ALTCS
The Arizona Long Term Care System (ALTCS) is health insurance for people who need a nursing facility level of care. ALTCS helps you get this kind of care at home or other community places, so you have personal freedom and independence. You must be at least 65 years old or have a disability to be eligible for ALTCS.
ALTCS Eligibility
There are some basic eligibility requirements for ALTCS services. To be eligible, you must:
- Be a citizen or qualified immigrant.
- Have a Social Security Number (SSN) or apply for one.
- Be an Arizona resident.
- Apply for all cash benefits that you may qualify for, like pensions or veterans benefits.
- Meet income requirements.
- Need the same level of care provided in a hospital, skilled nursing facility, or intermediate care facility.
- Live in an approved place, like your own home or an AHCCCS-certified nursing facility or assisted living facility.
You must live in Arizona to get ALTCS benefits. You do not need to live in Arizona for a specific time.
You meet the residency requirement if:
- Arizona is your permanent home.
- You just moved to Arizona.
- You temporarily moved away but plan to return.
Here are examples of what you can give AHCCCS to prove residency:
- Proof of address like a lease agreement or utility bills;
- State issued identification like a driver’s license or ID card;
- A residency statement from a non-relative who does not live with you. This statement must state where you live and who you live with. The person must date and sign it with their address and phone number.
Applying for ALTCS
You can apply to the Arizona Health Care Cost Containment System (AHCCCS) to get services through the Arizona Long Term Care System (ALTCS). AHCCCS is Arizona’s Medicaid agency.
The Arizona Department of Economic Security (DES) helps AHCCCS decide eligibility for ALTCS and other programs. You may talk to someone from DES if you apply for ALTCS.
You can apply for ALTCS services several ways:
You can have another person help you with your application. AHCCCS (or DES) may ask you for more information to decide if you are eligible for ALTCS services. They may call you or e-mail you with questions.
After you apply for ALTCS, AHCCCS (or DES) does a financial interview. This interview can happen in person or over the phone.
You must provide all the information that AHCCCS or DES asks for. AHCCCS may deny or stop your benefits if you do not provide everything they ask for.
Keep copies of everything you give AHCCCS or DES.
Keep proof that you gave them documents, like date-stamped copies, fax confirmations, or online confirmation printouts. If AHCCCS denies your application because they do not have information from you, the copies you keep will help you prove you gave them what they asked for.
What are the ALTCS eligibility requirements?
If you meet the income and resource requirements, AHCCCS will review your medical eligibility. AHCCCS figures out your medical eligibility with a Pre-Admission Screening (PAS). AHCCCS uses the PAS to decide if you are at an immediate risk of institutionalization.
A registered nurse or social worker does the PAS. The PAS is completed by telephone unless you request it to be in person. You have a right to an in-person PAS.
They will ask about your independence in your daily activities. For example, you will talk about how you bathe, dress, eat, groom, and move around in your home. The more help you need with these activities, the higher your PAS score will be.
They will also review available medical records. The interview and the medical records will help decide how independent you are. The nurse or social worker can also ask anyone who knows about your medical condition for information. They will also ask others about how independent you are.
If AHCCCS finds you are at risk of facility-based care during the PAS, they will approve your application for ALTCS.
AHCCCS will find you are at immediate risk of nursing facility placement if either:
- You have a PAS score equal or higher than 60; or
- A physician consultant decides you are eligible.
Usually, after the nurse or social worker completes the PAS, they calculate your PAS score and compare it to the basic eligibility score of 60. If your PAS score is not 60 or higher, AHCCCS will likely deny your claim for ALTCS.
It is still possible for a physician consultant to decide you are eligible even though your score is not 60 or higher.
What happens after I apply for ALTCS?
After you finish your PAS, AHCCCS will decide if you are eligible for ALTCS. AHCCCS will write to you to tell you their decision about your eligibility for ALTCS services. They may send you the notice by mail or e-mail.
AHCCCS letters, e-mails, and notices often have important deadlines. For example, AHCCCS will give you a deadline to appeal if you disagree with their decision on your ALTCS application. Carefully read all letters and e-mails from AHCCCS.
If AHCCCS approves you for ALTCS, they will send you a notice. The notice will tell you how to report household changes to the ALTCS eligibility office. Examples of changes that you must report include:
- A change in your address.
- Your admission to or discharge from a medical facility, public institution, or private institution.
- A change to your household composition.
- A change in your income.
- A change in your resources.
AHCCCS will redetermine your eligibility at least once every 12 months and if you report changes.
If AHCCCS makes a change to your ALTCS benefits, they will send a notice. AHCCCS must give you 10 days notice before any change in your eligibility or share-of-cost.
The notice must have the following information:
- A statement of AHCCCS’s change to your benefits.
- The effective date of the change.
- The specific reason for the intended action.
- Any actual number AHCCCS used in your eligibility determination – they must tell you how far you are over income or resource limits if they stop your benefits for those reasons.
- The specific law or regulation, or change in the law, which supports AHCCCS’s action.
- Your right to request an evidentiary hearing.
- The deadline for your request for hearing to continue your eligibility or current share of cost.
If AHCCCS denies your ALTCS application, they will send you a denial notice. Common reasons AHCCCS may deny your application include:
AHCCCS may send you the notice in the mail or electronically through their online application system. Read the entire notice. The denial notice will tell you the reason for the decision and what to do if you disagree.
AHCCCS may also approve you for ALTCS but not approve you for all the hours and services you need. Whether AHCCCS denies your ALTCS application or approves your application in a way you disagree with, you have rights.
