AHCCCS Proposes Updates to ALTCS Assessments: What Arizona Families Should Know

In October 2025, AHCCCS paused its newly introduced Home and Community-Based Services Needs Tool after families and advocates raised concerns. AHCCCS then began revising the tool and developing an Extraordinary Care Review process for certain minor DDD members.

Important: This article provides general information and does not offer legal, medical, financial, or Medicaid eligibility advice. AHCCCS and DDD policies may change. Families should confirm current rules, timelines, authorized services, and appeal rights with AHCCCS, their health plan, or their DDD support coordinator.

What Are the AHCCCS ALTCS Assessment Changes?

AHCCCS proposed updates target the Home and Community Based Services (HCBS) Needs Tool, the standardized assessment used to determine what services children qualify for under ALTCS. The new tool shifts how case managers evaluate children’s functional abilities and assigns stricter age limits to specific care categories.

Draft versions of the assessment use age-based standards for toileting needs. Because AHCCCS continues to revise the tool, families should confirm the current age criteria in the latest official guidance. Feeding assistance assessments now apply only to children five and older, down from eight. Mobility and transferring assessments start at age two instead of four. These age thresholds changed based on developmental milestone research, according to AHCCCS clinicians.

The state framed these changes as necessary to manage rapidly rising costs. Spending on attendant care and habilitation services for members under 18 jumped from $77 million in 2019 to $614 million in 2025, nearly eight times higher in just six years. The supplemental funding required to sustain this growth became unsustainable, prompting Arizona House Bill 2945 to mandate a new assessment tool by October 1, 2025.

Assessment Area	Previous Approach	Proposed Update
Toileting	The previous tool assessed toileting needs under earlier criteria.	Draft revisions use age-based developmental standards. Families should confirm the current criteria with AHCCCS or their DDD support coordinator.
Feeding Assistance	Applied to children beginning at age 8.	Assessment now begins at age 5.
Mobility and Transfers	Typically assessed starting at age 4.	Assessment now begins at age 2.
Additional Care Needs	Standard assessment determined authorized service hours.	Families can request an Extraordinary Care Review (ECR) if additional hours are needed.

 

Why Did AHCCCS Make These Changes?

The primary reason driving these updates is fiscal pressure. When the federal government allowed parents to be paid caregivers during the pandemic, Arizona families suddenly had the option to use authorized service hours, something many couldn’t do before due to caregiver shortages. Utilization exploded. Total authorized hours of attendant care and habilitation services for children under 18 soared from 3.8 million hours in 2019 to over 22.8 million hours in 2025.

Arizona continued the paid parent program after the federal subsidy ended, meaning the state absorbed the full cost. With limited budget flexibility and competing demands, state leaders decided new guardrails were necessary. The updated assessment tool is the result.

However, the change sparked significant backlash. Families argued that strict age limits don’t reflect real developmental needs. Some children mature faster or slower than state averages. Others have complex medical conditions that age-based cutoffs don’t address. Advocates at Disability Rights Arizona and Republican state legislators voiced concerns that the tool was “arbitrary” and lacked solid clinical evidence.

What Is the Extraordinary Care Review Process?

Recognizing that rigid age thresholds could harm children with genuine, complex needs, Governor Hobbs directed AHCCCS to create an exception mechanism. The Extraordinary Care Review (ECR) process allows families to request additional service hours beyond what the standard assessment authorizes.

To request an ECR, families must document that their child requires more direct care or habilitation hours than the Needs Tool assessment determined. Review timelines depend on the current AHCCCS policy and the circumstances of the request. Families should ask their support coordinator or health plan for the applicable deadline.

The ECR is not automatic. Families must actively submit a request and provide supporting documentation, such as medical records, assessments from therapists, or letters from providers explaining why standard hours are insufficient. This process gives families a voice, but it also places the burden on families to navigate the system and advocate for their children.

 

How Do These Changes Affect Arizona Home Care Families?

The impact depends on your child’s age, disabilities, and current service authorizations. Depending on the final policies and each child’s individual assessment, some families may experience changes to their authorized service hours. Others may experience minimal changes. Still others qualify for services they previously did.

For families receiving attendant care or habilitation services, the new tool might reduce authorized hours based on the stricter age categories. A child’s assessed toileting support may change under the revised age-based standards. Families should review the current assessment criteria and discuss any unmet needs with their DDD support coordinator. If toileting is a genuine need, families must use the ECR process to request an exception.

According to AHCCCS, the revised assessment process does not automatically eliminate services. Instead, eligible members will be reassessed under the updated process when applicable. The changes primarily concern certain ALTCS members under age 18 who receive DDD home- and community-based services, including attendant care or habilitation. Families should confirm whether the policies apply to their child with their DDD support coordinator or health plan.

