Paying for care in Arizona
ALTCS and assisted living: what Arizona Medicaid actually pays for
A plain-English guide to the Arizona Long Term Care System — who qualifies, what it covers, what it does not cover, and how to find a home that will actually accept it.
The one thing most people get wrong
ALTCS can pay for the care services your parent receives in an assisted living setting. It generally does not pay their room and board in assisted living — that comes out of their own income, and a “share of cost” may be applied.
Families routinely assume ALTCS approval means a free bed. It does not, and finding that out late is how a placement collapses in week three.
What ALTCS is
The Arizona Long Term Care System is Arizona’s Medicaid programme for people who need a nursing-facility level of care. It is administered by AHCCCS, the state Medicaid agency, and delivered through managed care plans.
It covers people who are elderly, physically disabled, or intellectually or developmentally disabled, and who require that level of care. Critically for families: ALTCS members do not have to live in a nursing home. Many live in assisted living homes and communities.
Who qualifies
1. Medical and functional eligibility
The applicant must require a Nursing Facility Level of Care, determined through a Pre-Admission Screening (PAS) assessment. The PAS looks at activities of daily living — bathing, dressing, transferring, eating, toileting, grooming, mobility — and at cognitive impairment.
A dementia diagnosis by itself does not automatically qualify someone. This surprises a lot of families. What matters is the functional need demonstrated at the assessment.
2. Financial eligibility (2026 figures)
| Test | Limit |
|---|---|
| Monthly income, single applicant | $2,982 |
| Countable assets, single applicant | $2,000 |
| Countable assets, married — both applying | $4,000 combined |
| Community spouse resource allowance | Up to $162,660 (minimum $32,532), January 2026 |
| Look-back period on transfers | 60 months |
Generally excluded from countable assets: the primary residence, one vehicle, burial plots, and ordinary household goods.
If income is over the limit: the income-only trust
If a single applicant’s gross monthly income is above the limit ($2,982 a month in 2026), they are not automatically out. Arizona allows an income-only trust (often called a Miller trust): the income over the limit is paid into the trust each month and used for the member’s care, and the applicant can then qualify on income. The trust has to be set up correctly and run every month without fail, so this is a job for an Arizona elder law attorney, not a form to fill in at the kitchen table. More in eligibility, in detail.
What ALTCS covers — and what it doesn’t
Generally covered
- Care and supervision services in an assisted living setting
- Nursing facility care, including room and board in that setting
- In-home and community-based services
- Acute medical care, behavioural health, prescriptions
- Case management
Generally not covered
- Room and board in assisted living — paid from the member’s income
- Costs above the member’s share-of-cost calculation
- Private rooms as an upgrade
- Care before the approval date, in most circumstances
Estate recovery: the question families ask later
AHCCCS runs an estate recovery programme. After an ALTCS member dies, the state may seek repayment, from the member’s estate, of what it paid for long-term care services, generally for members aged 55 or over. Recovery is usually deferred while a surviving spouse is alive, or while there is a child under 21 or a child who is blind or disabled, and AHCCCS can waive recovery in cases of undue hardship.
What counts as the “estate”, how the home is treated, and what planning is legitimate are legal questions with real money attached. We will always tell you to take them to an Arizona elder law attorney, and we receive nothing for that referral. AHCCCS publishes the current rules at azahcccs.gov.
How to apply
- Apply through Health-e-Arizona Plus online, by calling AHCCCS on 1-888-621-6880, or in person at an ALTCS office.
- Complete the PAS assessment. An assessor evaluates functional and cognitive need. Be accurate about the person’s worst days, not their best ones — families consistently understate.
- Financial review. Income and assets are verified, with the 60-month look-back applied to transfers.
- Decision. Approval commonly takes up to about 90 days, though it can be faster.
You do not have to wait for approval to move
Some homes accept residents who are ALTCS-pending — applied but not yet approved — with a private-pay bridge or a retroactive arrangement. It is a much shorter list of homes, and knowing which ones is most of the value we add. If your parent is in a hospital bed right now and the application is not filed, call us on (307) 200-5270 before you do anything else.
Finding a home that accepts ALTCS
This is the part families find hardest, and it is not because the information is secret. It is because it changes constantly. A home that took ALTCS residents in March may be full, or may have shifted to private pay, by August.
There is no reliable public list of current ALTCS openings by acuity. What works is relationships and a phone. We maintain current knowledge of which homes across the Valley — Sun City West through Queen Creek — are taking ALTCS and ALTCS-pending residents, at what level of care, and with what behaviours they will accept.
Most ALTCS placements land in Arizona’s smaller assisted living homes — ten residents or fewer — rather than large communities. That is usually a feature rather than a compromise.
Common questions
What is the difference between ALTCS and Medicare?
Medicare is federal health insurance based on age or disability. It pays for hospital care, doctors, and short-term skilled nursing after a qualifying hospital stay — up to 100 days, with cost-sharing after day 20. It does not pay for long-term assisted living or memory care.
ALTCS is Arizona Medicaid’s long-term care programme, based on need and on income and assets. It is what may help once Medicare’s rehab days run out. Many people have both.
Does ALTCS cover memory care?
ALTCS can cover care services for a member with dementia in a licensed setting, including homes offering directed care. As with assisted living generally, room and board is typically the member’s responsibility, and the member must meet the nursing-facility level of care standard. Secure memory care units that accept ALTCS exist but are a limited group.
We were denied. What now?
Denials are often about documentation or a PAS assessment that captured a good day, rather than a genuine failure to qualify. You have appeal rights, and reapplication is possible when circumstances change. If the denial was financial rather than medical, that is a question for an Arizona elder law attorney — asset planning for Medicaid is legal practice, not something we or any placement agency can advise on.
Can I be paid to care for my parent?
Arizona has paid-caregiver pathways through ALTCS in certain circumstances, administered through the member’s managed care plan. Eligibility and rules vary. Ask the member’s ALTCS case manager directly — they are the authority on what that specific plan allows.
The rest of the ALTCS guide
Eligibility, in detail
The 2026 income and asset limits, the level-of-care test, the community spouse rules, and the 60-month look-back.
How to apply
Step by step: what to gather, how the PAS assessment works, and how long approval actually takes.
ALTCS vs Medicare
Which one pays for what, and the day-100 wall that catches most families by surprise.
Homes that accept ALTCS
Why there is no public list, the room-and-board gap, and what ALTCS-pending really means.
Please note. This page is general information, not legal or financial advice. Eligibility determinations are made solely by AHCCCS. We help families understand the programme and find homes that accept it — we cannot approve anyone, and any agency that tells you it can “get you approved” is telling you something it cannot deliver. For asset planning, consult an Arizona elder law attorney. Figures on this page are 2026 and are reviewed each January; confirm current numbers at azahcccs.gov.
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