If you disagree with an ALTCS decision
If you disagree with any AHCCCS decision about your benefits, you usually have the right to ask someone to review the decision. This review is called an appeal. The notice will tell you the deadline to appeal. If you get the notice by mail, you have 35 calendar days from the date on the notice to appeal.
If you want to dispute or challenge an AHCCCS decision about your ALTCS application, you must appeal by the deadline.
In your appeal, you can dispute the denial of your ALTCS application. You can disagree with the PAS score or any other decision AHCCCS made about your ALTCS application.
You can also disagree with the hours or services AHCCCS approved and say you should get more hours and services. You can also appeal if they do not decide about your application within the required time.
You can ask for an expedited (faster) appeal if you have a statement from your medical provider.
AHCCCS or DES must resolve an expedited appeal as soon as possible, but no later than seven working days after getting it.
The statement must say:
- You have a procedure or treatment scheduled, or you cannot schedule one because you do not have health care coverage.
- You do not have health insurance that will cover most of the treatment cost.
- Your life, physical or mental health, or ability to function is at serious risk if you must delay treatment for 90 days (about 3 months) or less from the date of your appeal request.
If you want to keep your benefits during the appeal process, you must appeal within 10 days (about 1 and a half weeks) of the date on the notice or before your medical assistance ends.
If you lose your appeal, you may have to pay back any benefits you received during the appeal process.
You usually cannot appeal decisions based on changes in law. For example, if the federal government changes the law and it affects your benefits or eligibility, you cannot appeal that change.
How to appeal
There are several ways you can appeal a decision made by AHCCCS:
You do not need to use special language in your appeal. Each decision letter includes a pre-printed “Appeal Request Form” or “I Am Asking For A Hearing” section. You do not have to use the form or letter to request an appeal. You can write your own letter that explains why you disagree with the decision.
Make sure to include:
- The reason for your appeal (e.g. “I disagree with…”)
- The date of the notice you want to appeal
- Your DES case number or AHCCCS application/member number
Keep proof of how and when you appeal. This will help you prove you appealed before the deadline in case AHCCCS or DES loses your appeal or does not process it. If you appeal by phone, make a note of the date, time, and who you talked to.
What to expect after your appeal is filed
After you appeal, AHCCSS or DES will schedule a hearing with an Administrative Law Judge (ALJ).
An ALJ is like a judge for your appeal. The ALJ does not know about your case until the hearing. The ALJ learns about it from you and AHCCCS or DES.
You will get a notice in the mail before the hearing. The notice will tell you:
- The date and time of the hearing;
- Issues the ALJ will talk about;
- The legal rules; and,
- Your hearing rights.
Hearings are usually by phone unless you ask for an in-person hearing. The notice will tell you how to ask for an in-person hearing. It will also explain how to send proof to the ALJ and how to have witnesses speak.
Appeals of an AHCCCS hearing decision
If you or the agency fair hearing coordinator disagrees with the AHCCCS Director’s decision, you can ask for a rehearing from the AHCCCS Director. You can also appeal to the superior court.
The rehearing process involves a review of the hearing file and other written documents from you or the agency. Either party can object to the petition, and sometimes there may be more testimony. After reviewing the information, the Director issues a Final Decision.
You can ask for a rehearing or review for any of these reasons:
- There was an irregularity in the hearing or appeal proceedings that deprived you of a fair hearing.
- There was misconduct by the eligibility office or the agency.
- There is newly discovered evidence that you could not have found before the hearing.
- There was prejudice in the decision.
- The decision was not justified by the evidence or is against the law.
- One of the parties had a good reason not to appear at the hearing.
Appealing a decision about your services
Sometimes, an AHCCCS health plan will deny medical supplies, a service, or treatment your doctor prescribed. When this happens, the health plan – not AHCCCS or DES – will send you a written notice. You can appeal this decision. Your appeal will go to the health plan.
The notice will tell you the deadline to appeal and how to do it. You have 60 days from the date on the notice to appeal. There are deadlines that affect your right to medical assistance. You need to carefully read all communications from AHCCCS.
The first level of appeal is an internal review by the health plan.
AHCCCS health plans want to know why the prescribed service is medically necessary. In Arizona, AHCCCS is governed by a law that defines a service as medically necessary if “it is provided by a physician or other licensed practitioner to prevent disease, disability, or other adverse health conditions or their progression, or to prolong life.”
AHCCCS health care plans only have information from the medical provider who sent the request for the medical supplies, services, or treatment. If you believe your health plan did not have important information when they decided to deny you services or treatment prescribed by your doctor, give them the information with your appeal.
The AHCCCS health plan will review your case. They will decide either to approve the service or keep the original denial. The notice of the appeal decision will tell you how to appeal to the second level.
The second level of appeal is a request for a fair hearing.
You have 30 days to appeal and request a fair hearing. The notice will explain how and where to appeal. The fair hearing happens before an Administrative Law Judge (ALJ).
Estate Recovery
Under federal law, Arizona must put an Estate Recovery Program in place to get back the money spent on some benefits, like ALTCS. So, if you get ALTCS benefits and you pass away, AHCCCS will try to get the money back from your estate.
But this only happens if you own a home alone or with someone else but without the right of survivorship. If your family lives in the house when you die, they might not have to pay back the money. AHCCCS can make an exception for hardships and won’t try to get the money from the estate.
This topic can be complicated. You may want to talk to a legal professional for help.
This website shares general legal information. Some content may be simplified or may not reflect recent changes in law. If you need advice for your specific situation, you should talk to a legal professional.
This content was last updated on Oct 1, 2025.