What Services May ALTCS Help Cover?

ALTCS does not provide a single universal list of covered services that applies identically to every member. Coverage is determined through a combination of factors: Eligibility assessment: AHCCCS evaluates the applicant's functional needs (activities of daily living, cognitive status) and medical needs to determine the appropriate level of care. Care plan: Once enrolled, an ALTCS case manager works with the member and their family to develop an individualized care plan. Services are authorized based on that plan. Health plan assignment: Most ALTCS members are assigned to a contracted ALTCS health plan (such as Mercy Care ALTCS or UnitedHealthcare Community Plan ALTCS). The health plan coordinates and authorizes specific services. Provider participation: Services must be provided by an AHCCCS-contracted provider. Not every provider, facility, or community participates in ALTCS. For authoritative information on covered services, visit azahcccs.gov or contact your assigned ALTCS health plan directly.

For members who qualify and whose care plan supports it, ALTCS may help cover services that allow a person to remain living at home or in a community setting. AHCCCS lists the following among services available to ALTCS members: Attendant care: Support with personal care and related tasks provided by a trained attendant. Personal care services: Assistance with activities of daily living such as bathing, dressing, grooming, and mobility. Homemaker services: Assistance with household tasks directly related to the member's care needs. Adult day health care: Structured daytime programs providing health monitoring, social activities, and support in a community setting. Respite care: Temporary relief for primary family caregivers, provided in-home or in a short-term care setting. Home health services: Skilled nursing visits, physical therapy, occupational therapy, or speech therapy provided in the home, when medically necessary and authorized. Home-delivered meals: Meal delivery services for eligible members whose care plan includes this support. Environmental modifications: In some cases, minor home modifications (such as grab bars or ramps) may be covered to support safe in-home care. The availability and scope of these services depend on the member's assessed needs, their care plan, and health plan authorization. Contact your ALTCS health plan to confirm what is authorized for a specific individual.

ALTCS may help cover the cost of care services provided in an approved residential care setting, which may include assisted living facilities and memory care communities — but there are important limitations families should understand: Care services vs. room and board: ALTCS may help cover the cost of personal care, supervision, and health-related services provided within an approved setting. Room and board (rent, meals, lodging) is generally a separate cost that ALTCS does not cover and is typically the resident's or family's responsibility. Not every community accepts ALTCS: Participation in ALTCS is voluntary for providers. Not all assisted living facilities or memory care communities are contracted ALTCS providers. Families must confirm directly with a specific community whether it accepts ALTCS members. Contract and availability: Even communities that are ALTCS-contracted may have limited availability for ALTCS members, and acceptance may depend on the individual's care needs, their assigned health plan, and the provider's current contract status. Level of care requirements: ALTCS residential care coverage is tied to the member's assessed level of care and care plan. Not every ALTCS member will be authorized for residential placement. Families should contact their ALTCS health plan and speak directly with any community they are considering to confirm participation, availability, and what costs ALTCS would and would not cover.

For members who require a higher level of skilled care than can be provided in a home or residential setting, ALTCS may help cover nursing facility services. AHCCCS lists nursing facility care among ALTCS-covered services. Covered services for eligible members may include: • 24-hour skilled nursing care • Medical supervision and treatment • Physical, occupational, and speech therapy (when medically necessary) • Personal care and assistance with activities of daily living • Social services and discharge planning Nursing facility placement requires medical necessity and authorization through the member's ALTCS health plan. The facility must be an AHCCCS-contracted provider. As with assisted living, room and board costs may be handled separately depending on the member's income, assets, and cost-sharing obligations under ALTCS rules. Confirm nursing facility coverage and participating facilities directly with your ALTCS health plan.

AHCCCS lists hospice as a covered service for ALTCS members. Hospice provides comfort-focused care for individuals with a terminal illness and a limited life expectancy. Services may include: • Pain and symptom management • Nursing and personal care support • Counseling and social services for the member and family • Spiritual care (where available) Hospice coverage under ALTCS requires a physician's certification of terminal illness and enrollment in an AHCCCS-contracted hospice program. Members who elect hospice typically transition away from curative treatment. Confirm hospice eligibility and coverage directly with the ALTCS health plan and AHCCCS.

