The Arizona Long Term Care System (ALTCS) application collects personal, financial, and medical data to determine eligibility for Medicaid-funded long-term care.
Eligibility requirements: Arizona residents age 65 or older, blind, or with a physical or developmental disability who need nursing-level care. Financial limits on income and assets also apply.
What the form covers: Personal details (name, date of birth, Social Security number), current living situation, medical history, income and asset information, and authorized representative details.
Submission methods: Phone, fax, email, or in person at an AHCCCS office. After submission, ALTCS schedules a needs assessment interview. See the Long Term Care Form and Medicaid Application for related forms.
| Question | Answer |
|---|---|
| Form Name | Application Altcs |
| Form Length | 7 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min 45 sec |
| Other names | arizona long term care application form, arizona long term, application for altcs in arizona, applying to altcs online |
