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Did you know that many advance directives don’t include the authority to make mental health decisions? That’s why it’s vitally important to protect yourself and your loved ones.

The mental healthcare power of attorney, or POA, is probably the least known of the advance directives. As with healthcare and financial powers of attorney, this document is critical for all Arizonans, regardless of age or health status.

Mental health POAs are important in ensuring your loved one gets effective care. Without a mental health POA, family members and friends stand by helplessly when a loved one experiences an episode of mental illness, unable to intervene until their loved one’s condition deteriorates severely enough to meet state law standards for involuntary commitment and treatment. A mental health POA is also important because it can ensure you know your loved one’s wishes in advance and have the authority to carry them out.Did you know that many advance directives don’t include the authority to make mental health decisions? That’s why it’s vitally important to protect yourself and your loved ones.

Without a mental healthcare POA, if inpatient behavioral health treatment is required and you’re unable or unwilling to accept treatment, the only other option is for someone to pursue an emergency guardianship.

Power of Attorney is a legal instrument that delegates an individual’s legal authority to another person. If an individual is incapacitated or mentally incompetent, the POA assigns a trusted party to make decisions on his or her behalf.  It’s hard to argue that anyone does not need a power of attorney.  Here’s what you need to know about putting a power of attorney in place.

Many Power of Attorney documents are “durable.”  The word “durable” means the Power of Attorney will still be effective  even if the principal becomes mentally incapacitated. A Durable Power of Attorney must state that “this Power of Attorney shall not be affected by the subsequent disability or incompetence of the principal” or similar words. The powers you give to your attorney-in-fact will remain effective even though you are unable to give your agent instructions.  Without these special words, your agent will not be able to use the Power of Attorney when you are unable to manage your own affairs, which is when most people want it to be used.

When you give someone a Power of Attorney, you still have the right to control your money and property.  However, you are giving your attorney-in-fact the ability to access your money.  Your agent is not supposed to take or use your money without your permission, but there is a risk that a dishonest or unscrupulous agent might steal your money.  It is therefore very important to choose an agent you trust.

Such a legal document can help you protect your right to make medical choices that influence your life and the lives of your loved ones. It can protect your family from the stress and responsibility of having to make difficult choices about your medical care. It can even help your physician by providing specific guidelines for your care. If you would like more information about establishing a Durable Power of Attorney for Health Care, talk to your physician, attorney, or other appropriate person.

living will, also called a directive to physicians or advance directive, is a document that lets people state their wishes for end-of-life medical care, in case they become unable to communicate their decisions. It has no power after death. Living will can give invaluable guidance to family members and healthcare professionals if a person can’t express his or her wishes. Without a document expressing those wishes, family members and doctors are left to guess what a seriously ill person would prefer in terms of treatment. They may end up in painful disputes, which occasionally make it all the way to a courtroom.

By planning ahead, you can get the medical care you want, avoid unnecessary suffering and relieve caregivers of decision-making burdens during moments of crisis or grief. You also help reduce confusion or disagreement about the choices you would want people to make on your behalf.

Advance directives aren’t just for older adults. Unexpected end-of-life situations can happen at any age, so it’s important for all adults to prepare these documents.

 

Buy long-term care insurance. A long-term care policy pays a specified daily amount for nursing home care for a specified number of years or for the policyholder’s lifetime. It typically covers care in other settings as well, such as the home or an assisted living facility.

Many long term care insurance policies have limits on how long or how much they will pay. Some policies will pay the costs of your long term care for two to five years, while other insurance companies offer policies that will pay your long term care costs for as long as you live—no matter how much it costs. But there are very few that have no such limits.

Many experts are lukewarm about such insurance. The policies are complicated, the language is often confusing, and the Oracle itself would be baffled by the significant decisions that must be made. Take timing. Is it better to buy at a younger age, when premiums are cheaper, recognizing that you’ll likely write premium checks for decades before you need to tap the coverage—if you ever do? Or is it wiser to wait and buy when coverage is more expensive but you’re closer to when you’ll need it? A policy that pays out $100 a day for three years would cost an average 55-year-old $709 in annual premiums, according to the American Association for Long-Term Care Insurance. That same policy would cost a typical 65-year-old $1,342. If your family is stocked with hale and hearty 85-year-old marathoners, you may want to delay. On the other hand, if cancer runs in your family, you might want to consider buying on the earlier side. And although three years of coverage may be enough for an average long-term stay, are you willing to risk the possibility that you’ll need five or 10 years?

 

What is ALTCS?

ALTCS is the State of Arizona’s Medicaid program that provides long term care services, at little or no cost, to financially and medically eligible Arizona residents who are aged, blind, disabled, or have a developmental disability.

This information sheet provides general information about the ALTCS application process and includes basic program requirements about residency, age, disability, and citizenship status, as well as general guidelines for financial eligibility which includes resources and income.  You must also meet medical eligibility requirements. This is a guide only. Additional information sheets about Community Spouse rules (that apply when you are legally married), trusts and transfers are available upon request.  For more specific questions, contact an ALTCS office.

How do I apply for ALTCS?

•   To apply, you need to complete an application.

•   To start an application, call your local ALTCS office.

•   Another person can act on your behalf during the application process.

• You will need to provide documents to show that you meet financial and non-financial eligibility requirements.

•   You must be determined as needing a nursing home level of care.

What are the NonFinancial Eligibility Requirements?

