Paying for Personal Assistance Services

Most people either pay for Personal Assistance Service with their own money or with the support of the Arizona Long-Term Care System (ALTCS). First we’ll describe how you may be able to get ALTCS to pay for your services and then we’ll describe the additional duties you’ll have if you are paying for services on your own.

The Arizona Long-Term Care System (ALTCS)

The Arizona Long-Term Care System (ALTCS) is a public program that supplies some people who are blind, disabled, or over the age of 65 with various services. One of the benefits ALTCS offers to some people is Personal Assistance Services (PAS), so they can live safely in their own homes. PAS can range from assistance with household chores to personal care, such as dressing and bathing. The program is often seen as an alternative to assisted living or nursing facilities.

Eligibility

To qualify for ALTCS, you must meet all of the following requirements:

• Need a nursing home level of care medical and physical needs
• Be an Arizona resident
• Be a U.S. citizen or meet specific noncitizen requirements
• Have a valid Social Security Number
• Apply for any potential benefits
• Meet certain income requirements
• Have less than $2,000 in resources
• Cooperate with the assignment of rights to medical benefits

Note: If your disability began before you turned 26, you can open an ABLE account where you can save up to $18,000 each year and not have it counted by ALTCS. Learn more about ABLE accounts.

If your income and resources are below the income limit and resource limit, and you meet other eligibility criteria, an ALTCS employee will do a Pre-Admission Screening to decide whether your disability qualifies you for ALTCS services.

Not all people with disabilities qualify for these services. For example, many people with disabilities qualify for health insurance through the Arizona Health Care Cost Containment System (AHCCCS) or AHCCCS Freedom to Work, but don’t qualify for the additional services offered by ALTCS.

Application

You can apply for ALTCS by contacting an ALTCS office.

Once you are enrolled in ALTCS, you can get Personal Assistance Services if you:

• Need services that are medically necessary
• Are living in your own home and not in a licensed residential setting
• Are able to make decisions about your own care or have someone who can make decisions for you

You must also need help with one or more of the following:

• Activities of daily living, such as eating, toileting, grooming, dressing, bathing, transferring, mobility, and positioning
• Other common activities, such as meal planning and preparation, managing finances, shopping for essential items, performing essential household chores, communication by telephone and other media, and getting around and participating in the community

How ALTCS Decides if You Need PAS

After you have been screened, if ALTCS decides that you do qualify for long-term care services, you will join a Managed Care Organization (MCO) that will manage your health care and long-term care services. You will be assigned a case manager at your MCO who will evaluate your situation during a home visit and will work with you to figure out what services you need. Depending on your circumstances, Personal Assistance Services (PAS) are one of the services you may qualify for.

If you need PAS, ALTCS will pay for a certain number of hours of personal assistance each week, with the exact amount depending on your needs. For example, if you just need a bit of help a few times per week, ALTCS might pay for just 5 hours per week of assistance. However, if you need a lot of help every day, ALTCS could pay for 40 hours per week of assistance.

The Services You Can Get

Your ALTCS-supplied Personal Care Assistant (PCA) can help you with various things:

• Domestic services, such as sweeping, vacuuming, taking out the garbage, wheelchair cleaning and battery recharging, and changing bed linens
• Related services, such as meal preparation, clean-up, laundry, and shopping
• Personal care services, such as feeding, bathing, grooming, dressing, toileting, and help with medications
• Limited heavy cleaning
• General supervision for individuals with cognitive behavioral health disabilities

These services can let you live in your own home or apartment, giving you the support you need to continue living independently.

How Much You Pay

Typically, you pay nothing if you get Personal Assistance Services through ALTCS. Under limited situations members living in their own home may share in the cost of services. If you need more hours of personal assistance than state programs will pay for, you will have to pay for them yourself.

Your Responsibilities

You, or your representative, will need to make sure that your PCA does what you need. You may have additional responsibilities depending on whether you get your assistant through an agency or hire the assistant on your own.

If your PCA is funded by ALTCS, usually your ALTCS Managed Care Organization (MCO) will contract for your PCA through an agency. Depending on your preferences, you may know somebody who you would prefer to have as your attendant and they can become an employee of an agency or you may prefer to indicate some preferences and let the agency find somebody who has those qualifications. For example, you may request a male assistant or an assistant who can work a split shift.

If you are getting your PCA through ALTCS, you may select the Self-Directed Attendant Care (SDAC) option, which means you could hire a PCA on your own without going through an agency. If you use the SDAC option or are paying for your PCA yourself, you will have to:

• Prepare an outline of duties for the PCA
• Create the PCA’s schedule
• Make a backup plan if the PCA can’t come as planned
• Train your PCA
• Handle all supervision
• Firing your PCA if you are not satisfied with the job he or she is doing

If You Are Paying For Services on Your Own

If you are paying for services on your own, either because you do not qualify to get publicly funded PAS or because you need more hours than state programs will offer, you have the same 2 basic options that are described above:

1. You can hire a PCA through an agency
2. You can hire a PCA on your own

If you hire a PCA through an agency, the agency will help you find an assistant who knows how to do the tasks you need help with. A couple of big advantages of hiring through an agency is that the PCAs they supply have already been trained and if you need a substitute PCA for any reason, your regular PCA is ill, for example, the agency can supply you with a substitute.

If you hire a PCA on your own, you will have the most flexibility, but also the greatest responsibilities. You will have to handle not only all hiring, training, supervision, and possible firing of the attendant, but also all paychecks, taxes, and payroll withholdings. Still, for many people this works best because they get to hire somebody they really know and trust.