How to Apply for ALTCS in Arizona, Get Care at Home, and Appeal a Denial

You can apply for ALTCS (Arizona Long Term Care System) online through Health-e-Arizona Plus, by calling ALTCS at 888-621-6880, or through an ALTCS office. After you register, AHCCCS runs a financial interview and a medical assessment called the Pre-Admission Screening (PAS). If the answer is no, you have 35 calendar days from the date on the decision letter to ask for a hearing. Available 24/7 • Free confidential consultations • (480) 725-2257

Two tests: money and medical need

ALTCS is Arizona’s Medicaid long-term care program, run by AHCCCS. The applicant has to pass two separate tests, and failing either one means a denial.

• The financial test. Income and countable resources have to be under the program limits. AHCCCS’s How to Apply page currently lists $2,982 a month in gross income and $2,000 in resources for a single applicant. Details are on our ALTCS eligibility page, and married couples are covered on our community spouse page.
• The medical test. The applicant has to need the level of care given in a nursing facility (or, for a person with a developmental disability, an intermediate care facility). This is measured by the PAS.

How to apply for ALTCS: the three ways to start

AHCCCS calls the first step “registering” an application. A family member or other helper can assist with it.

The HEAplus registration can’t be saved halfway and times out after 15 minutes of inactivity, so have the applicant’s name, date of birth and addresses ready. After you register, a financial worker and a medical worker contact you to complete the two interviews.

Forms and documents you will be asked for

AHCCCS’s HEAplus guide lists two forms to send after you register, by upload, fax or email with the application number. More forms may follow after the financial interview.

• DE-200, Release of Information. Lets AHCCCS contact banks, doctors and others.
• DE-112, Authorized Representative. Needed when someone is helping the applicant with the process.

After the financial interview, the worker sends a Request for Information listing the proof still needed. Expect questions about income, bank and investment accounts, real estate, vehicles, life insurance, burial plans, trusts, and money or property given away in the past five years. AHCCCS checks home values against county assessor records.

Each request has a due date, and AHCCCS policy says the application will be denied if all the proof is not received by then. The worker is supposed to explain how to ask for a due date extension if you need more time.

The Pre-Admission Screening (PAS): what it measures

The PAS is the medical half of the application. An AHCCCS assessor, who is a registered nurse or social worker, completes it in person, by phone or virtually, using medical records and interviews with the applicant and family.

For an applicant who is elderly or physically disabled, AHCCCS’s PAS criteria look at three areas:

1. Function. Help needed with mobility, transferring, bathing, dressing, grooming, eating and toileting, plus continence and communication or sensory problems.
2. Emotional and cognitive. Orientation and behaviors such as wandering, aggression, resisting care, self-injury and disruptive behavior.
3. Medical. Conditions that affect function, conditions that need nursing care, medications and treatments, and services already in place.

The functional and medical scores are added together. For an elderly or physically disabled applicant, a total of 60 or higher means the person is considered at immediate risk of institutionalization, which is the ALTCS standard. A physician consultant reviewer can also find that a person meets it. Separate criteria apply to people with developmental disabilities.

How long an ALTCS decision takes

AHCCCS’s application processing policy measures time from the application date to the date the decision is made and sent. The table sets 45 calendar days for “all other programs” and 90 calendar days for certain disability-based programs. It does not name ALTCS directly, so treat these as general standards, not a promise. The period can be extended when a disability decision or a policy clarification is pending, or when the applicant asks for a one-time five-day extension to get proof.

Can ALTCS pay for care at home?

Yes. AHCCCS lists three settings where ALTCS members can get care: their own home, an AHCCCS certified nursing facility, or an assisted living facility. Care outside a nursing facility is called Home and Community Based Services (HCBS).

Under A.R.S. 36-2939, HCBS for ALTCS members can include:

• Personal care. Help with essential physical needs inside the home.
• Homemaker services. Help with household tasks.
• Home health. Home health services and home health aide services.
• Respite care. Short-term care so a family caregiver can get a break.
• Adult day health. Supervised daytime care and activities outside the home.
• Home delivered meals and transportation.

Who qualifies for in-home care through ALTCS? These services are for ALTCS members, so the applicant still has to pass both tests, including the nursing facility level of care on the PAS. After approval, the amount and type of in-home help is based on the member’s needs and a cost effectiveness study done by the member’s case manager.

