Two Types of ALTCS Denials
An ALTCS denial letter from AHCCCS can cite one or both of two categories: financial ineligibility and functional ineligibility. Understanding which applies determines your next steps.
A financial denial means AHCCCS determined the applicant has income or assets above the eligibility thresholds. The 2026 thresholds are $2,829/month in net income and $2,000 in countable assets for a single applicant. Financial denials can be overturned if documentation was incomplete, deductions were not properly credited, or if asset planning has since been completed.
A functional denial means the applicant did not meet the clinical level-of-care criteria. ALTCS requires ADL dependency at a level consistent with nursing home level of care. Functional denials can be appealed if the assessment did not accurately reflect the applicant's care needs.
The 30-Day Appeal Window
Arizona law gives ALTCS applicants 30 days from the date on the denial notice to request a fair hearing. Missing this deadline means waiving your appeal rights — so the 30-day clock is the single most important deadline in the process.
To request a fair hearing, submit a written request to the Arizona Office of Administrative Hearings (OAH) at the address specified in the denial notice, or call AHCCCS at (602) 417-4000 and request a fair hearing verbally — then follow up in writing.
Requesting a fair hearing does not prevent you from reapplying or working to resolve the underlying issue while the appeal is pending.
The Fair Hearing Process
An ALTCS fair hearing is conducted by an administrative law judge (ALJ) at the Arizona Office of Administrative Hearings. Hearings can be conducted in person, by phone, or by video.
For a financial appeal: you or your attorney present corrected financial documentation or the legal basis for allowable deductions.
For a functional appeal: submit additional medical documentation — physician letters, care assessments, occupational therapy assessments — that demonstrate care needs at or above the nursing home level of care.
Families representing themselves can succeed, but the process is significantly more effective with an attorney who has ALTCS hearing experience.
When to Hire an Elder Law Attorney
An Arizona elder law attorney is the right resource when: (1) the denial involves the 5-year look-back and asset transfers; (2) the financial documentation is complex (multiple income sources, pension trusts, annuities, community property issues); (3) the functional denial appears inconsistent with documented clinical records; or (4) the appeal involves a Miller Trust that was not properly documented.
Fees for ALTCS representation vary — some attorneys charge flat fees, others charge hourly. Many offer a free initial consultation. The State Bar of Arizona's Lawyer Referral Service (1-800-252-9690) and the Arizona Elder Law Attorneys Association can provide referrals.
For help navigating an ALTCS denial, our senior care advisors can connect you with Arizona elder law attorneys who specialize in ALTCS appeals.