What Is ALTCS? Arizona's Long-Term Care Medicaid Program

ALTCS (pronounced “all-tecks”) stands for the Arizona Long Term Care System. It is part of Arizona's Medicaid program and is administered by the Arizona Health Care Cost Containment System, better known as AHCCCS.

If the cost of long-term care feels out of reach, Medicaid may be an option. ALTCS is Arizona's Medicaid program for people who meet both financial and medical requirements for long-term-care coverage. Families can learn more through the official AHCCCS ALTCS page. The privately operated ALTCS.com also provides educational information and application assistance through Senior Planning; it is not the government ALTCS office.

For people who qualify, ALTCS may cover long-term-care services in a nursing facility, an assisted-living setting, or the member's own home. It also coordinates medical and behavioral health coverage through an ALTCS health plan or, for certain members, through the Division of Developmental Disabilities or a Tribal ALTCS program.

ALTCS can be one of the most valuable sources of financial help available to Arizona families facing long-term-care needs. Eligibility and coverage are individualized, however, and ALTCS does not necessarily pay every cost associated with care.

Who may qualify for ALTCS?

ALTCS serves people who are age 65 or older, blind, or disabled and who require nursing-facility-level care. The program also serves eligible people with intellectual or developmental disabilities through Arizona's Division of Developmental Disabilities.

Applicants generally must:

• Be Arizona residents
• Be U.S. citizens or qualified immigrants
• Have a Social Security number or apply for one
• Live in an arrangement where covered long-term-care services can be provided
• Meet both medical and financial eligibility requirements

The medical and financial tests are separate. An applicant must satisfy both to receive the full ALTCS long-term-care benefit package.

The medical test: nursing-facility level of care

ALTCS is intended for people whose medical, functional, cognitive, or behavioral needs place them at risk of institutional care. An applicant does not need to live in a nursing facility to qualify. Many members receive services in their own homes or in assisted-living settings.

AHCCCS determines medical eligibility through a Pre-Admission Screening, or PAS. A PAS assessor who is a registered nurse or social worker evaluates the applicant's circumstances. The assessment may be completed face-to-face, by telephone, or virtually.

The assessor considers information such as medical conditions, functional abilities, cognition, behavior, and the help the applicant needs with daily activities. These may include bathing, dressing, eating, mobility, and toileting. Medical records and information from the applicant, family, guardian, caregivers, or health professionals may also be considered.

Needing help with one particular task does not automatically establish eligibility. AHCCCS applies a structured assessment to the applicant's complete circumstances.

The financial test: income and resources

ALTCS applies separate rules to income and countable resources. The figures below are general 2026 standards, not a substitute for an individual eligibility determination.

Income

For 2026, the gross monthly income limit for an individual applicant is $2,982.

Income may include Social Security, pensions, retirement benefits, disability payments, and wages. The rules can differ based on marital status, living arrangement, and the type and ownership of income. Married applicants should ask ALTCS to evaluate their specific situation instead of assuming that a simple combined-income limit applies.

An applicant whose income exceeds the limit may still be able to qualify through a properly established Income Only Trust, sometimes called a Miller Trust. AHCCCS treats this as a type of Special Treatment Trust.

The trust does not make income disappear or eliminate every payment obligation. It must follow detailed rules governing deposits, permitted expenses, distributions, reporting, and any required share of cost. An Arizona elder-law attorney familiar with ALTCS can help determine whether a trust is appropriate and prepare it correctly.

Countable resources

For a single applicant, countable resources generally may not exceed $2,000.

Countable resources may include:

• Checking, savings, and credit-union accounts
• Cash, stocks, bonds, and certificates of deposit
• Real property other than an excluded home
• Non-exempt vehicles
• The cash value of some life-insurance policies

Some resources may be excluded, including:

• A qualifying primary home
• One vehicle
• Household goods and personal belongings
• Burial plots and certain burial funds or irrevocable burial arrangements
• Certain federally excluded accounts, including qualifying ABLE accounts
• Some life-insurance policies, depending on the policy type, ownership, face value, and cash value

For 2026, the general home-equity limit is $752,000. Home rules are more complicated than the equity limit alone. Intent to return, occupancy by a spouse or certain dependent relatives, ownership through a trust, and whether the property is in Arizona may affect how the home is treated.

Protections for a spouse at home

When one spouse applies for ALTCS and the other remains in the community, special protections may allow the community spouse to retain more resources and, in some cases, receive part of the applicant spouse's income.