To be eligible for ALTCS, you must:

•   Be determined in need of a nursing home level of care as determined by AHCCCS;

•   Be a citizen or qualified immigrant;

•   Have a Social Security Number (SSN) or apply for one;

•   Be an Arizona resident;

•   Apply for all cash benefits that you may be entitled to, such as Pensions or VA benefits;

• Live in an approved living arrangement, such as your own home, or an AHCCCS certified nursing facility or assisted living facility.

How are Resources Treated?

For single applicants, countable resources cannot be more than $2,000.  If you are legally married, you may be able to set aside some of your resources for the needs of your spouse, so long as your spouse is not living in a medical facility. If you are married, please ask for a Community Spouse Information Sheet.

Countable Resources Resources That We Do Not Count
• Checking, savings, and credit union accounts

• Real property that you do not live in

• Cash value of some life insurance policies

• Cash, stocks, bonds, certificates of deposits

• Non-exempt vehicles

• Your home that you live in, unless it is held in a trust

• One vehicle

• Burial plots and irrevocable burial plans

• $1500 designated for burial

• Household and personal belongings

If your resources are over $2,000, and you are under the age of 65, you may still be able to qualify by setting up a special type of trust. Please ask for the Special Treatment Trust Information Sheet.

How is my Income Treated?

Income that we count includes, but is not limited to, wages, Social Security, Supplemental Security Income and disability or retirement pensions.

The ALTCS gross monthly income limit is $2,163 (effective 1/1/14) for an individual. If you are married, ask for a Community Spouse Information Sheet.

If your income is over the limit, you may still be able to qualify by setting up a special type of trust.  If you are over income, ask for a Special Treatment Trust Information Sheet.

Will I Have to Pay Any of My Income Toward the Cost of My Care?

Once you have been determined eligible for ALTCS, a calculation will be made to determine if, or how much, you will need to pay towards the cost of your nursing home or home and community based services. This amount is called the Share of Cost. Your monthly gross income will be totaled and then the following deductions may be allowed:

• A personal needs allowance;

• A Community Spouse allowance for the needs of your spouse still living in the home;

• A family allowance for any dependents living in your home;

• A home maintenance allowance if you are in a nursing home but will go home within 6 months;

• Your medical insurance premiums; and

• Medical expenses that ALTCS does not pay for like hearing aids, eye glasses and dental care.

How does ALTCS Determine if I am Medically Eligible?

Once you have been determined financially eligible, a registered nurse or social worker will determine if you are medically eligible in a face-to-face interview. To meet medical requirements, you must be at immediate risk of institutionalization in a nursing facility or intermediate care facility for the mentally retarded (you must require that level of care but you do not necessarily need to reside in a facility).

What are the Different Types of ALTCS Services?

Once you have been determined eligible for ALTCS services, you will be enrolled with a Program Contractor and assigned to a case manager. The case manager will meet with you and your family to develop a service plan. Covered services may include the following:

• Institutional Care in a Nursing Facility;

• Home and Community Based Services, combining out-patient and in-home care;

• Medical Services, such as Doctor’s office visits and prescriptions (prescription coverage is limited for people with Medicare);

• Behavioral health services;

• Preventive and well care for children; and

• Hospice services.

If you have additional questions, contact your Eligibility Specialist in the ALTCS local office.

VA Aid & Attendance

This most important benefit is overlooked by many families with Veterans or surviving spouses who need additional funds to help care for ailing parents or loved ones. This is a “Pension Benefit” and IS NOT dependent upon service-related injuries for compensation. Aid and Attendance can help pay for care in the home, Nursing Home or Assisted Living facility. A Veteran is eligible for up to $1,788 per month, while a surviving spouse is eligible for up to $1,149 per month. A Veteran with a Spouse is eligible for up to $2,120 per month and a Veteran with a Sick Spouse is eligible for up to $1,406 per month*.

The household income of the veteran or the surviving spouse cannot exceed the Maximum Allowable Pension Rate (MAPR) for that category of application.  (We list 9 categories of pension income amounts in the section on how pension is calculated.)  As an example, using rates for 2014, a husband and spouse with no medical rating cannot have a combined income of more than $1,381 a month or $16,569 a year from all sources.  As another example, a single surviving spouse with an “aid and attendance” medical rating cannot make more than $1,149 a month or $13,562 a year from all sources. The household income can be reduced to meet the income test under certain special conditions.  Households earning $2,000 to $6,000 a month or more might still qualify even though their income does not meet the income test.

A veteran or the veteran’s surviving spouse may be eligible if the veteran:

  • Was discharged from a branch of the United States Armed Forces under conditions that were not dishonorable AND
  • Served at least one day (did not have to be served in combat) during the following wartime periods and had 90 days of continuous military service:
    • World War I: April 6, 1917, through November 11, 1918
    • World War II: December 7, 1941, through December 31, 1946
    • Korean War: June 27, 1950, through January 31, 1955
    • Vietnam War: August 5, 1964 (February 28, 1961, for veterans who served “in country” before August 5, 1964), through May 7, 1975
    • Persian Gulf War: August 2, 1990, through a date to be set by Presidential Proclamation or Law.

If the veteran entered active duty after September 7, 1980, generally he/she must have served at least 24 months or the full period for which called or ordered to active duty (there are exceptions to this rule).

Net Worth (the value of your assets) also affects eligibility. VA pensions are a need–based benefit, and a large net worth might affect your eligibility. All personal goods are exempt from the net worth. These goods include the home you live in, a vehicle used for the care of the claimant, and household goods and personal effects such as clothes, jewelry and furniture. Unfortunately, there is no asset limit set by law, and the determination of eligibility can be made at the discretion of a VA caseworker.

 

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