ALTCS Covered Services for Home Care: What Arizona Medicaid Pays For

How ALTCS Home Care Services Are Authorized

ALTCS does not operate like traditional Medicaid fee-for-service programs where a doctor orders services and the state pays claims. Instead, Arizona routes all ALTCS members through contracted managed care organizations (MCOs). The MCO assigns a case manager to each member, and that case manager builds an individualized care plan specifying exactly which services are authorized, how many hours per week, and from which providers.

As of 2026, three MCOs serve the ALTCS Elderly and Physically Disabled (EPD) population:

• Mercy Care — serves Maricopa County and several rural counties
• Banner-University Family Care — serves Maricopa and Pima counties
• UnitedHealthcare Community Plan (Arizona Physicians IPA) — serves Maricopa County and rural areas

County of residence determines which MCOs are available. In Maricopa County, members can choose among all three. Outside Maricopa County, members are auto-assigned to the single regional program contractor for their area.

The existing contracts with all three MCOs were extended through September 30, 2026, after a court-ordered stay on new contract awards. Starting October 1, 2026, Arizona transitions to the "hybrid procurement model" under Senate Bill 1713, which caps any single MCO at 20% of total enrollment (excluding voluntary member choice).

The Full List of ALTCS-Covered Home Care Services

When a member's care plan specifies home-based services, the MCO authorizes some or all of the following:

Attendant care. Hands-on assistance with activities of daily living — bathing, dressing, grooming, toileting, transferring (bed to wheelchair, chair to standing), eating assistance, and mobility support. This is the core service that enables aging in place. Hours are determined by the PAS assessment score and the case manager's functional evaluation.

Homemaker services. Meal preparation, light housekeeping, laundry, grocery shopping, and errand assistance when the member cannot perform these tasks independently and no other household member can do them.

Personal care services. AHCCCS defines this broadly to include both ADL assistance and instrumental ADL support — medication reminders, appointment scheduling, and routine health monitoring (not skilled clinical care).

Skilled home health. Intermittent nursing visits, physical therapy, occupational therapy, and speech therapy provided by licensed professionals through contracted home health agencies. This is distinct from non-medical attendant care and is used for wound care, IV therapy, medication management, and rehabilitation.

Environmental modifications. Permanent physical changes to the member's primary residence — wheelchair ramps, doorway widening, roll-in showers, grab bars, stairlifts — covered under AHCCCS Policy 1240-I. Requires prior authorization, an occupational therapy evaluation, and competitive bids from AHCCCS-registered contractors.

Durable medical equipment (DME). Wheelchairs, hospital beds, walkers, commodes, bath benches, and other medically necessary equipment prescribed by a physician.

Non-emergency medical transportation (NEMT). Round-trip transport to covered medical appointments. The MCO arranges sedan, wheelchair van, or stretcher transport and may also reimburse family mileage.

Adult day health care. Daytime programming at a licensed facility providing socialization, therapeutic activities, meals, and basic health monitoring. Useful for caregivers who work during the day or need respite.

Respite care. Temporary relief care — either in-home or at a facility — so the primary caregiver can rest. ALTCS authorizes a limited number of respite hours per year through the care plan.

Behavioral health services. Mental health counseling, psychiatric medication management, and crisis intervention. Particularly relevant for members with dementia-related behavioral symptoms.

Dental, vision, and hearing. Check the member's AHCCCS benefit package and MCO for current covered services; do not assume every dental, vision, hearing, or device-related service is covered.

What the Case Manager Does

The ALTCS case manager is the operational hub of your parent's care. Their responsibilities include:

• Conducting the initial home assessment and developing the care plan within 14 days of MCO enrollment
• Authorizing service hours based on the member's functional needs, reassessed at least annually
• Coordinating providers — connecting the member with contracted home care agencies, home health agencies, DME suppliers, and transportation brokers
• Monitoring care quality through periodic home visits and phone check-ins
• Processing service changes when the member's condition improves or declines — adding hours, changing providers, authorizing new services, or adjusting the care setting
• Managing self-direction requests — initiating Agency with Choice or Self-Directed Attendant Care if the member wants to hire their own caregiver

If you are dissatisfied with your parent's case manager, you can request a change through the MCO's member services line. You can also switch MCOs during the annual open enrollment period (if more than one plan serves your county).

Services ALTCS Does Not Cover

ALTCS is comprehensive but not unlimited:

• 24/7 private-duty nursing. The available home-health services are generally described as intermittent skilled visits, not a blanket entitlement to round-the-clock nursing at home. Ask the MCO what level of skilled care is authorized; continuous needs may require a different setting.
• New home construction or additions. Environmental modifications must be to existing structures only.
• Non-medical personal preferences. Companionship-only services (someone to sit and talk with the member without providing any physical care) are not a covered ALTCS benefit.
• Out-of-state care. ALTCS services must be delivered in Arizona. Temporary out-of-state coverage exists for emergencies only.

How to Maximize Covered Hours

The number of attendant care hours your parent receives is determined by the case manager's assessment of documented functional needs after PAS eligibility is established. If you believe the authorized hours are insufficient:

1. Document daily care needs in writing. Keep a log for two weeks showing every task you perform, how long it takes, and how the member responds. Bring this log to the next case manager visit.
2. Request a PAS reassessment. If your parent's condition has declined since the last screening, a new PAS score may justify additional hours.
3. File a grievance. If the MCO denies a service increase you believe is medically necessary, you have the right to file a formal grievance and request a fair hearing through AHCCCS.

For a complete walkthrough of ALTCS eligibility, the application process, MCO selection, and how to work with your case manager to build the right care plan, the Arizona Home Care, Waivers & Support Guide covers every step.

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