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Medicaid and ALTCS Eligibility

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Long Term Care Insurance

Applying for Medicaid/ALTCS is a little easier if you have a general idea of whether the applicant meets all of the eligibility requirements.

Medicaid vs. Medicare

Medicaid and Medicare are both government programs that help relieve the cost of medical care. Medicare is a federal program that provides benefits for individuals 65 and older, and individuals with disabilities. Medicaid is a federal and state program that provides benefits for individuals with limited income and assets. Medicare functions as a health insurance where people pay part of the costs of their medical coverage through premiums or deductibles. Medicaid covers the entire cost of most medical expenses and provides benefits for things like home care.


Arizona’s Medicaid program is called the Arizona Health Care Cost Containment System (AHCCCS). Within AHCCCS, there is a program called the Arizona Long Term Care System (ALTCS). There are five factors required to qualify for ALTCS. You must be a US citizen, an Arizona resident, medically eligible, below the income limit and below the asset limit. Citizenship and residency are relatively straightforward, but medical, asset and income eligibility require a little more discussion.

Medical Eligibility

Medical eligibility for ALTCS requires that the applicant pass the Preadmission Screening (PAS). The PAS assesses several factors that create a functional score and a medical score. The functional score assesses the applicant’s ability to perform six activities of daily living (ADL), continence, sensory, orientation and behavior. ADLs include bathing, dressing, grooming, eating, mobility and transferring. The medical score assesses the medical conditions and services and treatments. The functional score has a maximum of 166 and the medical score has a maximum of 31.5. The combined score must total at least 60.

Income Eligibility

The monthly income limit for ALTCS eligibility is three times the maximum monthly Supplemental Security Income (SSI) payment. The current maximum monthly SSI payment is $943. The current monthly income limit for ALTCS eligibility is $2,829. However, there is a relatively simple solution to achieving income eligibility if you are over the limit. You can create an income only trust, what is known as a “Miller Trust,” to receive your income in excess of $2,829. Having your income go to the trust prevents ALTCS from counting it as your income for eligibility purposes. Still, you should not create a Miller Trust until you achieve medical and asset eligibility as well.

Asset Eligibility

The applicants total “available” assets cannot exceed $2,000. Available assets does not include “exempt” assets, such as the applicant’s primary home and car. ALTCS considers the applicant’s spouse’s assets as available as well. However, if the applicant’s spouse is not applying for ALTCS, they can keep a share of the assets known as the Community Spouse Resource Allowance (CSRA).

In Arizona, the CSRA is half of the couple’s assets on the applicant’ first day of institutionalization or the date they are eligible for Medicaid. The minimum CSRA is $30,828 and the maximum is $154,140. For example, if a couple has $200,000 the CSRA is $100,000. The applicant must “spend down” $98,000 to achieve asset eligibility. Spending down requires using money on non-exempt assets, like fixing up the house or buying a new car.


Medicare and Medicaid are separate programs. AHCCCS is Arizona’s version of Medicaid. ALTCS falls under the umbrella of AHCCCS. There are several different categories of factors that determine ALTCS eligibility. You probably do not want to take steps towards achieving income or asset eligibility until the applicant is medically eligible.

You can fill out our ALTCS questionnaire to schedule a consultation.


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Robert B. Fleming


Robert Fleming is a Fellow of both the American College of Trust and Estate Counsel and the National Academy of Elder Law Attorneys. He has been certified as a Specialist in Estate and Trust Law by the State Bar of Arizona‘s Board of Legal Specialization, and he is also a Certified Elder Law Attorney by the National Elder Law Foundation. Robert has a long history of involvement in local, state and national organizations. He is most proud of his instrumental involvement in the Special Needs Alliance, the premier national organization for lawyers dealing with special needs trusts and planning.

Robert has two adult children, two young grandchildren and a wife of over fifty years. He is devoted to all of them. He is also very fond of Rosalind Franklin (his office companion corgi), and his homebound cat Muninn. He just likes people, their pets and their stories.

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Elizabeth Noble Rollings Friman is a principal and licensed fiduciary at Fleming & Curti, PLC. Elizabeth enjoys estate planning and helping families navigate trust and probate administrations. She is passionate about the fiduciary work that she performs as a trustee, personal representative, guardian, and conservator. Elizabeth works with CPAs, financial professionals, case managers, and medical providers to tailor solutions to complex family challenges. Elizabeth is often called upon to serve as a neutral party so that families can avoid protracted legal conflict. Elizabeth relies on the expertise of her team at Fleming & Curti, and as the Firm approaches its third decade, she is proud of the culture of care and consideration that the Firm embodies. Finding workable solutions to sensitive and complex family challenges is something that Elizabeth and the Fleming & Curti team do well.

Amy F. Matheson


Amy Farrell Matheson has worked as an attorney at Fleming & Curti since 2006. A member of the Southern Arizona Estate Planning Council, she is primarily responsible for estate planning and probate matters.

Amy graduated from Wellesley College with a double major in political science and English. She is an honors graduate of Suffolk University Law School and has been admitted to practice in Arizona, Massachusetts, New York, and the District of Columbia.

Prior to joining Fleming & Curti, Amy worked for American Public Television in Boston, and with the international trade group at White & Case, LLP, in Washington, D.C.

Amy’s husband, Tom, is an astronomer at NOIRLab and the Head of Time Domain Services, whose main project is ANTARES. Sadly, this does not involve actual time travel. Amy’s twin daughters are high school students; Finn, her Irish Red and White Setter, remains a puppy at heart.

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Matthew M. Mansour


Matthew is a law clerk who recently earned his law degree from the University of Arizona James E. Rogers College of Law. His undergraduate degree is in psychology from the University of California, Santa Barbara. Matthew has had a passion for advocacy in the Tucson community since his time as a law student representative in the Workers’ Rights Clinic. He also has worked in both the Pima County Attorney’s Office and the Pima County Public Defender’s Office. He enjoys playing basketball, caring for his cat, and listening to audiobooks narrated by the authors.