ALTCS Eligibility: Income, Resources, and Medical Screening

To qualify for Arizona’s Long Term Care System, you have to meet three sets of ALTCS eligibility requirements at the same time: medical (you need a nursing-facility level of care), financial (income at or below $2,982 per month in 2026 and countable resources at or below $2,000 for a single applicant), and non-financial (U.S. citizenship or qualified immigration status, an Arizona residence, and a Social Security number).¹ Missing any one of the three means a denial, even if the other two are clearly met.

Who the Program Is For

ALTCS serves four groups: people age 65 and older, blind individuals, people with physical disabilities, and individuals with developmental disabilities.² You don’t have to be a senior. Younger adults with a qualifying disability are eligible, and children with developmental disabilities can qualify through a separate referral.

Beyond fitting one of those categories, the non-financial basics are straightforward. You must be a U.S. citizen or a qualified immigrant, have (or have applied for) a Social Security number, and physically live in Arizona with the intent to stay.² There’s no minimum time in the state, but you cannot keep a primary home elsewhere.

If You’re Applying Based on a Developmental Disability

Applications tied to a developmental disability that began before age 18 route through the Division of Developmental Disabilities (DDD) before ALTCS finishes processing. Qualifying conditions include autism spectrum disorder, epilepsy, cognitive or intellectual disability, cerebral palsy, and Down syndrome. Children under six who are medically at risk for a developmental disability also need the DDD referral.³

ALTCS will send authorization forms that must be signed and returned within 15 days. Miss the deadline and the agency will assess you using the standard elderly-or-physically-disabled criteria, which may not reflect your actual needs.³

Medical Eligibility: The Pre-Admission Screening

ALTCS won’t take your word for the fact that you need long-term care. A nurse or social worker conducts a Pre-Admission Screening (PAS) to decide whether you require a nursing-facility level of care. The screener evaluates how much help you need with daily activities like bathing, dressing, eating, toileting, and moving around, and also reviews your medical diagnoses, medications, and behavioral health history.

Each area is scored and weighted, then combined into a total. For elderly and physically disabled applicants, the threshold is 60.⁴ Higher scores signal a greater need for professional intervention. Applicants with developmental disabilities are assessed on a different scale.

You can’t cram for the PAS, but the medical record you bring to it matters. If your doctor’s notes don’t describe the daily assistance you actually require, the screener may underestimate your needs. Hospitalization records, therapy notes, and detailed physician statements about functional limitations all feed into an accurate score.

Income: $2,982 Per Month in 2026

ALTCS caps countable income at 300% of the federal SSI benefit rate. In 2026, that works out to $2,982 per month for an individual.⁵⁶ Go a dollar over and you’re technically ineligible, no matter how severe your medical need.

The state counts gross income before any deductions for taxes, health insurance premiums, or Medicare Part B. Social Security, pensions, annuities, rental income, and wages all count. For married applicants, only the applicant’s own income is typically counted; the non-applicant spouse’s income is generally protected.

The Miller Trust: A Workaround for Income Just Over the Limit

If your income runs above $2,982, an Income Only Trust (commonly called a Miller Trust) can still get you eligible. It’s an irrevocable trust into which you deposit your excess income each month. Once the income flows into the trust, it no longer counts toward the eligibility limit.⁷

Arizona’s rules are specific. You must be the trust’s primary beneficiary, and AHCCCS must be named as a remainder beneficiary. A separate bank account titled to the trust has to be opened with a zero balance, only your income can be deposited into it, and deposits have to happen in the same month you receive the income. Direct deposit is required unless the income source won’t allow it.⁷ Whatever remains when you die or the trust ends goes to AHCCCS up to the total amount the program spent on your care.

Getting a Miller Trust drafted correctly usually means working with an elder law attorney. A poorly drafted trust can be rejected outright, and depositing income late or into the wrong account can jeopardize eligibility going forward.

Resources: The $2,000 Limit and What Doesn’t Count

Countable resources cannot exceed $2,000 for a single applicant. For a couple where both spouses apply, the combined limit is $3,000.⁸ Those limits have not moved in decades and are far lower than most applicants expect.

Not every asset counts, though. Key exclusions:

Your home, if you, your spouse, or a dependent lives there and the equity is below approximately $752,000.
One vehicle used for transportation.
Burial plots held for you, your spouse, or immediate family.
Up to $1,500 in a designated burial fund, plus any appreciation while you remain eligible.
Household goods and personal effects.
Term and burial insurance. Cash-value life insurance is excluded only if the total face value across all policies is $1,500 or less per insured person.