Common reasons ALTCS applications are denied

• Income over the limit with no income-only trust. When gross income is above the limit, AHCCCS policy allows an income-only trust (often called a Miller trust). Only the applicant’s income can go into it, and the full gross amount of each assigned income source has to be deposited. Setup or funding mistakes can cause a denial.
• Assets over the limit. Countable accounts, investments and some property exceed the resource limit.
• A transfer penalty. AHCCCS looks back 60 months from the month of application for gifts or sales below market value. Under AHCCCS policy, an applicant who meets every other rule gets a limited ALTCS package during the penalty period, and cannot get long-term care services during that time. See our five-year lookback page.
• Failing the PAS. The score came in under the threshold.
• Missing paperwork. Proof was not received by the due date on the Request for Information.

What an ALTCS denial letter should contain

AHCCCS policy on written decision letters says a denial letter must include:

• The type of benefit denied
• The effective date of the denial
• The reason for the denial
• The legal references that support it
• The date by which a fair hearing must be requested
• If income or resources were over the limit, how those amounts were calculated

Read the calculation closely for an account that should not have been counted or a wrong value. Note the date printed on the letter, because the appeal deadline runs from that date, not from the day you opened the mail.

How to request an ALTCS fair hearing

Under AHCCCS’s eligibility appeal policy, the appeal request must be received by the 35th calendar day after the date on the decision letter. If that day falls on a weekend or state holiday, the deadline moves to the end of the next business day.

1. Send the request by mail, in person, by phone, by fax or by email. ALTCS customers cannot currently appeal through HEAplus, and you don’t have to use the form that came with the letter.
2. Include the basics: the applicant’s name, the decision being appealed, and the reason for the appeal.
3. Keep proof of the date. A mailed request counts on the day AHCCCS receives it, not the day you mail it, which is why many people use fax or email close to the deadline.
4. Get the authority paperwork right. If the applicant is incapacitated and the person appealing has no legal authority, AHCCCS needs a DE-112 Authorized Representative form and a DE-217 Physician Statement of Incapacity in the file.

A late request is denied, but you can ask for a good cause hearing. AHCCCS lists illness or never receiving the decision letter as examples of good cause. Some families instead fix the underlying problem, such as setting up an income-only trust, and file a new application.

Do benefits continue during an ALTCS appeal?

A first-time applicant has no coverage yet to continue. For someone already on ALTCS whose coverage is ending or whose share of cost is going up, AHCCCS examples show that an appeal filed before the change takes effect keeps the current coverage or share of cost in place during the appeal. AHCCCS generally has to send that notice at least 10 days before the first day of the month the change takes effect, so the window to appeal before the change takes effect is short.

When families bring in an elder law attorney

Many families file ALTCS on their own. Families most often bring in an Arizona elder law attorney at two points:

• Before applying, when income is over the limit and an income-only trust is needed, when savings are over the resource limit, when there were gifts or property transfers in the past five years, or when one spouse will stay at home.
• Right after a denial, because the hearing request has to be received within 35 days.

A durable power of attorney can let a family member act for a parent during the application. Without one, families sometimes need a guardianship or conservatorship first.

Frequently asked questions

Can I apply for ALTCS for my mother?

Yes. A family member can register the application online, by phone at 888-621-6880, or at an ALTCS office. If you are handling the case, AHCCCS asks for a signed DE-112 Authorized Representative form.

How long do I have to appeal an ALTCS denial?

AHCCCS must receive the appeal request by the 35th calendar day after the date on the decision letter. If that day is a weekend or state holiday, it moves to the next business day. A late request can only go forward if AHCCCS finds good cause.

Can someone fail the PAS score and still get ALTCS?

A physician consultant reviewer can also find that a person meets the medical standard, so the score is not the only route. If the score seems wrong, the denial can be appealed like any other.

Will ALTCS pay for assisted living?

ALTCS can pay for care services in an assisted living facility. AHCCCS does not cover room and board there, so the resident usually pays rent and meals separately.

What if my parent gave money to family in the last five years?

AHCCCS reviews transfers made in the 60 months before the month of application. A gift for less than fair value can create a penalty period with no long-term care coverage, even when the person is otherwise eligible.

Related guides

• Arizona elder law and ALTCS overview
• ALTCS income and asset limits
• The ALTCS five-year lookback
• Protecting the community spouse
• Arizona durable power of attorney
• Guardianship for an aging parent

Disclaimer: Arizona Estate & Family Law Resource Center is an independent legal referral service, not a law firm. We do not provide legal advice and do not employ attorneys. No attorney-client relationship is created by contacting us or submitting a request through this website. All attorneys in our referral network are independent licensed professionals. Verify attorney credentials through the State Bar of Arizona.