The Arizona Long Term Care System (ALTCS, pronounced ALL-Tecs) is health insurance for individuals who have an age related, and/or physical, and/or intellectual/developmental disability, and who require nursing facility level of care. Services may be provided in an institution or in a home or community-based setting.
Those who qualify do not have to reside in a nursing home. Many ALTCS members live in their own homes or an assisted living facility and receive needed in-home services.
The following application includes:
Filing an Application for the Arizona Long Term Care System (ALTCS) - DE-828 | Rich Text Version
Llenando una Solicitud para el Sistema de Cuidados a Largo Plazo de Arizona (ALTCS) - DE-828 | Rich Text Version
ALTCS 1-page Empowerment Tool - English | Spanish
Trusts and ALTCS Eligibility Quick-Reference Guide | Rich Text Version
Click the “How to Apply” link in the left menu for more information about how to apply, covered services, available health plans, and additional resources. For other questions please contact your nearest ALTCS office.
The Home and Community Based Services (HCBS) Needs Tool (HNT) is a standardized assessment tool created by AHCCCS to evaluate the functional and support needs of Arizona Long Term Care System (ALTCS) members who may benefit from receiving certain HCBS to support activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The HNT is used to assess member needs for Direct Care and Habilitation Services.
Direct Care services, which include attendant care, personal care, and homemaker services, are services provided to ALTCS members who require assistance to meet their needs and to allow members to reside in their own home. Habilitation service includes training in independent living skills or special developmental skills, sensory-motor development, orientation and mobility and behavior intervention.
Additionally, AHCCCS has developed an Extraordinary Care Review (ECR) policy to outline the process. Once finalized, AHCCCS will require its health plans, including DDD and the EPD health plans (currently UnitedHealthcare Community Plan LTC, Banner-University Family Care LTC, or Mercy Care LTC), to develop and implement an extraordinary care review process in alignment with AHCCCS policy.
Health plans will ensure that families understand the process and the criteria for requesting an exception. ECR will be available to members who document that they need more direct care or habilitation service hours than assessed, based on the age limits and number of hours documented in the HNT.
In October 2025, Arizona Governor Katie Hobbs announced direction for AHCCCS to ensure that a new, strengthened standardized assessment tool allowed for exceptions for extraordinary care. Governor Hobbs’ announcement increased flexibility for Arizonans with disabilities, including intellectual and developmental disabilities who receive care through the Division of Developmental Disabilities (DDD), and increase transparency while ensuring the program’s continued fiscal sustainability.
Arizona Attorney General Kris Mayes approved AHCCCS’s proposed guardrails through the emergency rulemaking process. This emergency rulemaking process was followed by regular rulemaking to ensure there was public comment to finalize these changes.
The new tool assesses the level of direct care and habilitation services available to children who receive services from ALTCS though DDD and health plans administering the Elderly and Physically Disabled (EPD) program. The new tool is more tailored to children with complex needs and includes an exception process for children whose families may require an ECR.
AHCCCS launched a new HCBS Needs Tool (HNT) on October 1, 2025, and then paused it in mid-October after community concerns. Governor Hobbs directed AHCCCS to pause the HNT for children under 18, create an exception process, and revise the tool.
An Emergency Rule took effect October 15, 2025, allowing AHCCCS to revise policies and launch the Extraordinary Care Review (ECR) process. Health plans (including DDD) returned to using prior assessment tools while revisions were made.
AHCCCS held community forums in Oct–Nov 2025 and received over 4,600 public comments on draft policies.
AHCCCS is pursuing Regular Rulemaking based on the Emergency Rule. The Emergency Rule will be renewed for another 180 days (through October 10, 2026) while the permanent rule is developed.
