Home and Community Based Services Arizona

Through ALTCS, Home and Community Based Services Arizona program provides long-term care, support, and services so individuals can live independently in their homes and independent communities. 

The program is designed to assist individuals who would otherwise need to live in an assisted living or nursing home. They also help people with developmental disabilities remain in their homes if they prefer while providing appropriate support and services. 

Through the ALTCS Home and Community Based Services (HCBS) program, the state allows eligible individuals to receive services in their home or in an independent community rather than in a long-term are institutional setting. This article explores what this program offers Arizonans and helps consumers understand eligibility requirements.

HCBS in Arizona

 The 2017 session of Congress passed a bill that revamped how long-term care is funded. The change gave more money to states as part of an effort to take care at home or in non-medical settings more cost-effective care. 

In Arizona’s ALTCS  HCBS program uses a managed care model. Care is provided one of two ways; either be informal caregivers (family members) or formal providers (home care and home health care agencies). 

Under the ALTCS, the family member, even a spouse, can be a paid caregiver. The family member must be hired by a plan provider.

Currently, these are the Approved Plan Providers:

  • Banner Health
  • Mercy Care
  • United Health Care

The Benefits of HCBS Waivers

 The latest data indicates that more than 2.5 million individuals receive services through an HCBS waiver in a typical month. In addition, waivers can be tailored to specific needs, allowing individuals to stay in their own homes instead of being placed into care facilities. 

Additionally, HCBS waiver services can help you save money on transportation and other out-of-pocket costs for care services. These waivers are also crucial for people who need assistance with daily tasks but may not qualify for SSI or Medicaid benefits; certain states have policies in place requiring them to include these benefits when determining eligibility. 

However, these waivers have strict qualification guidelines, so most people must be referred by a medical professional before receiving coverage. 

What Are HCBS Services?

Home-and community-based services (HCBS) are also known as personal care services. The services include:

  • adult daycare
  • adult day health care
  • home-delivered meals and meals at senior centers
  • home health aide
  • housekeeping
  • personal care
  • respite care
  • transportation and
  • visiting nurse

Who Can Receive HCBS Services?

 You must have a disability, which means that you have difficulty performing at least two activities of daily living, even with appropriate treatment, medication, or assistance. The disability must be expected to last six months or longer.

Activities of daily living include:

  • bathing,
  • dressing,
  • toileting,
  • transferring,
  • walking,
  • eating,
  • grooming,
  • and medication management.

Someone over the age of 60 or 18 with physical disabilities may be approved for HCBS, through ALTCS.

If your request is approved, Medicaid will pay service providers directly to provide your HCBS at no cost to you – just like any other Medicaid benefit.

How Do You Apply for HCBS Services?

 The first step to applying for Home and Community Based Services Arizona program is to contact the local Medicaid agency or an ALTCS Approved Representative. The representative should also be a Certified Medicaid Planner™ or CMP™.

A CMP™ can guide you through each step of the process and make sure you are eligible for these services.

You must also be medically approved, be prepared with as many details as possible: who currently helps provide you care and why; what kinds of tasks they do; how often they visit you; etc. 

If possible, give them names and phone numbers to verify everything you say. Ultimately, the ALTCS  medical caseworker will need to understand everything about your personal care situation to decide whether you qualify for ALTCS and home-based services would benefit you more than traditional nursing home care options. 

Your CMP™ will direct and help gather exactly what documents need to be submitted, when deadlines exist for turning in said documents, etc. 

Many applications are denied simply because a deadline is missed.

Where Can I Find a Facility near Me That Provides HCBS Services?

If you’re wondering where to look for home health care services near you, there are a few websites that can help. First, the U.S. Department of Health & Human Services maintains a directory of publicly-funded home health care agencies, searched by state or county. 

You can also find that a Certified Placement and Referral Specialist, CPRS is a great resource to finding the right place for you or a loved one.

Remember that these are all funded by public dollars (that means your tax dollars), in effect the HCBS Program is a long-term care policy that you have paid for with your tax dollars.

The Advantages of the ALTCS Home and Community Based Services Arizona Program

 Looking for care options for a family member can be challenging. (See CPRS)

You want them to receive individualized attention without being confined to a nursing care facility or assisted living care home or community. Here are some of the adviantages of the ALTCS HCBS program. 

  • They offer ways that patients can improve their health and mobility while staying at home.
  • They provide personalized assistance with daily tasks, like cooking meals and bathing. 
  • They help seniors with mobility issues avoid and provide general care such as wound care and pain management if necessary. 
  • There’s typically one caregiver on duty per eight residents compared to one caregiver per five in an assisted living facility. This helps reduce confusion and makes monitoring easier. 
  • The system is flexible, meaning you have full say over your treatment plan along with choices when it comes to scheduling shifts.. 

If you qualify for coverage through ALTCS, which provides financial assistance to qualified applicants, your costs are fully covered for up to 40 hrs a week of home care is generally approved. Though they can approve 50 hrs total it it is not a family member caregiver.

The Different Types of HCBS Waivers

 In Arizona, there are currently three types of HCBS waivers. They are: 

  • Personal Care.
  • Family Care. 
  • State Plan Waivers.

