Applicants must have a Social Security number.
• Applicants must make an effort to secure potential primary benefits.
• Applicants must reside in a medical institution, approved home and community based setting, or at home in need of care.
• Applicants must be willing to assign their rights to medical benefits.
• (Note: This is so ALTCS can verify all insurance coverage available to ensure ALTCS is payer of last resort.)
• Applicants must be cooperative and provide verifying documents to ALTCS which can be a long process.

The financial requirements are much more complex than the general eligibility criteria, and it is not uncommon for applicants to struggle with this portion of the eligibility process. Applicants who pay strict attention to detail and successfully demonstrate that they do not exceed the income and asset limits, however, many can complete this portion of the process on their own. Nevertheless, many applicants reach out to professionals who can help them arrange their financial affairs.
​
The financial assessment involves a close inspection of applicants’ income and assets with a five (5) year look back period of all assets, both of which must fall below a specified amount. Importantly, income and asset limits are based on an applicant’s marital status. Rules are quite different for married and single applicants.

Income
Whether applicants are married determines the amount of income they can receive under ALTCS rules. Single applicants cannot have more than $2,250 monthly income. Likewise, married applicants applying for the benefit alone are limited to $2,250 monthly income, and their spouse’s income is not considered. Married applicants applying together, however, can have up to $4,500 monthly income under ALTCS rules. These limitations are effective for 2018, and are reviewed each year. An ALTCS experienced Elder Law attorney should be able to help individuals be successful with their applications and obtain eligibility.

Individuals who would like to apply for the ALTCS benefit, but whose income is too high, might be able to establish a Miller/Income-only trust to help them qualify. Like other types of trusts, Miller/Income-only trusts must comply with strict legal formalities to be valid. Applicants whose income exceeds the limit should consult with a professional for guidance about whether this strategy could help them qualify. The fear of being over the income limit shouldn’t keep individuals from applying for ALTCS. There are ways to help.

Resources
Whether applicants are married also determines how many resources ALTCS allows them to have. Single applicants can have no more than $2,000* in countable resources. Married couples can have more. Importantly, ALTCS looks only at countable resources when determining eligibility, which means that the following types of assets are excluded:

• One home: The home must be the applicant’s principal place of residence, and cannot have equity value exceeding $525,000. Applicants living in a nursing home when they apply may have to demonstrate their intent to return home.
• One vehicle: The vehicle’s value cannot exceed $4,500 for a single applicant. There is no limit for a married applicant.
• Life insurance: If the total face value of all policies owned by an individual exceeds $1,500, the cash value is countable.
• Burial plots.
• Irrevocable prepaid funeral plans.

Countable assets, on the other hand, include all money and property that can be valued and converted into cash. More specifically, countable assets include:

• Cash, checking, and savings accounts.
• Certificates of deposit.
• U.S. savings bonds.
• Retirement accounts, including IRA, 401K, and TSA.
• Nursing home accounts.
• Revocable prepaid funeral contracts.
• Assets in Trusts.
• Real estate other than the primary residence.
• Additional car.
• Boats and recreational vehicles.
• Stocks, bonds, and mutual funds.
• Promissory notes.

Married couples might be able to arrange their affairs to minimize their countable resources. Doing so can help them keep more assets for the well spouse, while helping the other qualify for the ALTCS benefit.

The time for couples to make these arrangements is well before the financial assessment, as this could minimize potential delays in eligibility. While ALTCS rules are complex, single applicants with less than $2,000 in countable resources and less than $2,250 of monthly income generally qualify for the benefit, so long as they also meet the medical requirements. Of course, the case for eligibility is not always clear and simple, so many applicants can benefit from seeking professional guidance with their ALTCS application. One doesn’t need to spend down to their $2,000 resource limit before beginning the planning process.

ALTCS Resource Worksheet

Financial Relief Available For Well Spouses
Spouses of ALTCS applicants obviously need to keep enough resources to remain financially secure. And, to further this interest, ALTCS allows for a Community Spouse Resource Deduction (CSRD), which essentially sets a portion of a couple’s assets aside for a well spouse. If not for the CSRD, spouses would be forced into poverty before their husband or wife could qualify for the ALTCS benefit.

The CSRD allows well spouses to keep one-half of the couple’s countable resources, up to a certain amount. As such, a couple with $100,000 in countable resources could keep $50,000 for the well spouse. There is a minimum and maximum threshold, however, so the CSRD has certain guarantees and limitations. The minimum CSRD is $24,720. On the other hand, regardless of how many assets a couple has, the maximum CSRD is $123,600. The rules state the well spouses cannot keep more than this amount even if it is less than half of the couple’s total assets. However, an Elder Law attorney can use policy and federal regulation to protect assets.

Spend Down
It is not uncommon for ALTCS to deny benefits to applicants on account of having too many resources. ALTCS applicants whose resources exceed the limit are not precluded from qualifying at a later date. Rather, they might be able to spend down their countable resources and qualify for the benefit once they satisfy the financial requirements. Of course, prospective ALTCS applicants should never spend frivolously just to satisfy ALTCS requirements. Neither should they give their resources to family members in an attempt to meet ALTCS requirements, as gifts are penalized with a period of ineligibility. Instead, prospective ALTCS applicants should strategize with an Elder Law attorney who can prepare them to meet the ALTCS resource requirement with as little delay as possible.

ALTCS applicants can sometimes expedite their eligibility by spending excess countable resources on certain exempt resources, a process known as spend down. Because ALTCS penalizes applicants for making unauthorized transfers, however, they should be extremely cautious here. ALTCS currently looks back five years from the date of application, and questions any transfers without value, or gifts. Applicants who make gifts within this five-year window are likely to be penalized with a period of ineligibility. In short, applicants cannot simply give away excess resources in an effort to become eligible for the ALTCS benefit.

Once Approved for the Benefit – The Redetermination Process
The ALTCS benefit does not last indefinitely so members must undergo a redetermination process every year. In essence, this requires them to prove their medical and financial circumstances still satisfy ALTCS requirements. While a redetermination is not as complicated as an original application, it nevertheless requires ALTCS members to produce verifiable documentation that they meet financial and medical tests. ALTCS members can lose their eligibility at the redetermination for a variety of reasons. For instance, an inheritance or a settlement, or the selling of one’s house might push their assets above the allowable limit, and cause ALTCS to discontinue the benefit. With proper planning, however, even members who receive substantial assets might remain eligible for the benefit.