The protected amounts depend on the couple's resources, income, housing expenses, application date, and other circumstances. These standards change periodically, so couples should request a current Community Spouse Information Sheet from AHCCCS or obtain individualized advice.

What can ALTCS cover?

Depending on the member's assessed needs and authorized service plan, ALTCS coverage may include:

• Nursing-facility care
• Care services delivered in an eligible assisted-living setting
• In-home attendant care, personal care, and homemaker services
• Home health services
• Adult day health care
• Respite care
• Home modifications and emergency-alert systems
• Medical transportation
• Behavioral health services
• Hospice services
• Certain home-delivered meals
• Case management and other medical services

“Memory care” is not a separate guaranteed ALTCS benefit. A member with dementia may receive authorized services in an appropriate assisted-living or other approved setting when those services are medically necessary, included in the care plan, and available through an eligible provider.

Coverage is not automatic merely because a service appears on a benefits list. The member's case manager and health plan determine which services are medically necessary and cost-effective and authorize them through an individualized service plan.

What might the member still have to pay?

ALTCS does not necessarily make long-term care free.

Depending on income, living arrangement, and allowable deductions, a member may owe a monthly share of cost toward covered long-term-care services. AHCCCS calculates this amount, and it can change when the member's circumstances change.

In an assisted-living or other home- and community-based residential setting, ALTCS generally pays for authorized care services, not room and board. The member, family, or another source usually must pay the room-and-board portion. Before choosing a setting, ask the ALTCS health plan and facility for a written explanation of what ALTCS will pay and what the resident will owe.

Nursing-facility coverage treats room and board differently. A nursing-facility member may still owe an income-based share of cost.

Finding an assisted-living setting that works with ALTCS

Not every assisted-living facility can serve every ALTCS member.

An assisted-living setting must meet applicable Arizona licensing and AHCCCS certification or registration requirements. It also generally must participate in the member's specific ALTCS health-plan network. A facility's participation with one plan does not prove that it participates with every plan.

Before paying a deposit or signing an agreement, confirm all of the following:

1. The facility has an active license in good standing.
2. The setting meets applicable AHCCCS requirements.
3. The facility is currently in network with the member's ALTCS health plan.
4. The facility is willing and able to accept the particular member.
5. The health plan has authorized the placement and services.
6. The facility has explained room-and-board charges and any other private-pay costs in writing.

A directory listing is a useful starting point, but it should not be treated as proof of current network participation, availability, or acceptance.

Choosing an ALTCS health plan

ALTCS services for seniors and people with physical disabilities are generally coordinated through managed-care health plans. Available plans vary by county.

In areas with more than one available plan, an eligible member may be offered a choice. If the member does not make a selection, a plan may be assigned. Different arrangements apply to some members served through the Division of Developmental Disabilities or Tribal ALTCS, and Medicare plan enrollment may affect plan alignment in some cases.

When choosing among available plans, check whether preferred doctors, pharmacies, hospitals, home-care agencies, and residential facilities participate in the plan's current network.

How to apply for ALTCS

ALTCS eligibility is determined by AHCCCS, not by an assisted-living facility, private consultant, or managed-care plan. An application may be started online, by telephone, by fax, by mail, or through a local ALTCS office.

Official ways to apply

• Apply online: Health-e-Arizona Plus
• Application instructions and current eligibility information: AHCCCS | How to Apply for Medical Assistance
• Download the ALTCS request-for-application form: AHCCCS Form DE-101/DE-202
• Call ALTCS: 1-888-621-6880
• Fax an application: 1-888-507-3313
• Find an office: AHCCCS ALTCS office locations

Health-e-Arizona Plus is the State of Arizona's online benefits portal. Applicants can use it to register an application and, when available, upload documents and follow their case. If the online portal is unavailable or difficult to use, call ALTCS directly rather than waiting to begin.

The process generally includes:

1. Starting an application online or contacting ALTCS
2. Completing the application and required financial interview
3. Providing identity, citizenship or immigration, Arizona residency, income, resource, insurance, trust, and property records
4. Completing the PAS medical assessment
5. Receiving medical and financial eligibility determinations
6. If approved, choosing a health plan when a choice is available or receiving a plan assignment
7. Working with the plan's case manager to develop an individualized service plan

Helpful records may include recent bank and investment statements, property deeds and mortgage records, insurance policies, trust documents, proof of income, burial arrangements, identification documents, and relevant medical records.

The applicant or an authorized representative may complete the application. Another person may help start the process, but the application must be signed by someone with authority to act. Caregiver or family-member status alone does not necessarily create that authority.

