E County of Fiscal Responsibility

Revised 04/29/2025

Policy

The county of fiscal responsibility must be determined for all ALTCS customers. However, this determination only affects customers who are age 65 or older (elderly) or have a physical disability (EPD) and are enrolled with an EPD ALTCS Health Plan. Not all counties have the same ALTCS Health Plans. The fiscal county is determined in order to enroll the customer with the correct ALTCS Health Plan for that fiscal county.

The Benefits and Eligibility Specialist determines the customer’s county of fiscal responsibility. The following criteria are used to establish the county of fiscal responsibility:
 

If the applicant is...	And...	Then the county of fiscal responsibility is...
An adult	Resides in his or her own home; or Moved from another state directly into a nursing facility or alternative HCBS setting in Arizona	The county where the applicant currently resides.
	Resides in a nursing facility; or Alternative HCBS setting	The county where the applicant last resided in his or her own home.
	Moved from the Arizona State Hospital to a nursing facility or alternative HCBS; or Moved from a penal institution to a nursing facility or alternative HCBS	The county where the applicant resided in his or her own home prior to admission to Arizona State Hospital or the public institution.
A child (under age 18)	Parental rights have not been legally severed	The county where the parent(s) live at the time of ALTCS approval.
	Parental rights have been legally severed	The county where the child resides.
	Parents are legally separated	The county where the custodial parent lives at the time of ALTCS approval.

 

County of Fiscal Responsibility Examples

How Is Enrollment Affected?

Although the county of fiscal responsibility must be determined for all ALTCS customers, this determination only affects customers who are age 65 and older (elderly) and/or have a physical disability who are not American Indians with on-tribal lands status and not Developmentally disabled.

If the customer is...	Then the county of fiscal responsibility...
An American Indian with on-tribal lands status; or Developmentally disabled.	Does not affect enrollment.
Elderly and/or physically disabled (including an American Indian who does not have on-tribal lands status)	Affects enrollment with a ALTCS Health Plan.

The customer’s fiscal county and the customer’s Dual Eligible Special Needs Plan (DSNP) with Medicare, if the customer has one, is used to determine enrollment with an ALTCS Health Plan. Customers that have a DSNP will be automatically moved to the EPD ALTCS Health Plan that is aligned with their DSNP.

 

Definitions

Term	Definition
County of Fiscal Responsibility	The county of fiscal responsibility is the Arizona county that is responsible for paying the state’s funding match for the customer’s ALTCS Service Package. The county of physical presence (the county in which the customer physically resides) and the county of fiscal responsibility may be the same county or different counties.
Dual Eligible Special Needs Plan (DSNP)	A type of Medicare Advantage (Part C) plan designed for persons who are eligible for both Medicare and Medicaid.

 

Legal Authority

Program	Legal Authorities
ALTCS	42 CFR 422.107 ARS 36-2913 AAC R9-28-712