Arizona Long Term Care System
Medicaid / ALTCS Share Of Cost
When a person is on Medicaid / ALTCS (Arizona Long Term Care System) they are obligated to “pay what they can” for their care. The state recognizes that the member may need their income when they reside at home. Therefore, the state allows the member to keep their income to help pay for the costs to live and receive services while residing at home. (Rules may not allow for this if the member has an Income Only Trust.)
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However, when the member is in a residential setting like a skilled nursing center, or an assisted living facility, the member must pay a “share of the cost” for their services. Arizona calls the amount paid towards care different depending on the type of setting the person lives in, but the amount is evaluated generally the same way.
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The share of cost/room and board amount varies from person to person. The amount primarily depends on the amount of the recipient’s monthly income and whether the recipient is married. Generally speaking, single applicants pay the facility all of their monthly income, less insurance costs, and a lesser Personal Needs Allowance (PNA) of $110.25 as the amount due for their care.
With married applicants, the calculation is somewhat more complicated.
Medicaid / ALTCS has adopted the policy that a community spouse is entitled to a monthly income of at least $2,003. If the community spouse’s income falls short of this amount, the community spouse can draw from the applicant spouse’s income to bring his or her income up to $2,003. The applicant spouse then takes a Personal Needs Allowance of $110.25, and any remaining monthly income goes to the facility. Also, if the community spouse pays their own utilities, ALTCS allows the community spouse to take an additional allowance based on the amount paid out.
An example of this is:
Well-spouse makes $500/month
Ill-spouse makes $1,800.00/month
Well-spouse makes $500/month
Ill-spouse makes $1,800.00/month
If the ill spouse goes to the nursing home, the well-spouse can keep $1,503 from ill-spouse’s income, and the ill spouse gets $110.25. Therefore, the share of cost would be assessed at $186.76.
PNA $2,003 - $500 = $1,503 ($1,503 is what the well spouse keeps)
$1,800 - $1,503 = $297 ($297 of ill spouse left after well spouse deduction)
$297 - $110.25 = $186.76 ($186.76 is what is left for the "Share Of Cost" this is paid to health care provider)
After the "Share Of Cost" is determined and paid to the facility or care provider, Medicaid/ALTCS will then pay the difference between the "Share Of Cost" and the amount agreed upon for that service (Medicaid creates the total dollar amount for type of service provided they are willing to pay) Not all care providers are contracted with Medicaid / ALTCS.
PNA $2,003 - $500 = $1,503 ($1,503 is what the well spouse keeps)
$1,800 - $1,503 = $297 ($297 of ill spouse left after well spouse deduction)
$297 - $110.25 = $186.76 ($186.76 is what is left for the "Share Of Cost" this is paid to health care provider)
After the "Share Of Cost" is determined and paid to the facility or care provider, Medicaid/ALTCS will then pay the difference between the "Share Of Cost" and the amount agreed upon for that service (Medicaid creates the total dollar amount for type of service provided they are willing to pay) Not all care providers are contracted with Medicaid / ALTCS.
Paying share of cost is an important part of a member’s responsibility of receiving this benefit. Considering that the average cost of skilled nursing care in Maricopa County is more than $6,400 per month, even applicants with relatively high incomes still have much to gain from qualifying for Medicaid / ALTCS.
Also take into considerations that there are limited resources and providers that actually contract with Medicaid / ALTCS, for reimbursement of services.
Also take into considerations that there are limited resources and providers that actually contract with Medicaid / ALTCS, for reimbursement of services.
