Jack is 56 years old and has cerebral palsy. He has been living alone for a number of years and is having an increasingly difficult time taking care of himself and his home. Tasks like cooking, bathing, and getting dressed in the morning take far more energy than they used to.

Jack has become depressed about the situation. He is very independent and has always prided himself on his ability to take care of his affairs on his own. The last thing he wants to do is move into an assisted care facility, but he doesn’t know what else he can do.

He explains his situation to his friend Guillermo over lunch one day. Guillermo suggests that he talk to his Arizona Health Care Cost Containment System (AHCCCS) case worker and see if she has any ideas for him.

So Guillermo and Jack go online to find the phone number for the local DES/Family Assistance Administration office, which is the office that handles AHCCCS Health Insurance for people with disabilities. Jack calls and is transferred to an eligibility worker, Darlene. Jack briefly explains his situation to her.

“It’s good that you called,” says Darlene. “The state of Arizona actually has a program that supplies Personal Assistance Services (PAS) for people who need them. Personal Assistance Services include helping with stuff like cooking, cleaning, and getting in and out of bed.”

“Hmmmm. Sounds like it could be really helpful,” Jack says.

Darlene explains that to get these services, Jack will need to apply for services from the Arizona Long-Term Care System (ALTCS). She explains that not all people with disabilities qualify for ALTCS, only people who are at risk of being institutionalized.

This makes Jack nervous, because he doesn’t want to go to an institution. But Darlene tells him that ALTCS does not mean you have to go to an institution. It just means that the program recognizes that your disability means that you should get services that go above and beyond what standard AHCCCS services offer. She explains, “If you qualify for ALTCS, they’ll review your situation and may recommend that you get Personal Assistance Services so that you can keep living at home.”

“First,” Darlene says, “go ahead and apply for ALTCS. You can do that by calling or visiting your local ALTCS office. When you apply, you’ll have to give information about your income and resources and also tell them about your disability. If you meet the income limit and the resources limit for this program, you’ll be scheduled for a Pre-Admission Screening. During the screening, they’ll decide if your medical condition qualifies you for ALTCS.”

“If you do qualify,” she continues, “you will be accepted into the ALTCS program and assigned to a Managed Care Organization (MCO). You’ll have a case manager at the MCO, who will review your situation and decide what services you need from ALTCS.”

Jack interrupts Darlene at this point with a question, “If I’m approved for ALTCS, does it cost me anything?”

“Not usually. Most people on ALTCS living in their own home don’t have to share in the cost of services,” says Darlene.

“Well, that’s good news,” says Jack.

“It sure is,” agrees Darlene.

Jack goes home, gives ALTCS a phone call the next day, and goes into the ALTCS office the following week when he has some time. He fills out the application while he’s there.

Two weeks later, he gets a call from an ALTCS representative requesting additional documentation. The representative explains, “You can only get ALTCS services if your disability requires the level of care a nursing home would offer. To figure out whether you qualify, we need to schedule a time to come to your home for a Pre-Admission Screening.”

ALTCS does the screening and says that Jack probably will qualify for ALTCS services. After the screening process, Jack asks when he will start getting services. The person who did the screening says that he will get an official letter in the mail within a couple of weeks from ALTCS that will tell him if he is eligible or not. If he is eligible, a Managed Care Organization (MCO) will contact him to set up a meeting in his home to explain to him exactly what services he qualifies for.

Sure enough, 2 weeks later, Jack gets a letter from ALTCS that says he qualifies. Another week later, his case manager, Raven Smith, calls him to schedule a home visit so she can talk to him and they can figure out the exact services that he needs from ALTCS.

Jack schedules the visit and later that week, Raven comes to visit him at his home. She is there to do an in-home interview to figure out what Jack needs help with and how many hours of assistance ALTCS will pay for. She asks him a series of questions about his physical and mental abilities to figure out which tasks he can safely perform on his own and which tasks he needs help with.

Clearly, what Jack needs help with are physical chores, like cooking, cleaning, getting dressed, and getting in and out of bed. Raven decides that Jack needs 20 hours of Personal Assistance Services (PAS) each week. She tells Jack that she can contract with a local PAS agency to help find him a Personal Care Assistant (PCA) or he can look for one on his own and be responsible for hiring, firing (if necessary), and supervising that person. Either way, someone else would take care of handling any taxes and the personal assistant’s paychecks.

Jack is thrilled. He decides that he’d prefer to hire his own assistant, so he signs up for the Self-Directed Attendant Care (SDAC) option. Then he hires Wendy, a retired neighbor and long-time friend to supply the services. Wendy comes by every day to help Jack in and out of bed. She prepares meals for him, cleans, and does some of his laundry. She also offers personal care services like dressing, grooming, and bathing.

It turns out to be a great arrangement. Wendy enjoys the part-time work and Jack is extremely grateful for the help. His depression has lifted, he has more energy than he used to, and he is thrilled to be able to continue living in his own home.