ALTCS and Community Resources


A little-known and seldom-used section of federal law may provide relief for married couples who have difficulty meeting asset limitation for Arizona Long Term Care System (ALTCS) eligibility. The relatively obscure provision requires ALTCS to increase the value of assets which a “community spouse” is entitled to retain under some circumstances.

Most workers who deal with ALTCS eligibility are familiar with the concept of a “Community Spouse Resource Allowance” (CSRA). When one spouse enters a hospital or nursing home, the community spouse may retain half the assets “available” to the community at the time of admission (plus the residence and some other assets). The maximum amount of this Allowance is usually $72,660.

For some poorer couples, the government’s largesse may permit retention o all (or nearly all) the community’s assets. No matter how little is available at the time of admission, the community spouse is always permitted to retail a minimum of $14,532 in addition to the residence, vehicle and some other assets.

Can You Pronounce MMMNA?

But the maximum CSRA is not really $72,660. The obscure (but highly useful) provision that requires a higher CSRA is found in 42 United States Code Section 1396r-5(e)(2)(C). That law, which is binding on Arizona’s ALTCS program, provides that:

If…the community spouse resource allowance… is inadequate to raise the community spouse’s income to the minimum monthly maintenance needs allowance, there shall be substituted, for the community spouse resource allowance…an amount adequate to provide such a minimum monthly maintenance needs allowance.

But what on earth is a “minimum monthly maintenance needs allowance?” In a different context, Congress decided that a community spouse should be entitled to retain the first $1179 of community income to ensure sufficient funds to maintain basic needs (this number can also be increased in some circumstances). All section 1396r-5(e)(2)(C) says is that the community spouse is entitled to retain enough assets to guarantee that he or she receives that $1179 per month, even though that may be more than the $72,660 (or whatever the CSRA equals in an individual case).

Fair Hearings

There is one catch to the increased CSRA. Eligibility officers are not able to invoke the provision during the initial eligibility application. The higher CSRA can only be granted after a “fair hearing”–usually in the course of an appeal from the denial of eligibility. But since most eligibility workers are unfamiliar with the provision, and since no one is telling applicants to appeal from denials (ALTCS usually just talks applicants into withdrawing applications), many eligible couples may be denied benefits to which they are entitled.

In such cases, it may be advisable for applicants to have legal counsel during the application process and subsequent appeal. Substantial assets may be retained by the community spouse, making the cost of legal advice seem reasonable by comparison.

Safe Return

Demented patients who wander away from home care settings can be very difficult to deal with. For many family members, the fear of losing a wandering family member may make it impossible to keep a patient at home.

While it does not provide a complete solution, the Alzheimer’s Association has come up with a plan to help families deal with anxiety about wandering. The “Safe Return” program provides an identifying bracelet, a national registry, an 800 number contact system, and wallet and garment tag identification for patients prone to wandering. The year-old national program may provide peace of mind for family caretakers, and has the potential to save patient’s lives and permit community placement in more instances. For information about Safe Return, contact the Alzheimer’s Association at (800)272-3900.

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