Long-Term Care Medicaid in Arizona: 2026 Guide

In Arizona, Medicaid is called AHCCCS (the Arizona Health Care Cost Containment System, said “access”). Long-Term Care Medicaid is the Arizona Long Term Care System (ALTCS), and AHCCCS decides eligibility for it. ALTCS can pay for nursing home care, care at home and care in assisted living. Arizona is an income-cap state, and its penalty divisor depends on the county you live in. This guide explains the 2026 rules in plain language.

At a glance: Arizona 2026 figures

Figures last updated for 2026. Sources are listed at the end of this page.

Figures change periodically. Double-check current amounts with AHCCCS before relying on them.

What Long-Term Care Medicaid covers in Arizona

ALTCS is a managed care program. Once you qualify, you are enrolled with an ALTCS health plan (for older adults and people with physical disabilities, an “ALTCS Elderly and Physical Disability” or EPD plan). A case manager works with you to plan services.

Nursing home care. ALTCS pays for care in a certified nursing facility. You pay part of your income toward the cost each month (your “share of cost”), and ALTCS pays the rest.

Care at home. ALTCS can pay for attendant care, personal care, homemaker help, home health care, adult day health, home-delivered meals, respite and emergency alert systems. Your case manager plans which services you receive based on your assessed needs.

Assisted living. ALTCS can pay for care services in an approved assisted living home or center. It does not pay room and board, which the resident pays.

PACE. Arizona has a PACE (Program of All-Inclusive Care for the Elderly) option in some areas.

Who qualifies

A person generally must:

• be 65 or older, or blind or disabled;
• live in Arizona and be a U.S. citizen or qualified non-citizen;
• be at immediate risk of needing nursing home care. AHCCCS does a Pre-Admission Screening (PAS), an assessment of your medical and functional needs, usually in person;
• meet the income and asset rules below.

Income rules

Arizona is an income-cap state. In 2026, gross monthly income must be $2,982 or less.

If your income is above $2,982, you can still qualify by setting up an income-only trust (Arizona’s name for a Qualified Income Trust or Miller trust). Income above the cap is placed in the trust each month and used toward the cost of care. AHCCCS has rules for how the trust must be set up.

Once you are on ALTCS in a nursing home, most of your income goes to the facility as your share of cost. You keep a personal needs allowance of $149.10 a month, and money can be set aside for a spouse at home and for health insurance premiums. People receiving care at home keep a larger amount for living costs; ask AHCCCS how this is figured.

Asset rules

In 2026, a single applicant can have up to $2,000 in countable resources. For a couple who both need care, the limit is $3,000.

Countable resources include cash, bank accounts, CDs, stocks, bonds, mutual funds, retirement accounts that can be cashed in, life insurance cash value above set amounts and real estate other than the home.

Usually exempt:

• Your home (equity up to $752,000) if you live there or plan to return, or a spouse or dependent relative lives there
• One vehicle
• Household goods and personal belongings
• Burial plots and limited burial funds, within AHCCCS rules

Spousal protections

• Assets: The spouse at home keeps half of the couple’s countable resources, but not less than $32,532 or more than $162,660 in 2026, plus the home, one car and belongings.
• Income: The spouse at home keeps their own income. If it is below the monthly spousal need standard of $2,705 (from July 1, 2026), part of the applicant’s income can go to them. Extra is allowed for high housing costs, up to $4,066.50 a month.

Look-back and penalties

When you apply, Arizona looks back at the 60 months (5 years) before the application date. This is called the look-back period. The state checks whether you, or your spouse, gave away money or property, or sold something for less than it was worth, during that time.

Common examples of transfers that can cause a problem:

• Cash gifts to children or grandchildren, even small yearly gifts. (A gift that is fine for federal gift-tax purposes can still count for Medicaid.)
• Adding a child’s name to a house deed or bank account in a way that gives them part ownership.
• Selling a house or car to a relative for much less than it is worth.
• Paying a family member for care without a written agreement made at the time.

Some transfers are allowed, such as transfers between spouses, or transferring a home to a child who is blind or disabled.

How the penalty works. If the state finds a transfer that is not allowed, it does not deny Medicaid forever. Instead, it sets a penalty period: a stretch of time when Medicaid will not pay for long-term care. The state divides the amount given away by the penalty divisor (the average private pay rate for your county: $9,117.67 a month in Maricopa, Pinal and Pima counties and $8,239.92 a month elsewhere, for October 1, 2026 to September 30, 2027).

Example: In Maricopa County, a $50,000 gift divided by $9,117.67 is about 5.5 months without ALTCS payment for long-term care.

The penalty period starts only once you have applied, are otherwise eligible, and are in (or need) long-term care. This is why gifts made while someone is healthy can still matter years later. If a gift is returned in full, the penalty can be removed.

Estate recovery in Arizona

Arizona’s Estate Recovery Program is run by AHCCCS.

