Arizona Long Term Care System (ALTCS) members who receive attendant care, habilitation, and other services can also choose the Agency with Choice option, which allows them to play an active role in directing their own care. Read on to learn more about Agency with Choice in Arizona. 

What is Agency with Choice

Agency with Choice (AWC) is a service model available to Arizona Long Term Care System (ALTCS) members who prefer to receive care in their own homes rather than in an alternative residential setting or nursing facility. 


The Arizona Long Term Care System (ALTCS) offers long-term care to individuals who are eligible for Medicaid and who require ongoing medical or personal care services. The program is administered by the Arizona Health Care Cost Containment System (AHCCCS), the state’s Medicaid agency.

Agency with Choice

Agency with Choice is a non-medical ALTCS option that focuses on personal care, chore assistance, and other services for less medically needy seniors. AWC allows individuals to choose the providers and services they need, while still receiving support and guidance from an agency. 


Care recipients and providers are in a co-employment relationship. The provider agency serves as the legal employer of record, while the recipient acts as the day-to-day managing employer of the caregiver. The recipient can hire, schedule, supervise, and dismiss caregivers, in addition to identifying specific training needs.

Services Provided by Agency with Choice

Agency with Choice offers a number of services, including: 


  • Case management to help individuals develop a support plan that meets their unique needs and goals.
  • Caregiver recruitment and management. Individuals using AWC services can select their own providers and manage their schedules, training, and other related activities.
  • Financial management services: handling the payment of service providers and managing the budget for the individual.
  • Training and education for individuals and their families on how to manage their services and finances.
  • Support and advocacy services for members and their families, including assistance with navigating the healthcare and disability systems.
  • Coordination of care with healthcare providers and other service providers.

Benefits of Agency with Choice

Agency of Choice holds numerous benefits that can help elderly or disabled individuals live independently: 


  • Receiving the necessary care at home
  • The possibility of self-directed care
  • Entitlement, which automatically enables all eligible applicants to choose this option. 

Agency with Choice Requirements

To qualify for the Agency with Choice option, applicants must be enrolled in the Arizona Long Term Care System and meet several functional and financial requirements.

Functional requirements

The applicant must be over the age of 65, blind, or disabled, and require the level of care provided by a nursing home or intermediate care facility. 

Financial requirements

Single applicants can have a maximum income of $2,742 per month, an amount equivalent to 300% of the SSI Federal Benefit Rate. In addition, they can have assets valued at up to $2,000. Married applicants, with both spouses applying for services, can have an income of less than $5,484 per month and assets of up to $4,000.

The Application Process

To apply for the Agency with Choice services, eligible individuals must enroll in Arizona Medicaid Long Term Care Services in person at one of the ALTCS offices


The next step is to download and complete the Self Directed Attendant Care Form. Once financial eligibility is determined, a social worker or nurse conducts an interview to assess whether the applicant is medically eligible. Finally, the applicant is assigned a case manager and chooses a care provider.


For additional information on ALTCS membership and Agency with Choice resources, please visit the AHCCCS website.

Who Can Be a Caregiver?

Anyone above the age of 18 can be a caregiver, including a child, a relative, a friend, a neighbor, or a professional caregiver. The only restrictions are any form of parent of a minor child including stepparent, Natural parent, Foster, etc. Individual Representatives, Medicaid payees and legal guardians of mentally incompetent adults are also restricted from being a paid caregiver.

Pros and Cons of Hiring

While hiring a family member or a friend for at-home care has many benefits, it is important to consider the potential risks and challenges before making a decision. 

Hiring friends or neighbors


  • Familiarity: When you hire a friend or neighbor for at-home care, you already know and trust them. This can make the experience less stressful.
  • Flexibility: Friends or neighbors may be more willing to adjust their schedules to accommodate your needs.
  • Convenience: Having a caregiver who lives nearby can be convenient for emergencies or last-minute needs.


  • Boundary issues: Hiring someone you know personally can make it difficult to establish clear boundaries and maintain a professional caregiver-client relationship.
  • Strained relationships: If the caregiving relationship doesn’t work out, it could affect the friendship or neighborly relationship.

Hiring family members


  • Convenience: Hiring a family member for at-home care can be more convenient than hiring a stranger. 
  • Flexibility: Family members are more likely to be available at short notice and can be more flexible with their schedules.
  • Familiarity: Family members may have a better understanding of the patient’s needs and preferences because they already know them well.
  • Trust: Family members are usually the people you trust the most. You can have peace of mind knowing that your loved one is in good hands.


  • Tense relationships: Hiring a family member for at-home care can lead to strained relationships and tension between family members, especially if there are disagreements about care decisions or if the caregiver is not providing the level of care that the patient needs.
  • Lack of expertise: Family members may not have the necessary training or expertise to provide the level of care that a professional caregiver would be able to offer. 
  • Caregiver fatigue: Providing care for a loved one can be emotionally and physically draining, and family members may experience caregiver fatigue. This can lead to decreased quality of care and potentially harmful situations for the patient.

Hiring someone you don’t know


  • Availability: Hiring someone you don’t know might increase the pool of available caregivers, giving you more options to choose from.
  • Fresh perspective: Someone you don’t know might bring a fresh perspective to caregiving, which could lead to a better quality of care.
  • Convenience: It may be easier to establish an employer/employee relationship with someone who is not a family member or a friend.


  • Unfamiliarity: You don’t know anything about the person except for what you read on their resume and references.
  • No guarantee of compatibility: It is possible that the caregiver and the person receiving care may not be compatible, which may lead to potential conflicts or a poor experience for the care recipient.

Attendant Care Worker Qualifications

An attendant care worker must be a caring individual who is willing to perform required tasks with sensitivity, flexibility, confidentiality, and dependability. 


Other requirements include: 


  • Age 18 or older
  • US citizen or permanent resident
  • Physically able to accomplish required tasks
  • Able to show two valid forms of ID
  • Have a valid social security number
  • Able to provide personal and/or professional references
  • Have CPR and First Aid certifications
  • Submit to a criminal background check


Caregiver training is provided through OMNEAN, an educational platform that offers in-person, virtual, and self-paced online classes.

Choose FreedomCare as Your Fiscal Intermediary

FreedomCare is the ideal option if you are looking for a reliable and professional fiscal intermediary for Agency with Choice. We have a proven track record of providing high-quality services to the elderly and individuals with disabilities, ensuring that they receive the support they need to continue living independently. 


Our offices are staffed with caring personnel ready to provide superior customer service to help you succeed in self-directing your care. We offer services statewide, through offices in the following counties: Maricopa, Gila, Pinal, Pima, La Paz, Yuma, Santa Cruz, Graham, Cochise, and Greenlee.