Many applicants want to know how long does it take to get approved for ALTCS.
Our average claims approval is 47 days, well below the 60-day statewide average. Here I will explain why our average claims approval is below the statewide average.
Let me tell you about one of my cases.
The person needing long-term care was already ALTCS medically approved. Still, the ALTCS financial caseworker denied her claim because she was over the “Individual Resource Allowance.” She had more than $2000 in countable assets.
A new memory care community had opened less than a year before in her area and required new residents to private pay for three years before moving or rolling on to ALTCS as a payor source.
My resource partner, who helps with senior housing placement, told me that the place had already set aside five beds with no waiting. Lifting the private pay requirement on those five beds was a unique opportunity for someone who would otherwise never been able to afford care in such a beautiful setting.
So once hired by the family, I corrected the application, quickly used a couple of legal ALTCS planning strategies, and reapplied for ALTCS three days later.
The application was approved four days after I sent in the application!
This might be hard to believe, but it’s true. I was able to get the application approved very quickly.
Keep in mind that four days is not the average processing time. I worked closely with the ALTCS financial caseworker. I told her about the new memory care community and that it had reserved five beds for ALTCS with no private pay requirements. The ALTCS caseworker was terrific and together we pushed the case through.
Each client and each situation is unique, so the processing time will vary from case to case.
How long does it take to be approved for ALTCS?
ALTCS has strict deadlines that the State agency should adhere to. Notice I said should, not would.
See 42 C.F.R. § 435.911. It clearly states that the state agency must decide within 45 days, or 90 for a disabled person.
But even though the law says 45 days, the Covid Efficiency Waiver Program gives the State of Arizona additional time.
The Covid Efficiency Waivers apply to governmental agencies, not to applicants.
So Covid Efficiency Waiver, has lengthened the actual average for most applications to nearly 60 days.
These extra days are costing you money!
Common reasons for delayed applications and how you can avoid them.
Trusts delay claims
All trusts need to be reviewed by P.M.C., referred to as the “Policy Department” by the ALTCS. This review process can take up to three weeks to complete.
In addition, besides the review process, the caseworker asks for banking information about the trust. They may ask for up to five years of trust bank records, as they do with all bank accounts. Generally, though, this is not done for a non-trust account, where it is more common when a living trust is involved. [JG1]
As soon as you decide to file a claim, you can start to gather the five years of trust banking history that the caseworker will request.
ALTCS will want a copy of the entire trust, including all amendments and codicils, not just the “Certificate of Trust.”
You will also need “Schedule A.” In Arizona, a Schedule A or Schedule of Assets is not required to be part of a living trust. But ALTCS will need one. Our office will assist with this as part of our service to help complete the ALTCS claims process.
Life Insurance and Annuity Values
ALTCS will require full disclosure of cash value and annuity values, and income from these contracts. Depending on the insurance company, getting this required information can take seven days [JG2] to two months.
It is best to obtain this information as soon as you have decided to file for ALTCS benefits.
Here again, our office will assist in obtaining these needed statements and in contacting the insurance company to make the request.
ALTCS requires a current statement for all pension and annuity payment income streams.
One company made it so difficult to get the needed information that we could not provide the information by the deadline.
The claim was denied and had to be reopened, costing the family thousands of dollars!
It is hard to anticipate a company will be hard to work, and delays like this may be unavoidable, so it is best to start the process as soon as possible.
Our office will assist in obtaining the needed statements and in contacting the pension administrators and insurance companies to make the request.
If you are married, you may be able to have the income paid to your non-institutional spouse, at-home spouse, or sometimes called the “well spouse.” The non-institutional spouse can have unlimited income, using this income for their living expenses. This is called “The Name on the Check Rule.”
Not all pension administrators and annuity companies will accommodate your request, but there’s no harm in asking. We will help in requesting this change of payee.
Veterans benefits can delay the ALTCS claim.
