Alaska Medicaid for Seniors & Long-Term Care

The Alaskans Living Independently (ALI) Waiver — formerly known as the Older Alaskans Waiver — is one of Alaska's 1915(c) HCBS waivers, serving adults age 21 and older who need nursing facility-level care but choose to remain in the community. Services include personal care, home modifications, specialized medical equipment, meal services, adult day care, and private nursing. The waiver was renewed for a new five-year cycle effective July 1, 2026.

To qualify for the ALI Waiver, an applicant must meet both a nursing facility level-of-care (NFLOC) assessment and Medicaid's financial eligibility requirements. The clinical assessment is conducted by the Division of Senior and Disabilities Services (SDS) Assessment Unit. The ALI Waiver is not an entitlement — it has a limited number of enrollment slots, so applicants who exceed capacity may be placed on a waitlist. Contact Alaska Senior and Disabilities Services for current slot availability and to start the assessment process.

The Community First Choice (CFC) program provides attendant care services to Medicaid-eligible Alaskans with disabilities who need help with daily living activities such as bathing, dressing, eating, and mobility. CFC is available in the member's own home or in certain community settings. Unlike waiver programs, CFC does not have a cap on slots — anyone who meets the clinical and financial eligibility criteria can receive services.

CFC is intended to reduce institutional placement. Under federal regulation, CFC services must be provided in the most integrated setting appropriate to the individual's needs. Alaska implemented CFC as a mechanism to serve people who would otherwise face nursing facility placement.

Alaska Medicaid covers skilled nursing facility care for seniors who meet clinical and financial criteria. Clinical eligibility requires a documented need for skilled nursing care — typically assessed through a standardized instrument. Financial eligibility means income and countable assets fall within the program's limits.

Once approved, Medicaid pays the nursing home directly. The resident contributes most of their monthly income toward the cost of care, keeping a personal needs allowance of $200 per month for personal items, plus enough to cover Medicare premiums if dual-eligible. Medicaid covers the gap. The 2026 income limit for Alaska Nursing Home Medicaid and HCBS waivers is $2,982/month for a single applicant (300% of the SSI federal benefit rate). If an applicant's income exceeds this limit, Alaska allows use of a Qualified Income Trust (Miller Trust) to route excess income through a trust account, making the person financially eligible.

Unlike MAGI-based Medicaid, long-term care Medicaid has an asset test. For a single applicant, the 2026 countable asset limit is $2,000 ($3,000 for married applicants who are both applying). Countable assets include bank accounts, investments, second vehicles, and vacation property. Exempt assets are not counted: the primary home is exempt (up to $752,000 in home equity as of 2026) while the applicant lives there or intends to return, as well as when a spouse, minor child, or disabled adult child lives there. One vehicle is typically exempt, along with personal belongings and a prepaid funeral arrangement. Medicaid has a 60-month (5-year) lookback period for asset transfers; transfers for less than fair market value within those 60 months can result in a penalty period during which Medicaid will not pay for care.

When one spouse needs nursing home care, federal law protects the other spouse from complete impoverishment. The community spouse is entitled to keep a minimum amount of assets — the Community Spouse Resource Allowance (CSRA) — and a minimum monthly income (the minimum monthly maintenance needs allowance, or MMMNA). For 2026, Alaska's CSRA can allow the non-applicant spouse to keep up to $162,660 in countable assets, and the MMMNA can provide the non-applicant spouse up to $4,066.50 per month.

Alaska DPA operates an estate recovery program for Medicaid members who received long-term care services at age 55 or older. The program may seek reimbursement from the member's probate estate after death. The family home is generally exempt during the lifetime of a surviving spouse, minor child, or disabled child. Consult an Alaska elder law attorney before making asset transfers if a family member may need Medicaid LTC.

HCBS waivers let states cover long-term care services outside nursing facilities — in a person's home, adult day program, or assisted living. Contact Alaska Medicaid to ask which HCBS waiver programs are currently open for enrollment and whether there is a waiting list.