Processing time varies. Missing documents, difficulty obtaining records, medical evaluations, disability determinations, trusts, transfers, and other complicated circumstances can cause delays. Respond promptly to AHCCCS requests and keep copies of everything submitted.

Optional private application guidance

ALTCS.com is operated by Senior Planning, a private Arizona organization, not AHCCCS or another government agency. Its website offers general ALTCS education, application guidance, and help locating care. Senior Planning says its initial consultations and placement assistance are free, that it may receive a commission from participating care communities, and that it also offers more comprehensive application assistance for a fee.

Families considering any private assistance service should ask for a written explanation of fees, services, referral relationships, and privacy practices. Hiring a private service is optional and does not improve or guarantee eligibility. An applicant may apply directly through AHCCCS at no charge.

The five-year transfer look-back

ALTCS reviews certain transfers made during the 60 months before the application month. Giving away money or property, transferring an asset for less than fair market value, or making some payments for another person's benefit can result in a period during which ALTCS will not pay for long-term-care services.

Not every transfer creates a penalty. Federal and Arizona rules contain exceptions, and circumstances such as fair-market-value compensation, return of an asset, or undue hardship may matter.

Do not give away assets or change ownership of a home merely to try to qualify for ALTCS without first obtaining qualified advice. A transfer that appears harmless can have serious eligibility consequences.

If income or resources exceed the limits

Being over an income or resource limit does not always end the inquiry. Depending on the circumstances, lawful options may include:

• An Income Only Trust for income above the cap
• Spending countable resources on fair-value goods or services for the applicant
• Purchasing qualifying exempt resources
• Certain prepaid burial arrangements
• Necessary home repairs or modifications
• Community-spouse protections
• Other planning permitted under ALTCS rules

These strategies are technical and fact-specific. A purchase is not automatically protected merely because it involves a home, vehicle, funeral, or caregiver, and gifts can trigger a transfer penalty. An Arizona elder-law attorney who regularly handles ALTCS matters can help a family avoid costly mistakes.

If an application is denied

A denial does not necessarily mean the inquiry is over. Read the written notice carefully. It should state why AHCCCS denied the application and explain how and when to request an appeal or fair hearing.

Appeal deadlines matter, so act promptly. Depending on the issue, it may help to gather missing records, ask the agency to explain its calculation or medical finding, and consult an Arizona elder-law attorney or qualified benefits counselor.

Some private benefits organizations report that applicants commonly encounter denials, but no official AHCCCS data was located that supports a general “75% denial rate.” Do not assume a denial is routine or that approval is guaranteed after reapplying. Use the reason stated in the official notice to decide whether to submit missing information, appeal, reapply, or obtain qualified advice.

Mercy Care and ALTCS

Mercy Care is a local, not-for-profit Medicaid managed-care organization that provides coverage to people who qualify for AHCCCS programs. Its Mercy Care Long Term Care plan serves eligible ALTCS members who are elderly or have physical disabilities in Maricopa, Gila, Pima, and Pinal counties as of September 2026. Mercy Care also participates in coverage arrangements for certain members with developmental disabilities.

Mercy Care does not decide whether someone qualifies financially or medically for ALTCS. AHCCCS handles the ALTCS application and eligibility decision. After approval, Mercy Care may be one of the health-plan choices available to a member, depending on county, program, Medicare-plan alignment, and current AHCCCS contracting rules.

For members enrolled in Mercy Care Long Term Care, the plan coordinates physical health, behavioral health, long-term services and supports, case management, and access to its provider network. Members can use the Mercy Care provider directory or contact the plan to check whether a doctor, agency, nursing facility, or assisted-living setting is in network.

Mercy Care has also publicized Benefit Eligibility Triage and Education, or BETE, as a no-cost public service that answers questions about government benefits such as Medicaid, Medicare, Social Security, and veterans' benefits. Because program names, phone numbers, and availability can change, verify current details through Mercy Care's official website before relying on the service.

Choosing Mercy Care, or any other ALTCS plan, is separate from applying for ALTCS. Start the eligibility application with AHCCCS first, then compare the plan options AHCCCS says are available in the applicant's area.

Estate recovery

Federal and Arizona law require AHCCCS to seek repayment from the estates of certain deceased ALTCS members for benefits paid after age 55. Estate recovery may apply to nursing-facility services and home- and community-based services.

Recovery generally occurs after the member's death, and exemptions, deferrals, and hardship reductions may apply. The rules can affect a home and the member's heirs. Homeowners and families concerned about preserving property should obtain individualized legal advice before applying or transferring assets.