These exclusions come directly from Arizona’s resource rules and mirror many federal Medicaid standards.⁸

Protections for the Community Spouse

When one spouse needs ALTCS and the other stays at home, the rules shift so the healthy spouse isn’t financially wiped out. The community spouse keeps a protected share of the couple’s combined assets, called the Community Spouse Resource Deduction. For 2026, that share ranges from a minimum of $32,532 to a maximum of $162,660.⁹

The math: the state totals all assets owned by both spouses on the first day the applicant enters a care facility or otherwise becomes institutionalized. The community spouse’s share is half that total, subject to the $32,532 floor and $162,660 ceiling. Anything above the protected share must be spent down to reach the applicant’s $2,000 individual limit.

The community spouse also receives a monthly income allowance drawn from the institutionalized spouse’s income, so the at-home household doesn’t lose its income entirely. If the community spouse’s own income is low, more of the applicant’s income can be redirected before the share of cost is calculated.

The Five-Year Lookback

ALTCS reviews every asset transfer you’ve made during the 60 months before your application date. Money given away, property sold below market value, or assets transferred without fair compensation trigger a penalty period during which the program won’t pay for your care.

The penalty is the uncompensated value divided by Arizona’s Private Pay Rate for your county. For October 2025 through September 2026, that rate is $8,666.72 per month in Maricopa, Pima, and Pinal counties, and $8,132.22 per month in all other counties.¹⁰ A $50,000 gift by a Maricopa County resident produces a penalty of roughly 5.8 months ($50,000 ÷ $8,666.72). The partial month converts into days, so you’d sit out five full months plus about 24 days.

Timing is the trap. The penalty doesn’t start when you make the transfer. It starts on the date you’re first approved for ALTCS and would otherwise begin receiving services. You can give away assets three years before applying and still face months without coverage after approval, while already in a facility. Planning around the lookback is one of the most consequential parts of ALTCS preparation.

How to Apply

The paperwork is the heaviest lift. Before you submit anything, gather:

Proof of citizenship or immigration status: original birth certificate or U.S. passport.
Photo ID and Social Security cards for the applicant, and spouse if applicable.
Consecutive monthly statements for every checking, savings, and investment account covering the full 60-month lookback period.
Social Security award letters, pension statements, and any other proof of monthly income.
Deeds for real estate, vehicle titles, and documentation for life insurance policies.

The application form is available from the AHCCCS website or a local long-term care office. Use exact figures from your documents. Discrepancies between the form and the supporting evidence are one of the most common causes of delay. Submit by mail, fax, or in person, and keep a receipt or delivery confirmation.

After submission, a caseworker schedules the Pre-Admission Screening and reviews your finances. The typical decision timeline is about 45 days.¹¹ Stay reachable. If the caseworker asks for extra records and you don’t respond quickly, the clock keeps ticking toward a denial rather than an approval.

If you’re approved, ALTCS may cover eligible medical costs incurred during the three months before your application date, provided you would have qualified during those months.¹² Keep receipts and billing statements from that window so they can be submitted for reimbursement.

Eligibility Isn’t Permanent

ALTCS reviews every case every 12 months to confirm you still meet the medical, financial, and non-financial requirements. AHCCCS sends a renewal packet or notification, and you have to complete and return it even if nothing has changed. Report changes in address, phone number, income, or household size between renewals. If you miss a renewal notice, coverage can lapse, and getting it back means starting the application over.

1
Arizona Health Care Cost Containment System. Arizona Long Term Care System
2
Arizona Health Care Cost Containment System. Filing an Application for the Arizona Long Term Care System
3
Arizona Health Care Cost Containment System. Health Insurance for Individuals With Developmental Disabilities
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Arizona Health Care Cost Containment System. Preadmission Screening Criteria for an Applicant who is EPD
5
Legal Information Institute. Arizona Code R9-28-408 – Income Criteria for Eligibility
6
Social Security Administration. SSI Federal Payment Amounts
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Arizona Health Care Cost Containment System. ALTCS Policies On Special Treatment Trusts
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Legal Information Institute. Arizona Code R9-28-407 – Resource Criteria for Eligibility
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Arizona Health Care Cost Containment System. Arizona Long Term Care System Policies on Community Spouse
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Arizona Health Care Cost Containment System. Transfer Penalty Period
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Arizona Health Care Cost Containment System. ALTCS Services and Benefits
12
Arizona Health Care Cost Containment System. Retroactive Coverage (also called Prior Quarter Coverage)