Long-Term Care and Arizona Counties: What Lawmakers Need to Know
- 2 days ago
- 2 min read
$500M
Annual County Contribution to AHCCCS/ALTCS
Counties contribute nearly half a billion dollars each year to Arizona's long-term care system.
28%
Share of County Property Taxes Consumed
For many counties, this single program obligation rivals the largest line items in their budget.
▲$145M
Increase in County Contributions Since FY 2018
Growth has outpaced property tax levy limits, leaving counties with fewer tools to absorb rising costs.
Arizona's long-term care system is funded through a partnership between the state, federal government, and counties. For lawmakers and policy staff working on healthcare and budget issues, understanding the county contribution to the Arizona Long Term Care System (ALTCS) and the Arizona Health Care Cost Containment System (AHCCCS) is useful context for evaluating the full fiscal picture of the program.
The Historical Basis for County Participation
Prior to the creation of AHCCCS and ALTCS, Arizona statute required counties to directly provide care for elderly residents and adults with physical disabilities. When the state assumed administrative control of the program — in part to capture federal Medicaid matching funds and in response to the significant restrictions placed on local budgets in 1980 — counties transitioned from service providers to financial contributors.
That historical role is preserved in statute today. Counties are required to contribute approximately 50% of the state's non-federal match for ALTCS. Despite this financial obligation, counties have no policy or administrative role in the program. They are payors, not policymakers.
What the Contribution Looks Like in Practice
Under the FY 2027 Baseline, counties are projected to contribute nearly $450 million to ALTCS, approximately $45 million to Acute Care, and more than $5 million to AHCCCS administrative costs — bringing the total to roughly half a billion dollars annually.
For many counties, the ALTCS obligation alone represents as much as 20% of their entire general fund. To put that in state-level terms: an equivalent proportional burden on the state would mean the state's ALTCS payment alone would total approximately $3.3 billion — nearly 7.5 times its current level.
Statute does provide some relief mechanisms based on property tax burden, per capita costs, and other factors, but the obligation remains significant for virtually every county in the state.
A Growing and Volatile Cost
County contributions to ALTCS have increased by $145 million since FY 2018 and are projected to grow by at least another $35 million in FY 2027. For scale, that cumulative growth exceeds the total annual revenue Arizona counties receive from the taxation of online retail sales.
This growth has outpaced increases in county property tax levies and the corresponding constitutional levy limits.
Counties also face year-over-year contribution swings driven by program costs outside their control. Graham County experienced a 45% increase in its ALTCS contribution from FY 2025 to FY 2026 — an equivalent increase at the state level would represent approximately $580 million in a single year. That kind of volatility is difficult to manage within the constrained financial environment counties operate in.
Learn More
For additional information on the county role in funding for AHCCCS and ALTCS, check out the Healthcare portion of our website: https://www.countysupervisors.org/healthcare
Counties and the Long-Term Care System, Creatures of Statute Podcast
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