AHCCCS Long Term Care: How Arizona's ALTCS Program Works for Dementia

Most states split their Medicaid long-term care into two separate systems — one for nursing home coverage and another for home-based waivers. Arizona does neither. The state runs a single managed long-term care system called ALTCS (Arizona Long Term Care System), administered through AHCCCS (Arizona Health Care Cost Containment System), that consolidates everything — facility care, home modifications, adult day programs, and family caregiver compensation — under one application and one case manager.

This unified structure has real advantages for families managing a parent's dementia. But it also means there's only one track, one set of eligibility criteria, and one application process. If you get denied, there isn't a separate waiver program to fall back on.

What ALTCS Actually Covers

ALTCS delivers services through contracted managed care organizations — Mercy Care, Banner University Family Care, and UnitedHealthcare — which assign a dedicated case manager to coordinate the beneficiary's care across all settings. Coverage includes:

• Memory care facilities — monthly residential care in assisted living communities licensed for directed care, including those with the Memory Care Services subclass
• Nursing home care — for patients requiring skilled nursing beyond what assisted living provides
• Home and Community Based Services (HCBS) — personal care assistance, home health aides, homemaker services, and home modifications like grab bars and ramps
• Adult Day Health Care — structured daytime programs with therapeutic activities and supervision
• Family caregiver compensation — ALTCS allows family members to be paid as caregivers through its HCBS program, something most families don't realize
• Respite care — temporary relief for primary caregivers
• Medical equipment and supplies — hospital beds, wheelchairs, and incontinence supplies

The case manager creates an individualized service plan and adjusts it as the parent's cognitive decline progresses. Families aren't locked into a single care setting — a parent can move from home care to adult day programs to residential memory care as their needs change, all under the same ALTCS enrollment.

The Dual Eligibility Test

Unlike standard AHCCCS medical coverage, ALTCS requires meeting both financial and medical eligibility simultaneously:

Financial eligibility:

• Individual countable assets cannot exceed $2,000
• Gross monthly income cannot exceed $2,982 (2026 threshold)
• If income exceeds the cap, a Qualified Income Trust (Miller Trust) resolves the overage — Arizona does not allow income spend-down
• A 60-month lookback period applies to all asset transfers
• If the applicant has a spouse, the Community Spouse Resource Allowance allows the at-home spouse to retain up to $162,660 in countable assets

Medical eligibility (the PAS exam):

• A face-to-face Pre-Admission Screening (PAS) exam conducted by an AHCCCS nurse or social worker
• The applicant must score 60 or more points on the PAS assessment scale
• A formal dementia diagnosis alone is worth 20 points toward the threshold
• The remaining 40 points come from documented deficits in Activities of Daily Living and behavioral challenges (wandering, aggression, resistiveness)
• Scores between 56 and 59 trigger an automatic physician review, which can approve eligibility based on clinical judgment even below the numeric threshold

How the Application Works

The formal application goes through Health-e-Arizona Plus (HEA Plus), the state's online portal, or in person at a local AHCCCS eligibility office. Processing typically takes 45 days.

What you'll need to assemble:

• Five years of comprehensive financial records (bank statements, investment reports, property deeds, tax returns, life insurance valuations)
• Clinical medical files and a current medication list
• The formal dementia diagnosis documentation
• Proof of Arizona residency and U.S. citizenship or qualifying immigration status

The primary caregiver should attend the PAS exam in person. The assessor needs detailed documentation of the parent's daily functional limitations, behavioral episodes, and supervision requirements. What the caregiver reports directly influences the PAS score — understating the parent's deficits out of pride or denial can result in a score below the 60-point threshold.

After Approval: What to Expect

Upon receiving the approval letter, the assigned managed care contractor schedules an intake meeting to develop the service plan. If the family chooses residential placement, they have 180 days to place the parent in a contracted facility.

Ongoing compliance matters: countable assets must stay below $2,000 at the end of every calendar month, and any changes in income, living situation, or health status must be reported to the case manager. The managed care contractor conducts periodic clinical reviews to ensure the care plan matches the beneficiary's current needs.

How ALTCS Differs from Standard AHCCCS Coverage

Standard AHCCCS provides basic medical coverage — doctor visits, prescriptions, hospital stays — to low-income Arizonans. ALTCS is a separate program within AHCCCS that adds long-term care services on top of that medical coverage. The distinction matters because:

• Standard AHCCCS does not cover residential memory care, ongoing personal care assistance, or family caregiver compensation
• ALTCS eligibility requires the additional PAS medical evaluation — standard AHCCCS does not
• ALTCS operates through its own set of managed care contractors with dedicated long-term care case managers
• A parent can have standard AHCCCS medical coverage while their ALTCS application is processing, but the long-term care services only begin after ALTCS approval

If your parent is already on AHCCCS for medical coverage, that doesn't mean they're on ALTCS. The ALTCS application is a separate process with its own financial and medical criteria.

The Arizona Dementia & Memory Care Guide includes a complete ALTCS application walkthrough with a financial eligibility tracker, PAS self-assessment worksheet, and document checklist covering everything the application requires.

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