Personal Care

A Personal Care service allows a person to remain in their home, with help from someone who comes regularly (typically at least three times per week). A Personal Care attendant takes care of personal tasks such as dressing, bathing, and grooming. The state pays for only one Personal Care attendant. If a person needs more help than one attendant can provide, Home Health is an option. 

Family Care

Home and Community based services Arizona program covers community-based care for family members. The family member doesn’t have to be a relative; it could be a spouse, child, parent, or other person needing assistance with daily living. 

Services covered by a Family Care waiver include personal care and supervision, respite care, and medical services. Respite care means periodic breaks from regular personal care tasks. 

The goal is to help families avoid caregiver burnout by taking turns providing that support. Respite care can occur in various settings, including senior homes, adult day care centers, and even vacation time. 

State Plan Waivers

The state plan waiver provides services and funding for eligible people under a broad range of medical conditions and functional limitations. Generally, residents must be at least 18 years old and have Medicaid to qualify for a state plan waiver. 

In addition, states are limited to covering no more than 15 percent of their populations using waivers. Currently, nearly all states participate in these waivers. Some states provide eligibility to individuals who need assistance with daily living activities such as eating, bathing, or dressing.

These are called program-specific state plan waivers (PSSPs). Arizona uses PSSPs that provide services and funding for adults with an intellectual disability whose primary source of support is SSI or Medically Needy programs.

Also, keep in mind there are likely overlaps between all three waiver categories mentioned above; therefore, sometimes there could be overlap in which services would apply to which category at a given time. 

These overlaps often depend on federal and state laws concerning Medicaid eligibility and actual funding available via either program for individuals enrolled in these waivers. If additional funds become available, an individual who was previously covered under one program could then move over to another program.

Frequently Asked Questions

What Does HCBS Pay For?

 In Arizona, one service paid by Home and Community Based Services Arizona program is Personal Care Attendant (PCA). PCAs are people who come into your home regularly to help with things like bathing, dressing, cooking, or light housework. 

In most cases, they can also provide companionship and reassurance if you have Alzheimer’s disease or another kind of cognitive impairment that makes living alone difficult. 

They can also act as safety monitors, keeping an eye on you, especially when a fall or another accident could occur. Your doctor must certify that your health needs require PCA services before you can get them. 

Other covered services may include meals delivered to your home, assistance with shopping, and adult day care programs, which offer social activities combined with basic medical monitoring during hours when it would be impossible for caregivers to watch over patients full time.

How Can I Get Help with My Bills Through HCBS Programs?

 If you’re caring for a person who lives in your home, you may be eligible for HCBS (home and community-based services). This program helps pay for care so that you don’t have to give up your job or leave your family to take care of them. 

Depending on your situation, these funds could also hire someone to help with tasks around your house or provide transportation services.

How to Qualify for HCBS?

 Again, to qualify for HCBS, you must have a physical or mental impairment that significantly limits your ability to live independently. The impairment must be expected to last six months or longer, and it must be one of those identified in the law. Your plan provider  will determine if your condition is eligible under HCBS and tell you how much assistance you need. 

Some examples include things like help with bathing, dressing, cooking, or other activities related to daily living (ADLs). If needed, they’ll also assess your need for help with managing money, medications, and basic life skills. 

In addition, you can meet certain requirements by applying for Supplemental Security Income (SSI) disability benefits from Social Security. Individuals who receive SSI are automatically qualified for HCBS services without additional assessments. You may also qualify based on age, income, and type of residence.

Available HCBS Settings

There are many available HCBS settings for people with disabilities. 

  • First, there are group homes for those who would prefer to live in a community home but do not have any family or friends nearby to assist them. 
  • Adult foster care homes allow individuals to have some form of independent living while still receiving assistance from staff or caregivers if needed. 
  • Lastly, there are assisted living facilities where services such as medication management and general personal care can be provided. These facilities will provide skilled nursing and rehabilitation services when necessary but often will only involve medical needs when they occur and are not ongoing issues. 

Once individuals have been approved for Home and Community Based Services Arizona, they may choose their setting based on what is most appropriate for their needs.

Home Care VS Home Health Care

Home Care – is non-medical care.  Homecare assists individuals with the basic activities of daily living, wherever you call home*.  It includes companionship, engagement, transportation to appointments or errands, meal preparation, light housekeeping, laundry assistance, changing the sheets on the bed, assistance with walking or transferring from sitting to standing, assistance with bathing, dressing, and grooming, including personal care and toileting help.  It also includes respite care for family caregivers.  

It’s paid for privately, with long-term care insurance, and in the right circumstances be supplemented by Veteran’s Aid and Attendance.  Medicaid can cover a set amount of non-medical homecare hours if you qualify for ALTCS or AHCCCS with a long-term disability.

Home Health – is medical care. Home health is brought in most typically as a follow-up to hospitalization, procedures, and surgery, or after an extended illness when an individual is not at their peak strength.

It is also very common to follow an extended stay at a rehabilitation facility if patients continued to improve while in rehab.  

It includes medication management, wound care, and many kinds of therapy, including physical, occupational, speech, and behavioral therapy.  Home health is covered by medical insurance if you have a doctor’s order and continue to improve.

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Arizona Care Alliance