MEDICAID IN ARIZONA AND LONG TERM CARE
Arizona Health Care Cost Containment System or also known as AHCCCS, pronounced as “access,” is the name of Arizona’s Medicaid program. The state of Arizona, is a “1634” state which means that if you receive Supplemental Security Income (SSI) you will automatically qualify for AHCCCS, without filing a separate application or process. In addition, if you are also receiving Supplemental Security Income (SSI) due to 1619(b) provisions, you do not need to apply for AHCCCS separately either.What is a 1619 (b) Provision?
Section 1619 (b) provides protection against the loss of Medicaid coverage for individuals whose earnings make them ineligible for further benefit payments of Supplemental Security Income (SSI).
According to the Social Security Administration (SSA), in order for an individual to continue to receive Medicaid benefits, the individual must:
- Have been eligible for an SSI cash payment for at least 1 month;
- Still meet the disability requirement; and
- Still meet all other non-disability SSI requirements; and
- Need Medicaid benefits to continue to work; and
- Have gross earnings that are insufficient to replace SSI, Medicaid and publicly funded attendant care services.
The Social Security Administration (SSA) also states the following:
“SSI beneficiaries who have earnings too high for a SSI cash payment may be eligible for Medicaid if they meet the above requirements. SSA uses a threshold amount to measure whether a person’s earnings are high enough to replace his/her SSI and Medicaid benefits. This threshold is based on the:
- amount of earnings which would cause SSI cash payments to stop in the person’s State; and
- average Medicaid expenses in that State.
A threshold chart can be found on the Social Security Administration’s (SSA’s) website, https://www.ssa.gov/disabilityresearch/wi/1619b.htm.
If a SSI beneficiary has gross earnings higher than the threshold amount for his/her State, SSA can figure an individual threshold amount if that person has:
- Impairment-related work expenses; or
- Blind work expenses; or
- A plan to achieve self-support; or
- Personal attendant whose fees are publicly funded; or
- Medical expenses above the average State amount.”
Who Qualifies for AHCCCS Benefits?
AHCCCS is available to the following individuals
- Children birth to 1 year with family income up to 147 percent of the federal poverty level (FPL)
- Children 1 to 5 years with family income up to 141 percent of FPL
- Children 6 to 18 with family income up to 133 percent of FPL
- As of July 2016, children not eligible for Medicaid but with family income up to 200 percent of FPL are eligible for KidsCare or also known as Arizona’s Children’s Health Insurance Program (CHIP)
- Pregnant women with family income up to 156 percent of FPL
- Parents with family income up to 133 percent of FPL
- Childless, non-elderly adults with family income up to 133 percent of FPL (Medicaid expansion population)
- Elderly and disabled individuals who have special requirements and meet certain income limits
Basic Eligibility Requirements
- Meet income requirements
- S Citizen or have an immigration status that is eligible for AHCCCS
- Determined blind or disabled according to the Social Security Administration’s (SSA’s) definition and rules
Arizona Medicaid Income/Resource Limits
As of January 2017, Arizona’s Medicaid income/resource limits are as follows:
- Income limit: $2,205
- Resource limit: $2,000
- Maximum monthly community spouse resource allowance: $120,900
- Minimum monthly community spouse resource allowance: $24,180
- Maximum monthly maintenance needs allowance: $3,023
- Minimum monthly maintenance needs allowance: $2,003
- Personal needs allowance: $110.25
Keep in mind that these limits may change annually. For current AHCCCS eligibility requirements please review the following:
What is ALTCS?
ALTCS, pronounced as “ALTECS”, is the acronym for Arizona Long Term Care System. This specific program assists fixed income seniors and other individuals with disabilities be able to afford long term care.
There are two parts that are completed for an individual to receive ALTCS services. Those are financial assessment as well as a medical assessment. This program is a needs based program and has strict eligibility requirements for individuals.
Eligibility for ALTCS
There are eligibility requirements for ALTCS services, which include:
- Individual must be an Arizona resident
- Over the age of 65
- Developmentally disabled
- Have a recognized disability (e.g. blind)
If an individual qualifies for ALTCS, the individual would be eligible for some of the following:
- Coverage for acute services
- Nursing home care/services
- Home and community based services
If you are an Arizona resident and are interested in such services or know someone who would benefit from such programs, please contact your local Department of Economic Security Office location for more information or how to apply by visiting https://des.az.gov/find-your-local-office. In addition, it is recommended to reach out to a Special Needs Planning Attorney in your area who can guide you and provide more information regarding such programs.
DISCLAIMER: The information provided by CPT is for informational purposes only and is intended to be used as a non-legal guide prior to consultation with an attorney familiar with your specific legal situation. CPT is not engaged in the practice of law or in rendering legal advice or counsel. No such legal advice or counseling is either expressly or impliedly intended. This form is not a substitute for the advice or counsel of an attorney. If you require legal advice, you should seek the services of an attorney. © 2017 CPT All rights reserved.