Arizona Medicaid HCBS Waivers: How ALTCS Works

If you are searching for Arizona Medicaid HCBS waivers, the program you actually want is the Arizona Long Term Care System, known as ALTCS. Arizona delivers Medicaid long-term care for older and physically disabled residents, both the in-home kind and the nursing-facility kind, through ALTCS, a capitated managed-care program that the Arizona Health Care Cost Containment System (AHCCCS) has run since 1988 and that CMS lists under Section 1115(a) authority. ALTCS is health insurance for people who have an age-related, physical, or intellectual or developmental disability and who need a nursing-facility level of care, and the care it pays for can be delivered in your own home or an assisted-living setting, not only in an institution.1

In This Guide

• What Arizona Medicaid HCBS Waivers Actually Are
• How ALTCS Delivers Home and Community Care
• Who Qualifies for Arizona Medicaid HCBS Waivers
• What ALTCS Covers at Home and in the Community
• How Enrollment Works
• How to Apply for ALTCS

What Arizona Medicaid HCBS Waivers Actually Are

Home- and community-based services (HCBS) is the Medicaid term for long-term care delivered in your own home or community instead of inside a nursing facility. It covers the day-to-day help that lets someone with real care needs stay where they live: help bathing and dressing, help with meals and housekeeping, and hands-on personal care.

Here is the piece that trips people up. Many families expect to find a named Arizona "HCBS waiver" to apply to, the way some states run 1915(c) waivers with their own applications. For older adults and people with physical disabilities, Arizona's route is ALTCS: AHCCCS has covered long-term services and supports through ALTCS since 1988, and its services may be delivered in an institution or in a home or community-based setting, including a member's own home or an assisted-living facility. The application you file is an ALTCS application.1

So when you read "Arizona Medicaid HCBS waivers," read it as a plain-English description of what you are looking for, home and community care paid by Medicaid, and know that in Arizona the door to it is ALTCS.

How ALTCS Delivers Home and Community Care

ALTCS is best understood as health insurance for people who need a nursing-facility level of care, whether or not they ever set foot in a nursing home. Members who qualify do not have to move into an institution. Many ALTCS members live in their own homes or in an assisted-living facility and receive the in-home help they need there.1

Because ALTCS is a managed-care program, the mechanics work a little differently from a fee-for-service waiver. Once you are enrolled, AHCCCS assigns you to one of its contracted managed-care health plans, and that plan arranges and pays for your covered services in your setting. The plan coordinates the in-home caregivers, the assisted-living services, or the nursing-facility care, depending on where you live and what your assessment shows you need.1

Who Qualifies for Arizona Medicaid HCBS Waivers

Qualifying for ALTCS means clearing two separate tests: a functional test about your care needs and a financial test about your income and assets.

The functional test: a nursing-facility level of care

ALTCS is for people who need a nursing-facility level of care. In practice, that means a state assessment finds you need the kind and amount of daily help that a nursing facility would otherwise provide. Meeting this bar is what makes home and community care an option, because ALTCS can deliver that same level of care in your home instead of in an institution.1

The financial test: income and assets in 2026

ALTCS uses the same financial rules as institutional Medicaid. For 2026, the figures for a single applicant are:

• Gross monthly income: in 2026, Arizona ALTCS caps gross monthly income at $2,982 for a single applicant, which is 300% of the SSI federal benefit rate.1
• Countable resources: in 2026, Arizona ALTCS caps countable resources at $2,000 for a single applicant.1

If your income runs above the $2,982 cap, you are not automatically shut out. AHCCCS says an Income-Only Trust, sometimes known as a Miller trust, can allow a customer to qualify for ALTCS when income eligibility is determined using the 300% federal benefit rate gross income test. The trust can be funded only with the applicant's income, should be created only when counted income is more than that 300% figure, and cannot help when AHCCCS uses its net income test instead.2

Married couples get an extra protection. When one spouse applies for ALTCS and the other stays in the community, federal spousal-impoverishment protections set part of the couple's shared resources aside for the community spouse rather than counting it against the applicant. AHCCCS states that for 2026, between $32,532 and $162,660 of the couple's resources may be disregarded. This keeps the at-home spouse from being left with nothing.1 You can read more in our guide to Arizona Medicaid spousal impoverishment rules.

What ALTCS Covers at Home and in the Community

The point of ALTCS is that the covered benefits follow you to wherever you live. Its covered services include AHCCCS medical services, nursing-facility care, home- and community-based services, and hospice care.1

For members who stay at home, the heart of the benefit is what AHCCCS calls Direct Care services. These are the in-home supports that let someone remain in their own home instead of moving into a facility, and they include:

• Attendant care, hands-on help with daily activities.
• Personal care, help with bathing, dressing, grooming, and similar tasks.
• Homemaker services, help with cooking, laundry, and light housekeeping.

Those Direct Care services go to members who need assistance to meet their needs and to stay in their own home.1

One cost note worth understanding early. Someone living in a nursing facility contributes much of their monthly income toward that care, but keeps a personal needs allowance (PNA), which federal law sets at no less than $30 a month for an aged, blind, or disabled institutionalized individual. That floor is a minimum rather than a ceiling, and a state may protect more, as Tennessee does at $70. The PNA is also not the only income protected: federal rules deduct allowances for a spouse or family at home and for incurred medical expenses such as health-insurance premiums, so not everything above the PNA goes to the facility.3 How much of your own income would go toward care in a home or assisted-living setting is a question to put to AHCCCS when you apply, rather than one to assume from the nursing-facility rule. Arizona's specific figure is covered in our guide to the Arizona Medicaid personal needs allowance.

How Enrollment Works

Getting onto ALTCS is a determination. You apply, AHCCCS reviews both tests described above, the functional nursing-facility level of care and the financial limits, and if you meet them, you are enrolled and assigned to a managed-care health plan that arranges your services.1

Timelines and the availability of specific services in your area can change, so confirm the current details for your situation directly with AHCCCS when you apply.

One more thing to plan for. AHCCCS runs an estate-recovery program that seeks to recover the cost of ALTCS services you received after age 55, which can mean a claim against your estate after you pass away. It is worth understanding before you enroll. Our Arizona Medicaid estate recovery guide walks through how it works.1

How to Apply for ALTCS

You apply for ALTCS through AHCCCS, and you have more than one way in. Federal Medicaid rules require the state to accept your application through several channels, including online, by phone, by mail, and in person.4 In Arizona, the two most direct routes are:

1. Online. Register an ALTCS application through Health-e-Arizona Plus (HEAplus), the state's online benefits portal.1
2. By phone or in person. Contact an ALTCS office. The statewide ALTCS number is 1-800-654-8713.1

After you apply, AHCCCS schedules the medical and financial reviews that decide eligibility. Federal rules cap how long that decision can take: no more than 45 days for most applicants, and no more than 90 days for applicants who apply for Medicaid on the basis of disability, except in unusual circumstances such as a delay by the applicant or an examining physician.5 Which cap applies turns on the basis you applied under, not on whether a disability determination happens to arise, so an older adult applying on the basis of age is on the 45-day standard. Both are ceilings on AHCCCS rather than a promised decision date. For a step-by-step walkthrough of the wider process, see our guide to applying for Arizona Medicaid.

Learn More

Find personalized help applying for ALTCS home care at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.