ALTCS Eligibility in Arizona: Income Limits, Asset Limits, and PAS Scoring for 2026

ALTCS (Arizona Long Term Care System) is Arizona's Medicaid long-term care program — and it works fundamentally differently from every other state's Medicaid. Instead of maintaining separate tracks for nursing home care and home-based waivers, Arizona runs a single, consolidated managed care system through AHCCCS. One application, one set of eligibility rules, regardless of whether your parent will receive care in a nursing facility, an assisted living center, or at home.

This consolidation simplifies some things but makes the eligibility process itself more rigid. You must clear both financial and medical gates simultaneously.

Financial Eligibility: The 2026 Numbers

Individual income limit: $2,982 per month. This is the Special Income Level (300% of the Federal Benefit Rate). All income sources count — Social Security, pensions, retirement distributions, investment income.

If your parent's gross monthly income exceeds $2,982, they are not automatically disqualified. They must establish an irrevocable Income-Only Trust, commonly called a Miller Trust. All income above the cap is deposited into this trust each month. The trust must designate the State of Arizona as the primary payback beneficiary upon the recipient's death.

Individual countable resource limit: $2,000. This includes bank accounts, investments, cash-value life insurance over $1,500, and any other liquid assets.

Exempt assets (not counted toward the $2,000 limit):

• Primary residence, up to $752,000 in equity (unlimited if a spouse or dependent child lives there)
• One vehicle
• Household goods and personal effects
• Irrevocable burial trusts up to $9,000

If your parent's countable resources exceed $2,000, they must "spend down" — using excess assets to pay for care, prepay funeral expenses, make home repairs, or purchase other exempt assets. This must be done carefully: transferring assets to family members or gifting money triggers a 5-year lookback penalty.

Spousal Impoverishment Protections

Federal rules protect the "community spouse" — the spouse who is not applying for ALTCS — from financial devastation.

Community Spouse Resource Deduction (CSRD):

• Minimum: $32,532 — the floor the community spouse is guaranteed to keep from joint assets
• Maximum: $162,660 — 50% of joint countable assets, capped at this ceiling
• Assets above the maximum must be spent down or converted to income

Minimum Monthly Maintenance Needs Allowance (MMMNA):

• Floor: $2,705 per month (effective July 1, 2026 to June 30, 2027)
• Ceiling: $4,066.50 per month
• If the community spouse's own income is below the floor, income can be shifted from the ALTCS applicant's share to reach this amount

Standard Utility Allowance: $329 per month, used to calculate excess shelter cost deductions that can increase the community spouse's income allowance.

Medical Eligibility: The 60-Point PAS Test

Financial eligibility alone is not enough. The applicant must also pass the Pre-Admission Screening (PAS) functional assessment, administered by a state nurse or social worker.

To qualify under the Elderly and Physically Disabled (EPD) program, the applicant must score 60 points or higher. The maximum possible score is 166 for functional categories and 31.5 for medical categories.

The PAS scores Activities of Daily Living (ADLs) on a 0-to-3 scale:

• 0 = completely independent
• 1 = needs some assistance
• 2 = needs substantial assistance
• 3 = totally dependent

Raw scores are multiplied by specific weights to calculate the final score. The ADLs evaluated include bathing, dressing, toileting, transferring, continence, and eating.

Critical scoring factor: A formal diagnosis of Alzheimer's disease or a related dementia from a neurologist or licensed psychiatrist automatically contributes 20 points toward the medical score. That is 33% of the 60-point threshold from a single diagnosis. If your parent shows signs of cognitive decline but lacks a formal diagnosis, scheduling a neurological evaluation before the PAS assessment can be the difference between qualifying and being denied.

Borderline scores (56-59): If the initial PAS score falls between 56 and 59, the case is automatically routed for a secondary Physician Review. If the reviewer determines the applicant is at immediate risk of institutionalization, medical eligibility can still be granted.

Families can request a standalone "Private PAS" assessment to estimate whether the parent will meet the 60-point threshold before committing to the full ALTCS application.

ALTCS vs. Regular AHCCCS Medicaid

Standard AHCCCS provides basic medical coverage — doctor visits, prescriptions, hospital care. It does not cover long-term care services like nursing facility stays, assisted living, or in-home personal care attendants.

ALTCS covers everything standard AHCCCS covers, plus:

• Nursing facility care
• Assisted living facility care
• Residential adult care home placement
• Home and Community-Based Services (HCBS) including daily personal care, homemaker services, home modifications, and adult day health
• Hiring family members (including spouses) as paid caregivers

ALTCS is administered through contracted managed care plans. In Arizona, the major ALTCS health plans include Mercy Care, Banner-University Family Care, and UnitedHealthcare Community Plan. The assigned plan coordinates all care services, and the patient must use providers within that plan's network.

The Lookback Period and Transfer Penalties

ALTCS enforces a 5-year lookback on asset transfers. Any gifts, transfers for less than fair market value, or additions of family members to property deeds within the 60 months before application can trigger a penalty period during which ALTCS will not pay for care.

The penalty is calculated by dividing the value of the transferred asset by the county-specific divisor rate:

• Maricopa, Pima, and Pinal counties: $8,666.72 (effective October 1, 2025 to September 30, 2026)
• All other Arizona counties: $8,132.22

A $50,000 gift in Maricopa County creates a penalty period of approximately 5.8 months during which ALTCS coverage is denied. The parent or family must pay privately during the penalty period.

The Hospital-to-Home in Arizona toolkit includes the complete ALTCS financial eligibility workbook, PAS scoring guide, Miller Trust setup instructions, and spousal impoverishment calculations for families navigating a parent's transition from hospital to long-term care.

See more Arizona guides →