Per Title 42, Medicaid/ALTCS is the payor of last resort. So if you are eligible for V.A. benefits, you are required to apply for them. Not doing so will cause your claim to be denied, delaying the process. Knowingly not filing for them is Medicaid fraud!
Don’t let this be the reason your claim is delayed.
Be sure that the organization you are using to help with your ALTCS claim is legally able to help you with V.A. claims.
The Veterans Administration regulation under 38 U.S.C. § 5901, states:
“… no individual may act as an agent or attorney in the preparation, presentation, or prosecution of any claim under laws administered by the Secretary unless such individual has been recognized for such purposes by the Secretary.”
Care Funding Solutions® owner Steve Dabbs, CMP™, is a V.A. Accredited Claims Agent and can expedite this process without losing time, meeting this ALTCS requirement.
If denied, do I need to wait 30 days to reapply?
Nowhere in the regulations does it say that you must wait 30 days to reapply. This statement has appeared other websites, and it’s misinformation.
You can reapply the same day if you have everything ready. If ALTCS denied your claim because you didn’t have a requested requirement in your previous application, be sure to have it when you reapply.
Should I hire a Certified Medicaid Planner™?
Delays cost you money. If the ALTCS claim isn’t monitored closely, it can miss the deadline. A week can fly by if systems are not in place to keep track of the claim.
Our system is specifically designed to do just that, which means we can keep a close eye on your claim, making the cost of our service well worth the price.
Our fee is a quarter of what a law firm will charge for the same services.
One reason these delays cost you money is that on January 1, 2021, at least 12 states, including Arizona, received a waiver to the federal law that stopped the coverage from being retroactive up to 90 days.
If you are in a skilled nursing facility in Arizona, your coverage is still retroactive.
Under the Home and Community Based Services (HCBS) Program, assisted living is only retroactive back to the first day of the month of approval!
Let’s say that it is near the end of the month and your claim is not approved yet. We will do everything possible to push the claim along to get an approval before the end of the month so that month is not lost. A one-day delay could require you to pay the total cost for care for all 30 or 31 days of that month.
This one-month delay is easily double what it costs to hire a Certified Medicaid Planner™. So our services are, in effect, a zero net cost to you!
Here is another way we help to save you money. Once you apply, you have 15 days to provide the information. The ALTCS caseworker mails or emails it within 24 hours. Sometimes it takes up to three days. [JG3] Plus, if they use standard U.S. mail to send the application requirements, it Is up to seven additional days before you receive the application and list of requirements.
Our office anticipates these potential delays and assists clients in gathering the standard requirements needed on every application, so we do not lose any precious time.
Then once we receive the requested items from ALTCS, we only need to attach any additional ones to the file and then the case is ready to submit.
The 15 days is part of the 45 days the caseworker has to complete the application process. But again, they often take longer.
Caseworkers at ALTCS can cost you money too! Some caseworkers are more experienced than others. I can tell almost immediately when I am working with a newbie!
Newbies and often misinformed about regulations, but a layperson would not know this.
These newbies can cause delays and even deny a claim that should be approved. But if you are unfamiliar with the regulations, there is no way for you to know that your application was processed incorrectly.
A Certified Medicaid Planner™ knows the rules and will call their supervisor if needed to stop errors from being made.
We can AVERAGE the 47 days because we know what to expect and keep very close tabs on the application processing, including contacting the caseworker and their supervisor throughout the application process.
When deciding whether to hire a Certified Medicaid Planner™, keep in mind that the fee charged is an allowable expense for ALTCS and is included in the overall spend-down that may be required to qualify.
So as I often say, “You will spend the money anyway to qualify for ALTCS. You might as well use some of it to hire a Certified Medicaid Planner; it will save you money in the long run.”
At Legal Document Solutions, 100% of our full-time staff are Certified Medicaid Planners™, meaning that they are also Certified ALTCS Planners.
Cecilia Dabbs is a Certified Medicaid Planner who can help you to qualify for ALTCS. Now you got all information about how long does it take to get approved for ALTCS.
We a passionate about serving our clients. Call us today!