A. As of October 1, 1989, pursuant to A.R.S. 11-293, Pima County will provide long-term care services only for residually eligible members who are redetermined eligible for county-subsidized long-term care services on an annual basis.
B. Residually eligible members are those indigent persons who were receiving county-subsidized long-term care services on September 30, 1989 or who had requested screening by that date, and who either were not determined eligible for long-term care through ALTCS or those initial ALTCS' eligibility subsequently has been discontinued for failure to meet the need for institutional services requirement of A.R.S. 36-2936.
C. All redetermination for county-subsidized long-term care will be based on the applicant's financial and residency status on the date of redetermination.
D. An applicant for redetermination of eligibility for county long-term care shall be considered indigent if he/she:
1. Does not have a gross income prior to deductions which exceeds three hundred percent of the Supplemental Security Income benefit rate established by Section 1611(b)(1) of the Social Security Act;
2. Has resources of all persons in the household not exceeding fifty thousand dollars including, but not limited to, equity in a house or car, with no more than five thousand dollars cash or other liquid assets. However, the foregoing limit on equity value shall not apply if the applicant is severely mentally or physically disabled or sixty years of age or older and otherwise qualified as indigent.
a. The applicant's share of the current principal balance of notes, mortgages and sales contracts will be considered unavailable providing that the transfer of property resulted in the receipt by the applicant of consideration amounting to the fair market value of the property transferred.
b. Any transfer of property occurring within three years prior to the date of redetermination will be disregarded if it would have no effect on eligibility or on the county's lien rights. If the value of the transferred property would have affected eligibility or county lien rights, county eligibility will be denied.
3. Meets the readmission screening requirements for placement in a nursing care institution, supervisory care home or with an adult foster care provider.
E. Financial assistance to such indigent persons shall be in an amount not to exceed the difference between the reasonable cost of the long term care and the person's income available for the payment of such costs.
F. All indigent persons who receive long-term care services pursuant to this chapter shall be required to contribute towards the costs of such care their entire income available for the payment of such costs, with the exception of an amount equal to fifteen percent of the maximum benefit available under Title XVI of the federal Social Security Act, as amended, pursuant to A.R.S. 11-293(B), which amount is to be retained for the personal use of the person.
G. income required for the applicant's spouse or dependents to maintain the household of the couple or the applicant's dependents, including necessary living expenses, shall not be deemed available for the payment of costs of long-term care services within the range and to the extent as follows:
1. The amount actually expended for medical care on a monthly basis;
2. A standard monthly allowance for food;
3. The amounts actually expended on transportation;
4. The amount of monthly payments due on nonmedical term payment debts already established at the time of application.
In no event shall the allowance for the amounts expended in the foregoing exceed fifty percent of the amounts set forth in the most current edition of the "Arizona Statistical Review Urban Family Budget for Maintaining an Intermediate Living Standard," Metropolitan Tucson, adjusted for inflation. An additional nineteen percent may be added for each dependent in excess of one. Any exceptions must be approved by the director of the department of medical assistance or his/her designee.
5. The amount actually expended for maintenance of a residence as follows:
a. In cases when the dwelling is owned, this amount is limited to the mortgage payment including or in addition to principal, interest, taxes and insurance; the average monthly gas, electric, water, basic telephone expenses and garbage.
b. In cases where the member and spouse pay rent for housing, this amount is limited to the amount of monthly rent necessary to maintain the standard of living of the couple at the time of the redetermination;
c. The monthly gas, electric, water, basic telephone expenses and garbage, when not paid by the landlord.
In no event shall the allowance for the amounts in a and b of this subsection exceed the amount set forth in the most current edition of the "Arizona Statistical Review Urban Family Budget for Maintaining an Intermediate Living Standard," Metropolitan Tucson, adjusted for inflation.
H. In instances when it can be verified that an applicant is expected to remain in a long-term care facility for greater than ninety days, but less than one year, the reasonable costs of maintaining the applicant's permanent residence may be deducted from the payment amount. Property maintenance costs include rent/mortgage payments and necessary utility costs and may only be deducted when the residence remains unoccupied.
I. At the county's discretion, certain medical insurances may be maintained by the applicant. Such expenses will be deducted from the applicant's contribution to the county.
J. If a guardian or conservator has been appointed by a court for an applicant, reasonable, documented expenses that are incurred by a guardian or conservator in the course of establishing and fulfilling the guardianship or conservatorship duties shall not be deemed available for the payment of costs of long-term care services.
K. Application, verification and certification procedures shall be the same as those for general care services to the extent applicable, except that the duration for eligibility for long-term care shall be one year unless there is a spouse and/or dependent children, the applicant is living at home at the time of the redetermination or the applicant is AHCCCS MI/MN eligible. In which cases the county long term care expiration date will be the same as the AHCCCS expiration date.
L. During the redetermination process, if the member is incapable of completing the reapplication process for long-term care, and there is no one else willing or able to complete the process, the department will make every effort to procure the needed information and complete the redetermination for the applicant.
M. Patients receiving long-term care services pursuant to this section who are not eligible for AHCCCS medical assistance will be deemed eligible for county-subsidized medical care. The spouse or dependents of patients receiving long-term care services are not deemed eligible for county-subsidized medical care and must apply for such care separately.
N. In the event that a person receiving long-term care services at the county nursing home facility becomes financially ineligible for such services, the Pima long-term care system shall attempt to transfer the person to another nursing care institution or other appropriate setting. Should these attempts prove unsuccessful, the director of Pima health system may allow the person to remain in residence at the county facility. The person will then be charged for the cost of long-term care services provided until such time as the patient again becomes eligible for county payment of these services. If an appropriate discharge becomes available while the patient is financially ineligible for these services, the patient will be discharged and placed accordingly.
O. Pursuant to A.R.S. 11-293(B) and in accordance with state and federal law, Pima County may file a claim against a person's estate to recover paid assistance. The county may also impose liens, in accordance with state and federal law, on the property, both real and personal, of such persons, within the following restrictions:
1. The applicant must be or have been eligible for county long-term care services, and must be required to apply personal income to the cost of care.
2. It must have been established that the applicant cannot reasonably be expected to be discharged or returned home during the remainder of the applicant's lifetime. This determination may be appealed by the applicant.
3. A lien may not be filed against a home if any of the following are lawfully residing in the home.
a. The applicant's spouse;
b. The applicant's child who is under age twenty-one or blind or disabled;
c. The applicant's sibling who has an equity interest in the home and who was residing in the applicant's home for at least one year immediately before the date the applicant is admitted to the county long-term care system.
P. The county may file a lien against a county long-term care patient's property after the patient or his/her representative is notified of the following information:
1. A lien may be filed against the member's property;
2. What is meant by the term lien and its effect;
3. That imposing a lien does not mean the member will lose ownership of property;
4. The procedures for appealing the decision that the member is not expected to leave the facility;
5. That the lien will dissolve if the member is discharged from the facility.
(Ord. 1991-2 § 1 (part), 1991)