Jackson White Law ~ Staying In-Network for Long-Term Care

Staying In-network for Long-term Care

3 June 2015 by JacksonWhite Elder Law  |  Category: Senior News

Question: I filed an Arizona Long Term Care System application for my wife nearly a year ago, and I have had a horrible time trying to manage and understand the process on my own. After many months of working on this process, I am now being told that my wife has to move to a different facility in order to qualify for the benefit. Can ALTCS really tell me where my wife has to live?

Answer: ALTCS will never decide where your wife will live — this is your decision to make. Before ALTCS will approve your wife’s case, however, she must reside in an approved setting.

To clarify, ALTCS is just like any other insurance provider insofar as it will only provide coverage to its members who seek care from an in-network provider. Just like with any other insurer, ALTCS has a network of providers with which it is contracted to provide care.

As long as the setting in which you place your wife has an ALTCS contract, she will be eligible for coverage if she is otherwise eligible for the benefit.

It is worth mentioning that ALTCS contracts with care providers all along the healthcare continuum. There are approved in-home care providers, group homes, day care centers, assisted living facilities and skilled nursing facilities. Further, it is not as if there is a clear demarcation between ALTCS and non-ALTCS facilities — all ALTCS facilities also have non-ALTCS residents; and ALTCS members are given the same level of treatment and care as others.

If the only thing preventing your wife from qualifying for ALTCS is this setting requirement, it would certainly be worth considering moving to an approved setting to help facilitate eligibility. You have many good options available to you, and this benefit is too valuable to forgo.

Richard White is an elder law attorney at JacksonWhite Attorneys at Law. For more information on Elder Law at JacksonWhite, please visit www.ArizonaSeniorLaw.com.

Preserving Resources for Well-Spouse

Preserving Resources for Well-Spouse

Question: I was told that my ALTCS application was denied because I, the “well spouse”, had more than the one-half of the marital resources that ALTCS allows a well spouse to keep.  We are now in the process of reapplying, but now that I have spent my spouse’s one-half, I will also spend much of my spouse’s one-half during the months in which the new application processes.  Could this dilemma been prevented?

Answer: Given that ALTCS can take several months to process an application, the issue of who will pay for care while the application processes oftentimes arises.  In cases in which the applicant is married, the concerns are at least two-fold:  Obtaining care for the applicant is of paramount importance, but it is also critical that the well spouse preserves enough funds to sustain the quality of life to which he or she is accustomed.

The best way to preserve resources for a well spouse is to make sure that everything is in order before submitting the application.  It could take ALTCS several months to process an application, whether or not the application is ultimately approved.  And if ALTCS denies the application, you will have lost those months in which the application processed, and have to start the process anew.

While the general rule is that a well spouse can keep about one-half of the marital assets, there are oftentimes planning strategies to help the well-spouse maximize his or her resources.  But here again, the best way for a well spouse to accomplish this goal is to be proactive and engage in planning well before submitting the application to ALTCS.

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