What Does the Public Comment Timeline Mean?

AHCCCS conducted public comment periods in 2025. From May through July 2025, the agency collected feedback on the proposed rule and received over 600 public comments. Community forums in September 2025 allowed families to ask questions and voice concerns. An Emergency Rule took effect October 15, 2025, allowing the tool to launch on October 1 while the formal rulemaking process continued.

AHCCCS continues to revise the Home and Community-Based Services Needs Tool and Extraordinary Care Review policies through the rulemaking process. Families should monitor official AHCCCS and DDD communications for the latest timelines, public notices, and implementation updates.

If you missed the earlier public comment periods, you still have limited opportunities to submit feedback during formal rulemaking, though timelines are tight. Check AHCCCS’s website and your DDD support coordinator’s emails for any remaining comment windows.

 

What Should Arizona Families Do Now?

First, request a copy of your current assessment and review the age thresholds that apply to your child. Compare them to what you think your child needs. If you believe the Needs Tool underestimates your child’s care requirements, gather supporting documentation: recent evaluations, medical records, therapist assessments, and provider letters explaining the gap between assessed hours and actual needs.

Second, prepare for your quarterly support coordinator meeting. Bring your documentation and be ready to discuss potential ECR requests. Your support coordinator can explain the process and help you understand whether an exception request makes sense for your situation.

Third, stay informed. AHCCCS and DES publish updates on their websites. Subscribe to DDD email alerts and follow your health plan’s communications about any service changes.

If your loved one is eligible for ALTCS services or you’re exploring private home care options, Home Care Arizona is here to provide compassionate, non-medical support. Call (623) 292-5563 to learn more about our home care services.

 

FAQs About the AHCCCS ALTCS Assessment Updates

Is AHCCCS the same as ALTCS in Arizona?

No. AHCCCS is Arizona’s Medicaid program (Arizona Health Care Cost Containment System). ALTCS is the Arizona Long Term Care System, a specific Medicaid program within AHCCCS that provides coverage for individuals with age-related, physical, or intellectual and developmental disabilities who require nursing facility-level care. ALTCS members can receive services at home, in assisted living, or in institutions.

What is the ALTCS income limit in 2026?

ALTCS applies income and resource limits that vary depending on marital status and other circumstances. AHCCCS materials identify a $2,982 monthly income limit effective January 2026 in certain ALTCS eligibility calculations. Some applicants with income above the applicable limit may still qualify through an Income-Only, or Miller, Trust if they meet all other requirements. Because the rules are complex, applicants should confirm current limits directly with AHCCCS or a qualified benefits or legal professional.

What are the financial requirements for ALTCS in Arizona?

ALTCS has financial eligibility rules. Most importantly, applicants must meet a “medical need” test (requiring nursing facility level of care) and have limited resources and income. Resource limits and income treatment rules are complex and vary based on whether you’re applying as a single person, married couple, or in other family situations. The state publishes detailed guidance, and it’s advisable to speak with an eligibility worker or attorney familiar with ALTCS planning to understand your specific situation.

How do I request an Extraordinary Care Review for my child?

Contact your child’s DDD support coordinator or health plan case manager. Explain that you believe your child’s assessed service hours are insufficient based on their specific needs. Provide documentation (medical records, therapist evaluations, provider letters) supporting your request. Your support coordinator can guide you through the formal ECR process. Review timelines depend on current AHCCCS policy and the circumstances of the request.

Will my child automatically lose services under the new assessment tool?

No. AHCCCS states that no one will automatically lose services. However, all children under 18 will be reassessed using the new Needs Tool during their quarterly support coordinator meeting. Some may see hour reductions, some may see no change, and some may see increases. If you believe the reassessment underestimates your child’s needs, the ECR process is available.

For more information about ALTCS and how it can support your family’s home care needs, contact Home Care Arizona today. Call (602) 536-9000 or email Info@homecarearizona.com to speak with our team.

 

Understanding Your Rights and Next Steps

These AHCCCS proposed updates to ALTCS assessments represent a significant policy shift. While AHCCCS has stated that rising program costs were one reason for proposing these updates., families deserve clarity, transparency, and a genuine opportunity to advocate for their children’s needs. The ECR process exists to address that gap; use it if you believe your child qualifies.

At Home Care Arizona, we proudly provide non-medical home care services to eligible ALTCS members and private pay clients throughout Arizona. If you’re looking for compassionate Direct Care Workers to support your loved one at home, call (623) 292-5563 to learn more about our services.