Arizona:
Arizona Long Term Care System (ALTCS)

Agency with Choice and SDAC are different decisions

AHCCCS describes member direction as a service-delivery model rather than an extra benefit. Under Agency with Choice, an agency remains the legal employer while the member can help choose, schedule and supervise the worker. Under SDAC, the member or legal guardian assumes the employer role, supported by a Fiscal Employer Agent. Ask who handles replacement staff, training and payroll before choosing; a familiar agency name does not tell you which arrangement its contract supports.

ALTCS approval and care authorization

ALTCS reviews medical and financial eligibility. AHCCCS application guidance identifies medical records and financial or medical interviews as parts of that review. Once enrolled, the case manager helps determine which services fit the member’s assessed needs. The member-directed options described by AHCCCS are generally for members living in their own homes, rather than nursing facilities or alternative residential settings. Describe the assistance actually needed at home instead of assuming a diagnosis automatically authorizes a particular number of hours.

Track the application and the service start separately

Keep the date of the ALTCS application, interview requests and any outstanding-document notices together. Missing requested records or an interview can interrupt the eligibility process. After an eligibility decision, there can still be plan coordination, caregiver enrollment and a service start date to resolve. This guide does not assign Arizona a universal waiting period or promise that care already provided will be reimbursed. Request a written explanation of the next outstanding step from the office or case manager handling that stage.

Match the family relationship to the delivery model

Arizona’s ALTCS contract materials describe separate arrangements for spouses and for parents providing care to minor children. Their existence is not permission to use every family member within every self-directed option. Give the case manager the proposed caregiver’s exact relationship and any guardian or representative role. Then confirm the applicable hiring route, the named employer and all required worker training. If the family prefers SDAC, request its member-worker agreement and training materials before agreeing to employer responsibilities.

Get a usable payroll and backup-care plan

Ask the assigned agency or Fiscal Employer Agent to distinguish the written caregiver pay rate from the total amount billed for the service. Obtain instructions for recording visits, correcting mistakes and reporting a hospital admission or other change in where care occurs. Confirm whether EVV applies to the particular service and whether any live-in exception needs documentation; do not rely on another state’s exemption. Keep a backup contact so an absence does not leave an essential authorized task uncovered.

Your next steps

1. Start with the AHCCCS ALTCS application route if the person is not enrolled; keep copies of requested documents.
2. Ask the ALTCS case manager which approved in-home services can use member direction.
3. Compare Agency with Choice and SDAC, including the employer role and the proposed relative’s eligibility.
4. Complete the correct worker agreement, training and payroll setup with the assigned organization.
5. Obtain the authorized start date, service units and caregiver rate before calculating expected income.

Explore a pay scenario

The table uses a hypothetical amount of $18.00 per hour. This is not a rate verified for this state. Approved units depend on the assessment and written plan; the table does not establish a maximum or entitlement.

Monthly average = weekly × 52 ÷ 12. Overtime and taxes are not calculated.

Does caregiver pay qualify for IRS Notice 2014-7?

IRS Notice 2014-7 can exclude certain qualifying Medicaid waiver payments from federal gross income when the care recipient lives in the provider’s home. Sharing a home alone is not enough: the payment and program must qualify. This is not an exemption for all caregiver wages, all taxes or all state programs. Ask payroll which payments are covered and check the IRS guidance or a qualified tax adviser. Our calculator does not apply a tax exemption.

Questions families ask

Official sources and review notes

• AHCCCS: ALTCS member-directed options
• AHCCCS: ALTCS contract, effective October 2026
• AHCCCS: application denials and missing eligibility information

Sources describe the named programs; they do not endorse this website. Rules and provider arrangements can change. Check the linked agency before making a financial decision.