ALTCS, in plain English
ALTCS (the Arizona Long Term Care System, run by AHCCCS, Arizona's Medicaid agency) pays for long-term care for people who need it and can't afford it. It can cover care in an assisted living community, in a small care home, in a nursing facility, or at home. Here's how it actually works, and what we do to help, free, with no fee to anyone.
Who qualifies
Two tests, both must pass:
- Medical: the person needs a "nursing facility level of care", meaning roughly that they need hands-on help with daily living or supervision because of a condition like dementia. A state nurse or social worker assesses this in person (the "PAS", Pre-Admission Screening). It's a conversation and a look at the person's needs, not a test you can fail by having a good day.
- Financial: limits on income and on countable resources (savings and investments, but not the home they live in, one car, or personal belongings). The income limit is tied to the federal SSI benefit (about three times it) and rises each January; for 2025 it was $2,901 a month for a single applicant; the countable-resource limit for a single person is $2,000. AHCCCS publishes the current numbers; we'll tell you the figure in effect when you call.
Married? The spouse who stays home keeps a protected share of the couple's resources and income (the "community spouse" allowances). Don't assume a married couple doesn't qualify; many do.
"Our income is over the limit"
That is usually fixable, and it's the most common reason families give up too early. Arizona allows anincome-only trust (often called a Miller trust): the excess income goes into the trust each month and is used toward care, and the person can qualify. An elder-law attorney sets one up; it is routine.
"Too many assets" is a different situation: that's a spend-down over time, and it has rules (a five-year look-back on gifts, for instance). If that's you, we'll say so plainly and point you to an elder-law attorney rather than pretend ALTCS is around the corner.
What ALTCS covers in assisted living
- The care (help with daily living, supervision, nursing oversight) in a community that has an ALTCS contract. Not every community accepts it; many small homes do.
- The member still pays a room-and-board share from their own income (most of it), keeping a small personal-needs allowance. Families sometimes cover a gap.
- Also: in-home services, adult day health, medical equipment, and nursing-facility care when that's what's needed.
How to apply
- Call the ALTCS office for Maricopa County or apply online through AHCCCS (we'll give you the current number and link; they change occasionally, so we keep them on hand rather than printing them here).
- Gather paperwork: ID, Social Security and Medicare cards, income statements (Social Security award letter, pension), bank statements (several months), any insurance, the deed if there's a home, and power of attorney if someone is applying on the person's behalf.
- The medical assessment (PAS) is scheduled by the state.
- Timeline: usually several weeks to a couple of months. Start before you think you need it, especially if a hospital discharge is coming.
What we do, and what it costs you (nothing, ever)
If ALTCS is the path, we give you a direct shortlist of communities that accept it and the application pointer, and we stay available while you work through it. There is no referral fee on ALTCS placements; communities pay us nothing for them, and we'd tell you if they did. We do it because families in this situation are the ones everyone else turns away, and because the hospital discharge planners who trust us with their hardest cases are the ones who send us everyone else.
If it's "ALTCS eventually" (a spend-down over the next year or two), we treat it as a normal search today and plan the transition with you.
We are not attorneys and this is not legal advice. ALTCS rules and dollar limits change; AHCCCS is the authority. For complex spend-downs, trusts, or property questions, an elder-law attorney is worth the consultation fee.