Arizona Assisted Living and In Home Care Medicaid Waiver Information and Rules for 2017

Introduction

Arizona provides long-term care resources to seniors through the Arizona Long Term Care System (ALTCS). ALTCS is an Arizona Medicaid program that is designed to help fixed income seniors and other disabled individuals afford the care that they need. ALTCS pays for the care that you need after savings are exhausted. The program requires an application and typically takes between 60 and 90 days for approval. The Arizona Long Term Care System provides the following services:

Assisted Living

ALTCS pays for care at assisted living communities that choose to contract with one of the ALTCS plans. Assisted Living is a great option for those seniors that need daily care and assistance. Assisted living communities provide daily personal care to their patients, making sure they bathe, take medications, and eat three meals a day. Assisted living communities offer the opportunity to socialize with other residents and participate in activities. They keep residents active and engaged. Many residents of assisted living communities find it preferable to their lives alone at home after a time. In addition to the care that they provide for their residents, assisted living also provides community and social connection that many isolated seniors lack in their home lives.

Residential Care Homes

Residential care homes are a great option for many ALTCS patients. Also called group homes, these are typical family homes in neighborhoods that have been renovated house 5-10 residents in a small community. Residential care homes are a more flexible and affordable option than larger facilities. They provide around the clock care to their residents and caregivers frequently live on site with the residents. They are always available to the residents at the homes.

In Home Care

Many seniors and younger people with disabilities would prefer to remain in their home and receive their care there. A number of in-home care agencies can provide services to seniors and disabled individuals living in the home. Unfortunately, ALTCS does not cover in home care in all circumstances.

Skilled Nursing

For those who need 24 hour care for persistent acute medical conditions, skilled nursing facilities may be a good option. Skilled nursing provides around the clock care from licensed medical professionals. Some seniors may have need for skilled nursing when they are rehabbing from injury. Many skilled nursing stays are temporary and last for only a few weeks. While many people don’t like the hospital-like environment that comes with skilled nursing, it is the only option for those who need robust medical care on a day-to-day basis for an extended period of time.

Medicaid Waiver Program for Assisted Living and In Home Care

Arizona Health Care Cost Containment System (AHCCS) (Arizona Medicaid Section 1115 Demonstration Waiver)

The demonstration provides health care services through a prepaid, capitated managed care delivery model that operates statewide for both Medicaid state plan groups as well as demonstration expansion groups. The goal of the demonstration is to test health care delivery systems to provide organized and coordinated health care for both acute and long term care that include pre-established provider networks and payment arrangements, administrative and clinical systems for utilization review, quality improvement, patient and provider services, and management of health services. The demonstration will also test the extent to which health outcomes in the overall population are improved by expanding coverage to additional needy groups.

Services

Services include: Acute Hospital Admission; Adult Day Health Services; Attendant Care; Behavioral Health Services, Community Transition Services, Medical Supplies, Emergency Alert, Habilitation, Home Delivered Meals, Home Health Agency Services, Home Modifications, Home Maker Services, Hospice Services, Medcial Care Acute Services, Nursing Facility Services, Personal Care, Respite Care (in home), Respite care (institutional), Therapies, and Transportation.

Eligibility

  1. Health: Must require a Nursing Home Level of Care
  2. Financial: Applicants must meet certainincome and asset criteria to be eligible under the AHCCS. For 2017, the prior HCBS recipients follow a Special Income Limit (SIL) of up to 300% of the Federal Benefit Rate, which allows for a monthly income of $2,205 for an individual. The asset limit for an invidiaul is $2,000 (or $3,000 for a couple).

Practical Considerations

The new AHCCS waiver should provide more options to seniors for accessing in home care and assisted living resources. For 2017, the limit on expenditures for seniors over 65 receiving services is $6,016.98 and increases to nearly $7,000 by 2021.