Case management is a core component of ALTCS and is listed by AHCCCS as a covered service. All ALTCS members are assigned a case manager through their ALTCS health plan. The case manager's role includes: • Conducting and periodically reviewing the member's functional and care needs assessment • Developing and updating the individualized care plan • Coordinating authorized services with providers • Helping members and families navigate available resources • Monitoring the quality and appropriateness of services being provided Case managers do not provide legal, financial, or Medicaid-planning advice, and they work within the framework of AHCCCS rules and health plan policies. For questions about a specific case, contact the assigned health plan directly.

Depending on the member's assessed needs and care plan, ALTCS members may also have access to the following, where authorized: Behavioral health services: AHCCCS integrates behavioral health into its managed care programs. ALTCS members with behavioral health needs may be able to access mental health services through their health plan. Specific coverage depends on the health plan, the member's diagnosis, and authorization. Physical, occupational, and speech therapy: When medically necessary and included in the care plan, therapeutic services may be covered. Authorization is required. Transportation: AHCCCS offers a Non-Emergency Medical Transportation (NEMT) program for eligible members who need transportation to covered medical appointments. Availability and eligibility depends on the member's situation and health plan. Dental services: AHCCCS's covered-services information indicates that ALTCS members may have access to limited dental services — for example, up to $1,000 per contract year — subject to AHCCCS rules and health plan coverage. The annual limit and specific covered procedures may change. Always confirm current dental coverage with your ALTCS health plan. Not all of these services are automatically available to every ALTCS member. Coverage is always subject to medical necessity, care plan authorization, health plan policies, and provider availability. Confirm with your ALTCS health plan what is covered for a specific individual.

ALTCS is a long-term care program, not a comprehensive health insurance plan covering all medical expenses. The following are generally outside ALTCS long-term care coverage, though families should always verify with AHCCCS and the assigned health plan: • Room and board in residential settings: The cost of housing, meals, and lodging in assisted living or memory care settings is generally separate from ALTCS care service coverage. • Acute medical care: Hospitalizations, surgeries, and acute medical treatment are typically covered through the member's separate AHCCCS acute care coverage, not ALTCS long-term care. • Prescription drug coverage and other medical benefits: Prescription coverage may be handled through AHCCCS, Medicare, or the member's assigned health plan depending on the person's overall coverage situation. Confirm with your health plan what pharmacy benefits apply. • Services not in the care plan: Services that have not been assessed as necessary and authorized in the care plan are not covered. • Non-contracted providers: Services from providers who do not have a current AHCCCS contract are generally not covered. • Costs above ALTCS rate limits: Some providers may charge more than ALTCS reimbursement rates allow; any balance above the ALTCS rate is typically not covered. This list is not exhaustive. Always confirm what is and is not covered with your ALTCS health plan and AHCCCS directly.

Coverage under ALTCS is highly individualized. What one ALTCS member is authorized to receive may differ significantly from another member with the same diagnosis, because coverage depends on: • The individual's assessed functional and medical needs • The services included in their specific care plan • Their assigned ALTCS health plan and that plan's current policies • The availability of contracted providers in their area • Current AHCCCS rules and any applicable policy updates SeniorVue cannot determine what ALTCS will or will not cover for any individual. This page is intended only as a general educational overview of the types of services ALTCS may support. Before making any care decision based on expected ALTCS coverage, families should: 1. Contact AHCCCS directly at (888) 621-6880 or at azahcccs.gov 2. Speak with the assigned ALTCS case manager or health plan 3. Confirm directly with the care provider or community whether they accept ALTCS and what costs would apply SeniorVue is not AHCCCS, a Medicaid advisor, a benefits office, a legal advisor, a financial advisor, a medical advisor, or an ALTCS approval service. We do not determine, influence, or predict coverage outcomes.