• Be approved for DDD first. Remember, they always go together for financial support!

• The ALTCS application is a two part process. The first step is a financial interview. For this portion of the assessment, you will be asked a series of financial questions related to the applicant. Currently, the applicant cannot have more than $2,000 in their name. This includes things like a checking account, savings account, etc. The finances of the parent/legal guardian of the applicant do not matter when applying for ALTCS. They are only looking at the applicant’s information - the person in need of services income.

  • Don’t get too overwhelmed by this next part. I just want to make sure you have the information: Having a special needs trust or an ABLE account does not count towards the financial limitations. Below are the definitions of each. But before you read them, please know that unless your situation warrants it, you do not need to establish either of these options right away or even at all, it solely depends on your personal situation.

    • A special needs trust — also referred to as a supplemental needs trust or SNT — is a type of trust that’s set up for people with disabilities or access and functional needs. It helps provide financial support without disqualifying individuals for government benefits, such as Medicaid or Supplemental Security Income (SSI). -Ref. Special Needs Alliance. With a SNT, a beneficiary can be listed in the event the person with a disability is deceased. A SNT can be particularly useful if you know that someone in the member’s life will leave them a substantial amount of money or they are awarded a settlement. SNT can cost a couple thousand dollars. It is costly, but it’s even more costly, if you utilize a professional that doesn’t know what they are doing, so make sure to use an experienced provider!

    • An ABLE account is a savings and / or investment option for people with disabilities who qualify. It falls under Section 529A of the Internal Revenue Service tax code. The ABLE Act allows a person whose disability began before age 46, to save money in the ABLE account without affecting most federally funded benefits based on need. The money in the account may be used to pay for qualified disability expenses (QDEs). Any ABLE investment growth is not taxed and does not count as income if the funds are used for QDEs. -Ref. ABLE National Resource Center. A beneficiary cannot be listed for an ABLE account, as funding would go back to the federal government to offset the expenses paid towards the individual’s services and care. Multiple states offer ABLE accounts. You can sign up for any ABLE account.

    • There are professionals who specialize in special needs trusts and ABLE accounts that can help you in more detail. They often offer free classes in the community too. If you take a class, I always recommend using your own family’s names when making notes, especially if you have multiple children. This will help you when you go back to read your notes.

    • If at anytime your loved one exceeds the financial limitations, even if they were already approved for DDD/ALTCS, their coverage is at risk of being discontinued until they can again meet the financial limitations. These type of accounts help you plan to avoid this situation.

      
      

• The second step is to undergo a medical assessment, referred to as a Pre Admission Screening (PAS) Tool. There are two tools. One for those who are Elderly or Physically Disabled and another for those who are Developmentally Disabled. We recommend reviewing the tool most appropriate for your situation in advance. With the PAS tool, you will be asked a series of questions about the applicant’s development, capabilities and challenges. Questions will be based on your child’s age range. When reviewing the tool, really think about whether your child can complete the task being asked about completely on their own without any type of further prompting like repeated requests to do the action, including verbal cues and gestures. For example, getting dressed independently can involve picking out weather appropriate clothing, making sure the clothing still fits or is not inside out, etc. It may be helpful to review the CDC’s Developmental Milestones to prepare for the interview.

  • The PAS tool will be done by an interviewer. They can be a social worker, nurse or other professional. The PAS tool is not autism specific. Remember all those qualifying diagnoses? Sometimes we have to educate the interviewer about autism and how autism directly impacts the applicant.

  • The person in need of services must be present during the medical interview. Let the interviewer see what your daily life is truly like. Do not feel embarrassed or try to hide your child’s challenging behaviors. If you have someone who can assist in watching the child during the interview, I would recommend doing so because it can be hard to hear about one’s own challenges. We understand having another person attend isn’t always possible and that’s okay too.

  • These interviews can be difficult and draining, especially because you’re telling a stranger about your life and child. It can be difficult to discuss your loved one’s challenges. It is important to be honest about your answers and provide examples when possible.

  • Hopefully this won’t happen to you, but please know that if at any point time you are made to feel uncomfortable by the interviewer, you may ask to stop the interview and request to continue or start over with a new interviewer.

Important information to know: When submitting any type of documentation along with your application, whether from an educational or medical provider, make sure you agree with everything in the reports. The state will consider the professionals opinion over parental input. If something in a report doesn’t sit right with you, ask for a correction to be made. This should be the case at any point in your journey.

The ALTCS application, particularly the medical assessment, can be a difficult, lengthy process for some. Despite that, we still recommend applying because if you are approved, the applicant will receive a wide array of supports and services to aide in their long term care. There is a 45 day period for ALTCS to make an informed decision about your application. And there is no shame in seeking support.

It is not uncommon for an application to be denied. Perhaps insufficient documentation was provided or the applicant did not demonstrate a need for services. Whatever the case may be, you are able to reapply or appeal the denial as many times as you feel necessary. Reapplication means you are starting the process over again and appealing means you can provide additional support for why the services may be medically necessary for the applicant. You will have a 90 day period to appeal. There is no right or wrong answer for which route you should choose if you get denied. Just know that it is not a one and done application. Keep trying if you feel you or your loved need support! I have heard of some families getting approved on the first try and others reapplying several times before being approved.

If approved for services, the disabled individual will be eligible to receive a wide variety of medical, dental and behavioral health supports. View covered services by clicking here. Your assigned Support Coordinator (SC) will meet with you every 90 days to discuss the ALTCS members’ needs and determine the need for covered services. Visits can occur in-person or virtually based on certain criteria.

Side note: If you have private insurance, you can choose to keep it or drop it to just have DDD/ALTCS coverage. The state would of course love it if you kept your private insurance because it helps them offset the cost of care for your child but with the rising cost of insurance, we understand that maintaining dual coverage may not be within reach. If you do choose to keep your private insurance, it will act as the primary payor and DDD/ALTCS will be the payor of last resort. If you have copays, your DDD/ALTCS plan will typically cover those costs. There are some services, like braces and wisdom teeth removal, that DDD/ALTCS won’t cover unless absolutely medically necessary. Current DDD/ALTCS plans are supported by Mercy Care and United HealthCare Community Plan. You will be assigned a plan upon approval and will have the opportunity to switch plans at a later date. Ask your current providers if they are contracted with either plan; otherwise, you may need to find new providers.