Arizona Medicaid pays for in-home personal care and related services through 2 programs, including the Arizona Long Term Care System (ALTCS) - Elderly and Physically Disabled (EPD) and the ALTCS - Developmental Disabilities (DES Division of Developmental Disabilities). AHCCCS (Arizona Medicaid) delivers long-term care through ALTCS managed care plans rather than separate 1915(c) waivers. Respite is limited to 600 hours per benefit year and spouse-provided attendant care to 40 hours per week, and case manager authorization is required for attendant care, homemaker, personal care, respite, adult day health, and meals. Confirm developmental disability services with the DES Division of Developmental Disabilities.
Which Arizona waivers can a home care agency bill?
Each waiver below lists who it covers, the services it pays for, and how providers bill.
Arizona Long Term Care System (ALTCS) - Elderly and Physically Disabled (EPD)
Population
People who are elderly or have physical disabilities and need nursing facility level of care, including those who live in their own homes or assisted living.
Services covered
attendant care
personal care
homemaker
respite
adult day health
home delivered meals
home health aide
Billing format
Health plans (UnitedHealthcare Community Plan LTC, Banner-University Family Care LTC, Mercy Care LTC) pay claims; HCBS claims go on a CMS 1500 and must match the case manager's authorization, and EVV with data sent to the AHCCCS aggregator applies to attendant care, personal care, homemaker, habilitation, and respite.
ALTCS - Developmental Disabilities (DES Division of Developmental Disabilities)
Population
People with intellectual or developmental disabilities who meet the ALTCS institutional level of care.
Services covered
attendant care
personal care
homemaker
habilitation
respite
Billing format
DDD is the ALTCS health plan for this group; EVV with data sent to the AHCCCS aggregator applies to attendant care, personal care, homemaker, habilitation, and respite.
To bill Medicaid for home care you need a state license, a Type 2 NPI, state Medicaid enrollment and screening, waiver or managed care contracts, EVV and authorizations.
Private pay means higher rates and fast payment; Medicaid means steady volume at state-set rates with authorizations and EVV. Compare rates, cash timing and admin before you mix them.
Track units remaining, the end date and the service code for every client, and check them before each schedule change. Hours over the cap are unbillable.
Four units equal one hour. How to convert units to hours, the common HCPCS codes, how states round partial units, and how to stay inside the authorization.
These free tools are made by the team behind Caregiver Scheduling,
caregiver scheduling software for home care agencies.
Simple pricing
From$199/month
Up to 10 caregivers on Starter, 50 on Growth.
More than 50 caregivers? We'll put together a custom Scale plan for your agency.