Based on extensive clinical feedback from developmental pediatricians, OTs, STs, BCBAs, and other clinicians, several age thresholds have been updated:
| HNT Area | 10/15/25 Emergency Rule Language/Age | Proposed Regular Rule Language/Age |
|---|---|---|
| Housekeeping/Cleaning | Shall not be assessed for children under the age of 18 | No change from Emergency Rule |
| Laundry | Shall not be assessed for children under the age of 18 | No change from Emergency Rule |
| Incontinence-Based Laundry | Not included in the emergency rule | Do not assess under the age of four |
| Food Shopping | Shall not be assessed for children under the age of 18 | No change from Emergency Rule |
| Medication Pick Up | No age limitation | No change from Emergency Rule |
| Meal Prep/Clean Up | Shall not be assessed for children under the age of 12 | No change from the Emergency Rule |
| Specialty Meal Prep/Clean Up | No age limitation | No change from Emergency Rule |
| Eating/Feeding | Shall not be assessed for children under the age of 8 | Changed to: Shall not be assessed under the age of 5 |
| Specialty Eating/Feeding | No age limitation | No change from Emergency Rule |
| Bathing | Shall not be assessed for children under the age of 8 | Changed to: Shall not be assessed under the age of 5 |
| Dressing | Shall not be assessed for children under the age of 7 | Changed to: Shall not be assessed under the age of 5 |
| Grooming | Shall not be assessed for children under the age of 8 | Changed to: Shall not be assessed under the age of 5 |
| Toileting | Shall not be assessed for children under the age of 4 | No change from Emergency Rule |
| Specialty Toileting | No age limitation | No change from Emergency Rule |
| Mobility | Shall not be assessed for children under the age of 4 | Changed to: Shall not be assessed under the age of 2 |
| Transferring | Shall not be assessed for children under the age of 4 | Changed to: Shall not be assessed under the age of 2 |
| Attendant Care Supervision | Shall not be assessed for children under the age of 10 | No change from Emergency Rule |
| Specialty Supervision | Not included in the emergency rule | Added as a new task; no age limitations |
| Habilitation | 0-2: Do not assess 3-5: Not to exceed 5 hours in a 7-day period 6-9: Not to exceed 9 hours in a 7-day period 10-12: Not exceed 11 hours in a 7-day period 13-17: Not to exceed 14 hours in a 7-day period |
Changed to: 0-2: Do not assess 3+: No more than 14 hours/7-day period |
The Extraordinary Care Review process has no major changes from the Emergency Rule. AHCCCS is making technical clarifications and adding one key requirement: "Adhere to federal timelines regarding decision making and notification of the outcome to members and families."
April 2026:
Emergency Rule renewed; Regular Rule for another 180 days (through October 15, 2026) while filed with Secretary of State.
April-May 2026:
30-day public comment period on the Regular Rule opens.
May 2026:
AHCCCS hosts a public hearing on the Rule.
May-June 2026:
AHCCCS reviews public comments and refines Rule language.
July-August 2026:
Governor's Regulatory Review Council reviews and formally approves the Rule.
July-August 2026:
Governor's Regulatory Review Council reviews and formally approves the Rule.
August 2026:
Policies finalized; health plans begin readiness work.
Early Fall 2026:
New HNT and ECR policies go live. Families should begin planning now in case service hours change.
Find More Information:
New HNT and ECR policies are anticipated to be effective in early Fall 2026. Families should use the coming months to work with their case managers or support coordinators on plans in case their child's service hours are adjusted. Quarterly meetings with case managers are ongoing — please use them to address any concerns and to ensure your child has all the services they need.
For information about how ALTCS counts resources under The Long Term Care Partnership Program, please review the following document:
Some individuals receive income because they provide personal care or attendant care to an ALTCS (Arizona Long Term Care Services) member who resides in their home. The monies (income) received for providing personal care or attendant care services are NOT counted toward AHCCCS eligibility in some instances.
Income is usually included when determining Medicaid eligibility, however, income earned for providing attendant care or personal care services to an ALTCS member living in the same home is considered a Difficulty of Care payment. Income that meets the conditions of a Difficulty of Care payment is not counted against eligibility for some AHCCCS programs.
AHCCCS uses electronic sources to obtain income information. These sources do not identify income from providing attendant or personal care to an ALTCS member living with the caregiver as difficulty of care payments. Therefore, these payments may not have been excluded in the income calculation.
If you receive Difficulty of Care payments and have been denied or discontinued for being over the income limit, please contact AHCCCS at 602-417-5010 to report this income as Difficulty of Care income.
