Urgent LTC Planning

When it comes to qualifying for Arizona’s ALTCS (Arizona Long Term Care System), the process is not one-size-fits-all.  While some families plan in advance for the possibility of long-term care, the reality is that most people don’t think it will happen to them.  Human nature leads many to assume they won’t need long-term care—until the moment it becomes unavoidable.  In fact, studies show that one-third of the population will require some form of long-term care in their lifetime.

Many of TKWhite LTC Law’s clients reach out only when a pressing medical need arises, often after they’ve already started paying for long-term care.  While this timing isn’t ideal, it doesn’t leave them without options.  Even in these “urgent-need” situations, TKWhite can help preserve valuable assets and reduce financial strain.  More importantly, our primary mission is to ensure that clients gain access to the ALTCS coverage they need for the care they deserve.

The Key Eligibility Requirements for ALTCS.

To qualify for ALTCS, applicants must meet specific eligibility criteria that go beyond simply filling out an application.  Applicants must meet the following four requirements to qualify for benefits::

• Income Test

• Asset Test

• Medical Need

• Placement at an ALTCS-Contracted Facility, Community, or in their homes.

Each of these requirements plays a critical role in determining eligibility for ALTCS.  For many applicants, however, the most complicated aspects are the income and asset tests, particularly in cases where families haven’t pre-planned for Estate Preservation.

1. Income Test.

ALTCS has strict limits on income, which vary depending on whether the applicant is an individual or part of a married couple.  Whether married or single, though, if the applicant’s monthly income exceeds the program’s threshold, he or she will not qualify for assistance without implementing very specific strategies.  The good news is that these strategies do exist and TKWhite understands them from every angle.  The most common work-around to the income limit is an Income-Only Trust (“IOT”), often referred to as a Miller Trust, but just because this trust is commonly used does not mean it is easy to create or manage.

TKWhite has spent decades gaining a hard-earned education in Income-Only Trusts (IOTs), experience that was necessary to fully understand the essential do’s and don’ts, as well as the many pitfalls that can lead to an outright ALTCS denial.  ALTCS closely regulates every aspect of IOTs, including how they are drafted, funded, and managed; the timing and method of disbursements; and the way in which trust activity is reported.  If one can imagine a potential IOT regulation, there’s likely one in place.  Given the deep complexities and the high stakes that arise when one needs an Income-Only Trust, attempting to manage an IOT alone is a risky endeavor.

2. Asset Test.

ALTCS also has a strict asset test, determining how much an applicant can own while still qualifying for benefits.  Perhaps even more than one might expect, the ALTCS asset thresholds are devastatingly low.  For an individual, the allowable limit is $2,000 in countable assets, though some assets, such as a primary residence, one vehicle, personal effects, and burial plans are deemed unavailable.  For married couples, the rules are a bit more lenient, although still never an easy pill to swallow, and planning remains essential for couples to keep as much of their estate as possible.

Many of TKWhite’s clients come in after they’ve already felt the sting of paying for long-term care costs for a period of time, sometimes waiting until their assets have dwindled down to almost nothing.  Even in these “urgent-need” cases, though, the firm can often preserve a significant portion of what remains and make sure that a gap does not arise in the ability to pay for care.  Using creative strategies, intimate and instructive client-interaction, and continuous case-management, TKWhite can help shield resources that would otherwise be subject to Medicaid’s spend-down requirements.

3. Medical Need.

The medical need requirement involves demonstrating that an applicant requires a certain level of care, as determined by an ALTCS Assessor.  In short, applicants must demonstrate that they require nursing facility level care, whether or not they are in a nursing facility.  The assessor makes this decision by examining the applicants ability to perform activities of daily living, such as bathing, dressing, eating, grooming, and exercising mobility.

