What is AHCCCS: FAQs

AHCCCS stands for the Arizona Health Care Cost Containment System and is Arizona’s Medicaid program. It helps people who meet certain financial qualifications get medical coverage and assistance. AHCCCS partners with different programs throughout Arizona to provide medical assistance and care to many different types of people.

What is AHCCCS?

As Arizona’s Medicaid program, AHCCCS offers behavioral health care, long-term care, and medical health care. It is intended to help low-income Arizona residents, including people with developmental disabilities. Depending on what type of care a person needs, there are different qualifications. For example, for Arizona residents who require long-term care, there is a program underneath AHCCCS called the Arizona Long Term Care System (ALTCS), which has its own set of qualifications, both medical and financial. For general healthcare through AHCCCS, only financial qualification is necessary.

What is Covered With AHCCCS?

• Doctor’s Appointments
• Lab work and X-rays
• Emergency Care
• Pregnancy
• Surgery
• Podiatry
• Dental, Vision, and Hearing for children under 21
• Hospital Services
• Behavioral Health
• Long-Term Care under ALTCS
• Shots and Immunization

What is Long-Term Care?

Long-term care is a description of several medical services that meet the needs of people who cannot care for themselves because of a disability or chronic illness. It ensures that patients have a high quality of life while managing their treatment. Promoting independence can also be included in long-term care options.

Long-term care can cover specialized medical treatment and non-skilled care. People who need long-term care may not only need medical treatment, but also assistance in eating, dressing, and using the restroom. The right long-term care treatment will cover all these needs.

Care options can be broad, going from in-home treatment options to assisted living and nursing homes. People of any age can require long-term care, though it’s most common with elderly people as they age. Senior Planning can help you apply to ALTCS, which is a program under the AHCCCS umbrella specifically for long-term care.

Is ALTCS the same as AHCCCS?

ALTCS has a different application process than AHCCCS. It also has different eligibility requirements than AHCCCS. Just because someone qualifies for AHCCCS does not mean they qualify for ALTCS. ALTCS is meant to provide long-term care while AHCCCS is intended to provide medical care for low-income Arizonans. To qualify for ALTCS, a person must be 65 or older, need assistance with daily living, have less than $2,000 in total assets, and make less than a certain amount of income each month. The income requirements are different for AHCCCS qualification.

What Are the AHCCCS Requirements in AZ?

To qualify for AHCCCS, people must meet several basic requirements:

• Be under 65 years old
  -If you are 65 or older, you can still qualify if you are the parent or caretaker of a child
• Not be eligible for Medicare
  -Medicare will not disqualify you if you are the parent or caretaker of a child or are pregnant
• Be a U.S. citizen or meet specific non-citizen requirements
• Have income below a certain limit.

Am I Eligible for Medicaid?

A person is qualified for long term care Medicaid if certain conditions are me. First, they must be at least 65 years old.

Next, they must be unable to perform these basic activities of daily living:

• Bathing
• Dressing
• Toileting
• Transferring
• Eating

If they cannot perform any of these tasks, then they will qualify medically for long-term care. If they cannot perform one, but can perform the other four, then they do not qualify.

The next qualification is financial. A person’s total countable assets must be below $2,000 and person’s income must be below 2,742.00. This amount changes each year. If a person meets all other requirements but their income is above the limit, they can still qualify if they create what is called a Miller Trust. Senior Planning can assist in the creation of a Miller Trust or any other legal document. For more detailed long term care eligibility, please follow the link.

What Qualifies as Low Income in Arizona for AHCCCS?

AHCCCS uses Federal Poverty Guidelines (FPG) to determine financial need. These amounts change each year. For individuals, those who have an income at or below 138% of the Federal Poverty Level will qualify for AHCCCS. Children, eighteen or younger, can get AHCCCS KidsCare coverage if their family’s income is 205% of the Federal Poverty Level or less.

What are the Costs for AHCCCS?

Those with developmental disabilities can qualify to pay no monthly premiums. For children under 19, there may be small co-payments due, but for those with extreme financial need, these co-payments could be waived. For people in need of long-term care, their income is taken first before AHCCCS will pay. The amount taken varies based on the type of care being used as well as the person’s income.

What Deductions are Allowed for AHCCCS?

There are many income based deductions allowed if you are in need of AHCCCS health care.

• Child Support Deductions
• Student Earned Income Exclusions for those under 22
• Impairment Related Work Expenses
• Standard Work Expense Deduction
• General Income Deduction

For more detail on these deductions, please visit the AHCCCS site directly.

How to find In-Network Care?

AHCCCS works with many different hospitals, facilities, pharmacists, doctors, and even specialists so you can always find a medical facility or professional who can help you. No matter what care or treatment options you need, you can find someone who will work with you. AHCCCS is administered by a few different insurance companies with wide networks. As long as you work with someone in your network, co-pays will either be free or reasonably priced.

How Long Does It Take to Apply for AHCCCS?

Generally, you can expect the application to take 45 calendar days from the submission date. Application can be found here: des.az.gov 

What If I Need Help to Apply?

While Senior Planning can not help you with the general AHCCCS application, we can help if you need ALTCS for long-term care services. Senior Planning has been helping seniors and their families apply to ALTCS for years. We offer a robust application service where we can help you through the medical and the financial portions. If you have any questions at all about Medicaid eligibility in Arizona, don’t hesitate to give us a call.