Understanding the ALTCS Application Process, Pending Period & Approval Requirements

Understanding the ALTCS Application Process: ALTCS ~ "Pending is not a four letter word!"

When speaking with facilities about the ALTCS application and approval process, we often sense a certain reluctance to accept ALTCS-pending cases.  JW understands that a facility’s need for consistent revenue can foster this reluctance.  Even so, accepting ALTCS-pending cases in which there is a strong likelihood of ultimate approval can prevent gaps in payment, a benefit that far outweighs any risk associated with accepting ALTCS-pending cases.

In essence, virtually every resident who enters a facility does so with a “pending” status – whether or not that facility is even contracted with ALTCS.  Put differently, with the exception of those who have unlimited funds, all residents will someday exhaust their resources, and thus require an alternative payer source.  The rate at which a resident exhausts his or her resources can best be described as the burn rate.

There are several variables at play in the burn rate calculation.  For instance, a 99-year old with $600,000 in savings, and who pays $6,000 per month for care, is neither likely to burn through her resources nor require ALTCS.  A resident with $75,000 or less, however, is very likely to burn through her resources, and will ultimately require a payer source to prevent a gap in coverage.  This second example can very much be conceptualized as an ALTCS-pending scenario.

Viewed through the lens that every resident is pending, it makes a lot of sense to focus on managing the burn rate to ensure a consistent revenue stream.  Given that it takes between three and six months for ALTCS to process an application, families who spend down to $2,000 before filing the application necessarily create a gap in coverage.  This is precisely the pending period of which many facilities are afraid. 

The key to preventing this gap is being proactive and initiating the ALTCS process before the money is spent down.  Proper planning can ensure that funds are available during the pending period, and can facilitate ALTCS approval that will generate consistent revenue for the duration of the resident’s tenure at the facility.

Encourage your patients and families to call for a free prescreen with a JacksonWhite Elder Care Advisor before they are spent down in order to prevent any gaps in coverage.   With proper planning, ALTCS-pending cases do not have to be a bad thing.

For more information about Jackson White Elder Law or to download any of their free resources, feel free to visit:  http://www.arizonaseniorlaw.com/resources
http://www.arizonalongtermcare.com or http://www.myAltcs.com