This step is not as straightforward as one might think, proven by the vast number of ALTCS applicants who are denied for failing the medical assessment.  TKWhite has guided thousands of clients through the medical assessment, and has gained a deep understanding of what ALTCS is looking for.  While TKW cannot do the assessment for anybody, it is always helpful to know what to expect, how to prepare, and precisely what type of medical documentation might help a person satisfy the medical requirement.  Just as important, TKWhite oversees these medical assessments to protect clients from acts of impropriety and/or inaccurate conclusions.  There is a lot to think about during a medical assessment and TKW tries to shoulder as much of the burden as possible, making a trying time a little easier on the firm’s clients.

4. Placement at an ALTCS-Contracted Facility or Home & Community Service.

For ALTCS to cover long-term care costs, the applicant must be placed in a facility or community that is part of the ALTCS network.  A good way to think about this is that privately insured individuals can’t walk into just any doctor’s office and demand service – Where they receive their healthcare is limited to their insurance plan’s network.  So it is with ALTCS, but this is not to say that ALTCS members don’t have a multitude of options – The options are aplenty.

Just because a facility or community is contracted with ALTCS, one should not presume that it is not among the nicer options.  Contrary to popular belief, there aren’t strictly state-run Medicaid facilities; instead, facilities contracted with ALTCS are also contracted with a variety of other insurance plans, and ALTCS patients receive the same quality of care as anybody else.  Nevertheless, whether in a nursing home, assisted living facility, or home and community-based services program, proper placement is a necessary component of ALTCS-eligibility . TKWhite does everything the firm can to make sure that clients choose an ALTCS-approved long-term care option.

The Challenge of Crisis Cases: Addressing the New Realities of ALTCS.

While pre-planning is always the preferred route, the reality is that many people don’t start thinking about ALTCS until they have spent thousands, if not hundreds of thousands of dollars on long-term care. This is obviously less than ideal, but it does not mean that all hope is lost.  TKW has many clients who come in with an urgent situation—where long-term care is already needed—and still manage to avoid losing everything, the inevitable outcome of most anyone who needs long-term care for any substantial period of time.

In the past, the biggest challenge in ALTCS planning was navigating the application process.  However, with the introduction of the Automatic Verification System (AVS)—a sophisticated tool that scans bank accounts for transactions over $1,000—the real difficulty now often arises after ALTCS processes a case.  AVS flags any transaction exceeding $1,000 made in the five years prior to the application as a transfer, which, if not rebutted, can result in a penalty period where the applicant is ineligible for benefits.

This added complexity means that for many applicants, the most challenging work begins after the initial application.  TKWhite has developed expertise in addressing these presumed uncompensated transfers, including handling undue hardship requests, rebuttals, and appeals to reverse penalties and protect assets.  Over the years, TKW has successfully overturned millions of dollars in presumed transfers, ensuring that ALTCS does not unfairly penalize clients for actions that don’t violate its rules.

By employing these strategies, TKWhite has helped countless clients qualify for ALTCS—even after their financial records have been scrutinized by AVS.  The firm’s deep understanding of the ALTCS process means that clients who haven’t pre-planned can still secure the benefits they need.

The Bottom Line: It’s Never Too Late to Protect Your Wealth

Planning to become eligible to receive coverage for long-term care can be a complicated, time-consuming, and time-sensitive process, but when backed with the right experience, it is never too late to begin the journey. Whether in the early stages of considering long-term care or facing an immediate need for care, TKWhite Law has strategies to help people qualify for ALTCS and protect their assets.

While pre-planning offers the best chance to secure long-term care, TKWhite is no stranger to helping clients in urgent situations access the care they need.  With extensive experience handling complex ALTCS cases, TKW guides clients through every step of the ALTCS process receive necessary care without unnecessary delays.

It’s never too late to contact TKWhite LTC Law, as accessing appropriate care becomes much more difficult once funds are depleted.  Be that as it may, in urgent cases, timely legal counsel is more crucial than ever to make sure that individuals receive the quality care they need before their money has all been spent.  Those who plan early can save more, but even those with an urgent need for care can save some or all of what funds they have left.  Whether before long-term care is a mere consideration or already being delivered, TKWhite is here to help at whatever stage of the process one finds themself at.