I was lucky enough to attend a workshop with Jackson White Elder Law Attorneys last week and I learned a lot more about ALTCS (Arizona Long Term Care Systems) ALTCS is the long term part of AHCCCS (Arizona Health Care Cost Containment System) which is the Arizona Medicaid System. AHCCCS is the acute care plan which covers the same things as Medicare. Doctor appointments, medically necessary equipment etc. ALTCS goes beyond AHCCCS services in providing services such as housekeeping, home delivered meals (NOT MEALS ON WHEELS, although the same principle, MOW is a trademark and only THEY can use it, HDM is general which all other services can use).They also provide shower chairs, toilet risers, bedside commodes, attendant care for up to 40 hours a week and a family member or friend can become the paid attendant. There also is transportation for doctor appointments. And they pay for contracted group homes, assisted living centers and skilled nursing facilities for long term care. They also have a case manger for every member which helps in navigating the system and helps you remain independent as long as possible. A person must meet two standards prior to being accepted. First, the person has to meet the medical need. That specifically states that a person HAS TO BE AT RISK OF BEING IN A NURSING HOME. That does not mean they have to GO to a nursing home once on the program, just that if they did not have the In Home care, they would be at risk to go there. Second, the person has to meet financially. The monthly income cannot exceed $2199 per month (spouses income does not count) and they cannot have more than $2000 in tangible assets, meaning those you can quickly get cash from, such as retirements, CDs, stocks, bonds, IRAs, savings and checking. Even if taking money out means a hefty penalty, the state does not care. You must consider them as cash assets. Now, here comes the fun part. If you have a community spouse that is NOT going to be applying for ALTCS, They can keep up to $119,220 for their living in the community. Anything more is considered the assets of the ill spouse and has to be spent down to meet the $2000 mark. So what does this mean? Well, for example, you and your husband have $200,000 in assets, (IRAs and Your retirement account,as this is a community property state, that is considered the ill spouses asset as well). With the community spouse resource allowance (CSRA) you can keep $119,220 and then you would have to spend down $80,780 to $2,000. Some items you can purchase with that can be a car, if needed. Maybe a van that can accommodate a wheelchair, or a fancy wheelchair with all the bells and whistles. You can remodel your home to accommodate a disabled person or fix your roof, on the primary home where the ALTCS member will live. You can even hire your own caregiver out of pocket. There are many ways to do this, but if you are working with that much money, its best to seek legal advice. Those fees can be included in the spend down! yea! The second item which is very important is that if ALTCS candidate has more than $2199 as an individual (spouse does not count) there is an (Income only Miller Trust). What this means is that the total income for that individual goes into a trust and the candidate gets to keep $2199 for their community living expenses. The remainder stays in the trust and is eventually captured by either the health plan that is going to provide services or the state. Each county does it differently. For example, your income is $3000 per month, you get $2199 to continue to pay your bills and $801 goes into the trust and is applied toward the cost of your care. This is worth the loss as in home care, not even skilled, can cost $22 per hour at the minimum. If you are considering 10 hours a week at that rate, youd spend much more as ALTCS would pay for that care and also cover your co pays, any extra equipment not covered by medicare or AHCCCS. With that said, if you have a lot more than $1000 over income, it might not be a good choice to go onto ALTCS unless you are in a facility as they can be more than 6K per month. For example, youre monthly income is 5K per month, and you need a skilled nurse 3 times per week at $200 per hour, an attendant care worker for $40 per hour. Your out of pocket would be over 5K if you paid privately. Whereas: with ALTCS you would keep $2199 and $2801 would go into the trust to be used at some point to pay for all that care. Now THAT is worth the time. Here is where it gets good!! For example your husband has dementia and right now he is ok home. You are able to redirect him and he is pleasant and cooperative. You can still function well. You are thinking maybe its not worth putting money into the Miller Trust as your husbands income is 5K. Unfortunately, we know that he will decline and you know he will need a group home or memory care center at some point in the future. By getting enrolled in ALTCS and having to put the $2801 into the Miller Trust, you are ensuring that you will not have to pay the cost of a residential placement when that time comes. Those placements can range from 6K to 20K per month depending on the level of care needed. If you decide to wait until that time, you could be waiting for months before he gets on ALTCS and approved and will have to pay out of pocket for those months, until approved for ALTCS. Now the scary part. There are many rumors that if you get on ALTCS the state will take your home. This is not always the case and, in fact, rarely happens. If there is a community spouse and their name is also on the deed, they will not take a lean against the home. If there is a family member that lives with you, and they have provided your care for at least 2 years and with that, prevented you from going to a nursing home, they will not put a lean against the home. If you have a community spouse who is NOT on the deed, they will place a lean, but have never acted on that lean and will not act on that lean. The house remains with you. If you are single, own the home and provided care by ALTCS, they will only place the lean based on the amount they have spent for your care. For example you were on ALTCS for one year and die. ALTCS has computed that they spent $40,000 in your care. Your house sells for $200,000. They only will receive $40,000 and your estate receives the remaining $160,000. YEA! not as bad as we thought! So, that was lengthy but I think covers some of the basics. There is much more that can be involved depending on the potential members circumstances. I highly recommend seeking advice from JACKSON WHITE ELDER ATTORNEY if there are other situations which might make you ineligible. They are highly skilled and a social worker will screen your case before you even get an appointment with a lawyer. This way they can guide you and get a lawyer involved if needed. You can visit their website at Arizonaseniorlaw or call 1-800-243-1160.
Posted on: Tue, 27 Jan 2015 16:21:15 +0000