• What is recovered: ALTCS benefits received at age 55 or older. AHCCCS can file a claim against probate or small-estate assets, which can include a home.
• When it is put off: recovery is not made while a qualifying spouse is alive, or if there is a child under 21 or a child who is blind or disabled.
• Hardship waivers: AHCCCS can waive or reduce a claim in some situations. Ask AHCCCS for the current rules.
• Family members and personal representatives can contact AHCCCS Estate Recovery with questions.

How to apply

• Online: Health-e-Arizona Plus. Choose “Long Term Care (ALTCS)” and begin the long-term care registration.
• By mail or in person: using the AHCCCS request form for long-term care services, or at an ALTCS local office.
• The assessment: after you apply, AHCCCS contacts you to schedule an interview and the Pre-Admission Screening.

After you apply. AHCCCS will send you a written notice saying whether you qualify, from what date, and how much of your income goes toward your care each month. If you disagree with a decision, you have the right to ask for a fair hearing. The notice explains how to ask and the deadline for asking. Keep copies of everything you send and receive, and report changes in income, assets or address when they happen.

Gather what you can before you apply. The caseworker may ask for:

• Photo ID, Social Security card and Medicare card
• Proof of age and of U.S. citizenship or immigration status
• Proof that you live in the state (for example, a utility bill or lease)
• Proof of all income: Social Security award letter, pension statements, annuity statements
• Bank, credit union and investment statements (often for the full 60-month look-back period)
• Deeds, property tax bills and the value of any real estate
• Life insurance policies (showing cash value) and prepaid funeral or burial contracts
• Vehicle titles
• Health insurance cards and long-term care insurance policies
• Power of attorney or guardianship papers, if someone is applying for you
• For a spouse at home: their income and assets too, since both spouses’ assets are counted at the start

If you cannot find a document, apply anyway and tell the caseworker. They can explain what else is accepted.

Free public help in Arizona

• AHCCCS and ALTCS local offices: applications, eligibility and the Pre-Admission Screening.
• Area Agencies on Aging: local information on long-term care options and caregiver support.
• Arizona SHIP (State Health Insurance Assistance Program): Arizona’s free Medicare counseling program, through the Department of Economic Security’s Division of Aging and Adult Services.
• Arizona Long-Term Care Ombudsman Program: free advocates for residents of nursing homes and assisted living.

Recent and upcoming changes

A 2025 federal law (Public Law 119-21) makes two changes that affect Long-Term Care Medicaid in every state, including Arizona:

• Retroactive coverage gets shorter on January 1, 2027. Today, Medicaid can pay bills from up to 3 months before the month you apply, if you would have qualified then. For applications from January 1, 2027, this window shrinks to 2 months for older adults and people with disabilities. In plain terms: from 2027, it matters more to apply soon after care starts, so that earlier bills are not left unpaid.
• Home equity cap on January 1, 2028. States will no longer be able to set a home equity limit above $1,000,000 (except for some farm property). Arizona’s 2026 home equity limit, $752,000, is already below the new cap, so this change is not expected to affect Arizona’s limit.

The federal amounts that change each year (for example, the allowances for a spouse at home) will be updated on this page for 2027 once they are published.

State programs

Each program below has its own page with who qualifies, services, how to apply and waiting lists:

• Arizona Long Term Care System (ALTCS)

Frequently asked questions

What is ALTCS? It is Arizona’s Long-Term Care Medicaid program. It pays for care at home, in assisted living or in a nursing home through an ALTCS health plan.

My income is over $2,982 a month. Can I still qualify? Yes, with an income-only trust. Income above the cap goes into the trust each month and is used toward your care.

Why does the penalty divisor depend on my county? AHCCCS uses the average private pay rate for nursing homes, which is higher in Maricopa, Pinal and Pima counties than elsewhere.

How much can my spouse keep? In 2026, half of the couple’s countable resources, at least $32,532 and up to $162,660, plus the home, a car and belongings, and income of at least $2,705 a month.

Does ALTCS pay for assisted living? It can pay for care services in an approved assisted living setting. You pay room and board.

Will the state take my home after I die? AHCCCS can seek repayment for ALTCS benefits paid after age 55, which can include the home. Recovery is put off while a qualifying spouse or a young or disabled child survives.

Figures change periodically. Double-check current amounts with AHCCCS before relying on them.

Sources

• AHCCCS, Filing an Application for ALTCS (DE-828)
• AHCCCS Eligibility Policy Manual, MA0707 (spousal resources)
• AHCCCS EPM, Home Property
• AHCCCS EPM, ALTCS Share of Cost Deductions/C_Share_of_Cost_SOC_Deductions.htm
• AHCCCS EPM, Prior Private Pay Rates
• AHCCCS EPM, Estate Recovery Program Overview
• AHCCCS, ALTCS
• Health-e-Arizona Plus
• CMS, 2026 SSI and spousal impoverishment standards
• Public Law 119-21 (2025)

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.