MEDICAID: What You Need to Know

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MEDICAID: WHAT YOU NEED TO KNOW

Unlike Medicare, we are not entitled to Medicaid when we turn age 65. Medicaid is a means-based program, funded by federal and state resources, that maintains financial and medical requirements for for individuals with limited income. Secondly, Medicaid can also pay for LONG-TERM CARE  (i.e. assisted living and memory care) for individuals with limited income that qualify.

Although funded by the federal government, Medicaid is managed individually by each state. Arizona’s Medicaid program is called Arizona Long Term Care System (a.k.a. ALTCS). ALTCS covered services “may” include:

 Long-term care in an assisted living or nursing home facility

 Home and community-based services (in-home care and outpatient)

 Medical services (doctor’s office visits and prescriptions)

 Behavioral health

 Hospice

Below are the basic eligibility requirements:

Non-Financial

 Be a U.S. citizen or qualified immigrant

 Have a Social Security Number (or apply for one)

 Be an Arizona resident

 Live in your own home or an ALTCS-certified long-term care facility (assisted living or skilled nursing)

 Require a nursing-home level of care (determined by an ALTCS medical assessment)

Financial

 Gross monthly income limit of $2,205 (single applicants): not limited to wages, Social Security, Supplemental Security Income, disability, retirement and VA pensions. For married couples, eligibility is calculated using a “Community Spouse Resource Deduction” (CSRD); see details below.

 Countable resources of not more than $2,000: bank account balances, real property (not lived in), cash, stocks, bonds, CD’s, cash value of some certain life insurance policies and non-exempt vehicles. Resources that are NOT counted (non-countable resources) include primary residence lived in (unless held in trust), one vehicle, household/personal belongings, burial plots, irrevocable burial plans and $1,500 designated for burial.

 Community Spouse Resource Deduction: a legally married spouse of an ALTCS applicant who lives at home or anywhere other than a medical facility is called a “community spouse”. Countable resources of both spouse are totaled, and the community spouse may keep a portion to live on as calculated by an ALTCS Eligibility Specialist.

 Special Treatment Trust: if your income exceeds the ALTCS limits, you may still be able to qualify by creating a “Miller Trust”. It is best to consult with an elder law attorney when considering this option.

To explore your specific eligibility, it is best to speak with an ALTCS Eligibility Specialist at the nearest ALTCS office. Please click link below.

Source - “”Filing an Application for the Arizona Long Term Care System (ALTCS, DE-828 Rev 12/2016), “ALTCS Policies on Community Spouse” (ALTCS, DE-817 Rev 07/2017)

Resources -

https://www.azahcccs.gov/Members/ALTCSlocations.html


By: Mark Sylvester