Create your Arizona long term care Application Form from scratch

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Here's how it works

01. Start with a blank Arizona long term care Application Form
Open the blank document in the editor, set the document view, and add extra pages if applicable.
02. Add and configure fillable fields
Use the top toolbar to insert fields like text and signature boxes, radio buttons, checkboxes, and more. Assign users to fields.
03. Distribute your form
Share your Arizona long term care Application Form in seconds via email or a link. You can also download it, export it, or print it out.

Design your Arizona long term care Application Form in a matter of minutes

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Step 1: Access DocHub to set up your Arizona long term care Application Form.

Start by logging into your DocHub account. Try out the advanced DocHub functionality at no cost for 30 days.

Step 2: Navigate to the dashboard.

Once signed in, go to the DocHub dashboard. This is where you'll create your forms and manage your document workflow.

Step 3: Create the Arizona long term care Application Form.

Hit New Document and select Create Blank Document to be redirected to the form builder.

Step 4: Set up the form layout.

Use the DocHub toolset to insert and configure form fields like text areas, signature boxes, images, and others to your form.

Step 5: Add text and titles.

Add necessary text, such as questions or instructions, using the text tool to guide the users in your document.

Step 6: Configure field properties.

Adjust the properties of each field, such as making them required or arranging them according to the data you expect to collect. Assign recipients if applicable.

Step 7: Review and save.

After you’ve managed to design the Arizona long term care Application Form, make a final review of your form. Then, save the form within DocHub, transfer it to your chosen location, or distribute it via a link or email.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.
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Must be an Arizona resident, with the intent to stay in Arizona. Must have a Social Security number. Must make an effort to secure potential primary benefits. Must reside in their personal home, a medical institution or an approved home based community setting.
As of 2024, this is $41,496 for a household with four family members and $20,040 for an individual. If youre over 65, youll need to apply for Medicaid benefits through the ALTCS (Arizona Long Term Care System).
The Arizona Long Term Care System (ALTCS, pronounced ALL-Tecs) is health insurance for individuals who individuals who have an age related and/or physical disability and who require nursing facility level of care. Services may be provided in an institution or in a home or community-based setting.
How Long Does the ALTCS Application Take? The Arizona Long Term Care System (ALTCS) application can take anywhere from 60 days to 6 months to complete. Each application is unique and depends on a variety of factors, including medical and financial eligibility.
While Arizona has a Look-Back Period of five years for nursing home coverage or in-home services through the ALTCS, there is no Look-Back Period or asset limits for Arizona ABD Medicaid applicants. However, ABD applicants should be cautious about giving away their assets.
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Related Q&A to Arizona long term care Application Form

Arizona residents can have no more than 300% of the SSI Federal Benefit Rate (FBR) in monthly income. This means that single applicants (as of 2024) cannot have more than $2,829 in gross monthly pay. Married applicants, with both spouses applying for services, must have monthly income no greater than $5,658.
Statewide, ing to Genworths 2023 Cost of Care Survey, the average monthly cost in Arizona for assisted living is approximately $7,175, though average monthly costs range from $4,575 on the low end to $6,450 on the high end.

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