Assisted Living Basics: A Guide for ALTCS (Medicaid)

In Arizona, our Medicaid benefit has been contracted out to two insurance plan administrators, which are Banner University and United Healthcare.  

These two networks are the only options available in 2018 for anyone applying for benefits through ALTCS.  In order to apply for ALTCS, a person must either contact them directly at 602-417-6600 or by utilizing the assistance of an ALTCS planning representative, which are usually employed within Elder Law firms.  

ALTCS income limit is $2250 for an individual and $4500 for a couple and assets such homes, cars, savings, stocks, bonds, etc… have limits as well. ALTCS also has a five-year look-back rule, in which they require documentation for the past five years about income and assets.  

ALTCS determines which plan administrator (which network) the eligible applicant will be placed into once they reach the pending status in their application process.  For this reason, it is very important to ask the ALTCS case manager for a list of homes and facilities that are currently contracted with that network of ALTCS because the State of Arizona Dept. of Health Services does not post such a list on their website.  

There are thousands of assisted living homes and over 280 assisted living centers in the Phoenix metropolitan area and it would be nearly impossible keep track of which ones have current ALTCS contracts and with which networks.  It is advised to ask for a list of currently contracted homes or centers in specific zip code areas within the network you are pending in from your ALTCS case manager.

IMPORTANT NOTES:  

• ALTCS only pays for a shared room or shared suite in an assisted living home or community.  This means that the ALTCS recipient will have a roommate. Homes and centers always try to pair roommates to the best compatibility option available.  
• Even though an assisted living facility may be listed as accepting ALTCS, most of them have a private pay requirement period that can be anywhere from six months to two years. These are corporate owned centers that have allowed for a few ALTCS beds in order to give their current residents the option of staying once their personal funding sources run out or for new residents to know that they can move in and do a spend down of their private funds and eventually “roll” to ALTCS after their funds are dissolved.
• Some assisted living homes will take a person who is ALTCS pending and allow them to pay a reduced rate out of pocket until ALTCS is approved, but only ALTCS has a list of current homes that are contracted with the network that ALTCS plans to place the applicant on.  This list can be obtained by requesting it from the ALTCS case manager.

LETS BREAKDOWN THE MATH

The lower end of the cost range for a shared room in an assisted living home is between $2300 - $2800 per month for a private pay resident. Keep in mind that in 2018, the minimum wage in Arizona is $10.50 per hour.

• $76.67 per day = $3.19 per hour
• $93.33 per day = $3.89 per hour

However, ALTCS reimburses the homes for a shared room as follows:

• Banner University pays the homes $66 per day ($1980 per month), which equates to $2.75 per hour for 24 hours of care.
• United Healthcare has 3 tiers (levels)
  • Level ONE pays $67 per day ($2010 per month), which equates to $2.79 per hour.
  • Level TWO pays $72 per day ($2160 per month), which equates to $3.00 per hour,
  • Level THREE pays $100 per day ($3000) per month, which equates to $4.17 per hour and is only assigned to heavy care cases such as TBI (traumatic brain injury),  behavioral, etc…

Assisted living placement agencies are not legally allowed to collect a placement fee out of ALTCS funds. Since ALTCS does retro-activate payment on many cases back to the date of move-in to the assisted living environment, a fee that is paid to a placement agency on an ALTCS pending case could potentially run the risk of being in contempt of the law.

For this reason, we are unable to assist in placement services for anyone who has either already applied for ALTCS or is planning to apply within 6 months of contacting us. If you need to contact ALTCS, they can be reached directly at 602-417-6600 or you may contact an Elder Law firm who specializes in assisting ALTCS applicants through the process for a fee.  

Assisted Living Basics: The Costs of Assisted Living

Adult Care Connection has been helping families navigate their way through the process of selecting the appropriate settings in Assisted Living for over 21 years. Our highly skilled staff is comprised of medical social workers, with several years of extensive experience in working with the aging and disabled population.

Every day, we answer questions about assisted living when discussing cases with our clients and professional referral sources.  We would like to share some of the that information with you in our first blog series, #AssistedLivingBasics.

In this blog post, we will be discussing the costs for assisted living. It comes as a shock to most people to find out that assisted living is NOT paid for by Medicare.  The majority of people pay for assisted living out of pocket (personal funds). The only forms of insurance that can cover assisted living costs are:

• Long Term Care (LTC) Insurance
• Medicaid (ALTCS in Arizona)
• Veteran’s Benefits
• Worker’s Compensation.  

Although assisted living is not easily paid for out of personal funds, it is the most affordable option available for the long term care of a loved one when family members are unable to provide the care their loved one needs on a continuous basis (24 hour care).

The following are general ranges in assisted living for facility based care and for residential care homes:

• Assisted Living Communities/Facilities
  • $3500 - $8000 per month for private room.  Average rate $5000 - $6000.
  • $3000 - $6000 per month for shared suite (roommate). Average rate $4000.
• Residential Assisted Living Homes/Care Homes
  • $3500 - $6000 for a private room.  Average rate $4500 - $5000.
  • $2500 - $3500 for a semi-private (shared) room.   Average rate $3000.

When considering the reason for the rates, there are a few factors to consider: 

• The rate of employee minimum wage was raised to $10.50 per hour in 2018 in the state of Arizona.
• At the starting rate of $2500 per month for a shared room in a residential care home (lowest option available in assisted living) for 24 hour care, which includes meals, laundry service, medication management, etc… it works out to be $83.33 per day, which is $3.47 per hour.  
• Hiring a caregiver through a home care company/agency is about $25.00/hour on average in Arizona in 2018.  This works out to be $600.00 per day, which is $18,000 per month for 24 hours of private duty care daily in the patient’s own home.  Then there is the cost of meals, laundry, etc. to factor in. Most medication management is provided by a nurse from a home health company/agency and can range in cost widely, depending on various factors.  

Although assisted living is not easily paid for out of personal funds, it is the most affordable option available for the long term care of a loved one when family members are unable to provide the care their loved one needs on a continuous basis (24 hour care).

When families or individuals are not able to pay for the costs of assisted living, they can apply for Arizona’s form of Medicaid, which is called: Arizona Long Term Care System, or ALTCS, pronounced “All-Tex”. There are maximum allowable income and asset requirements as well as medical condition requirements which are reviewed by the State of Arizona prior to anyone being approved to receive benefits.  Next week, we will be discussing those parameters in further detail, so be sure to tune in to #AssistedLivingBasics which will be available on Monday, March 26th, 2018.

We hope this information is helpful to you and your family.  If you have any questions or wish to discuss your personal situation with us, please call us at 480-380-2348 or email us at info@adultcareconnection.com