DenaliCare (Alaska Medicaid) Long Term Care Programs, Benefits & Eligibility Requirements

Summary
Medicaid’s rules, benefits and name can all vary by state. In Alaska, Medicaid is also called DenaliCare. This article focuses on Alaska Medicaid Long Term Care for seniors, which will pay for care in a nursing home, a beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, HCBS Waivers or ABD Medicaid. This is different than regular Medicaid, which is for financially limited people of all ages.

Alaska Medicaid Long Term Care Programs

Nursing Home / Institutional Medicaid

Alaska Medicaid will cover the cost of long-term care in a nursing home for financially limited Alaska seniors who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:

• Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
• Skilled nursing care
• Physician’s visits
• Prescription medication
• Medication management
• Mental health counseling
• Social activities

Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.

Alaska Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover care expenses. They are only allowed to keep a “personal needs allowance” (PNA) of $200/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.

Alaska Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.

Home and Community Based Services (HCBS) Waivers

Home and Community Based Services (HCBS) Waivers will pay for long-term care services and supports that help financially limited Alaska seniors who require a Nursing Facility Level of Care remain living in the community instead of moving to a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long-term care services for Alaska residents who live in their own home, the home of a loved one or an assisted living residence. While Alaska’s HCBS Waivers may cover long-term care benefits in those settings, it will not pay for room and board costs.

The HCBS Waiver relevant to Alaska seniors is the Alaskans Living Independently Waiver.

Alaskans Living Independently Waiver
The Alaskans Living Independently (ALI) Waiver will provide long term-care services and supports to Alaska Medicaid beneficiaries who live in their own home, the home of a loved or an assisted living residence. However, the ALI Waiver will not cover room and board expenses in any of those settings.

ALI Waiver benefits include adult day care, private nursing services, home modifications and meal services. These benefits are made available depending on the needs and circumstances of each individual.

Unlike Nursing Home Medicaid, most HCBS Waivers are not an entitlement. Instead, each Waivers program has a limited number of enrollment spots, and once those spots are full, additional applicants are placed on a waitlist. The ALI Waiver had roughly 3,000 spots as of 2022.

Aged, Blind, and Disabled Medicaid

Alaska’s Aged, Blind, and Disabled (ABD) Medicaid provides healthcare coverage and long-term care services and supports to financially limited Alaska residents who are aged (age 65+), blind or disabled and live in the community. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for low-income people of all ages. ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive the benefits without any wait.

Alaska ABD Medicaid beneficiaries who show a need for long-term care benefits can receive through through the Personal Care Services (PCS) Program or the Community First Choice (CFC) Program.

Personal Care Services Program
Alaska’s Personal Care Services (PCS) Program provides long-term care services and supports to Alaska ABD Medicaid recipients who live in their own home or the home of a loved one. PCS Program participants are required to need help with at least one of the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) or Instrumental Activities of Daily Living (shopping, cooking, light housework, laundry, medication management).

PCS Program participants can receive personal care assistance with the Activities of Daily Living and the Instrumental Activities of Daily Living. How much and what type of assistance depends on their needs and circumstances. The state can assign a caregiver to deliver PCS Program benefits, or the program participant can self-direct their care. This means they can hire a caregiver of their choice, including friends and family members. Spouses, however, can not be hired as a PCS caregiver.

Like Alaska ABD Medicaid itself, the Personal Care Services Program is an entitlement. This means that all eligible applicants are guaranteed by law to receive benefits.

Community First Choice Program
Alaska’s Community First Choice (CFC) Program provides long-term care services and supports to Alaska ABD Medicaid recipients who require a Nursing Facility Level of Care but live in their own home or the home of a loved one. Alaska uses the Consumer Assessment Tool to determine if applicants meet that criteria. This tool takes into account an applicant’s need for nursing services, treatments and medications, as well as their ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and laundry).

CFC Program benefits include supervision, chore services, Personal Emergency Response Systems and personal care assistance with the Activities of Daily Living and the Instrumental Activities of Daily Living. Benefits are provided depending on the needs and circumstances of the individual. The state can assign a caregiver to deliver CFC Program benefits, or the program participant can self-direct their care. This means they can hire a caregiver of their choice, including friends and family members. Spouses, however, can not be hired as a CFC caregiver.

Like Alaska ABD Medicaid itself, the CFC Program is an entitlement. This means that all eligible applicants are guaranteed to receive benefits.

Eligibility Criteria For Alaska Medicaid Long Term Care Programs

To be eligible for Alaska Medicaid, a person has to meet certain financial and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.

Alaska Nursing Home Medicaid Eligibility Criteria

Financial Requirements
Alaska residents have to meet an asset limit and an income limit in order to be financially eligible for nursing home coverage through Alaska Medicaid. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for Alaska Nursing Home Medicaid for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, Alaska Medicaid beneficiaries who reside in nursing homes must give most of their income to the state to help pay for the cost of care. They are only allowed to keep $200/month of their income as a “personal needs allowance,” and they are allowed to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy, non-applicant spouses.

For married applicants with both spouses applying, the 2024 asset limit for nursing home coverage through Alaska Medicaid is a combined $3,000, and the income limit is $2,829/month per spouse. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

Functional Requirements
The functional, or medical, criteria for nursing home coverage through Alaska Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is usually associated with a nursing home. Alaska uses the Consumer Assessment Tool to determine if applicants require a NFLOC. This tool takes into account an applicant’s need for nursing services, treatments and medications, as well as their ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and laundry).

Alaska Medicaid Home and Community Based Services (HCBS) Waivers Eligibility Criteria

Financial Requirements
Alaska residents have to meet an asset limit and an income limit in order to be financially eligible for Home and Community Based Service (HCBS) Waivers. For a single applicant in 2024, the asset limit for HCBS Waivers in Alaska is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Counts the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for HCBS Waivers in Alaska for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants with both spouses applying, the 2024 asset limit for HCBS Waivers in Alaska is a combined $3,000, and the income limit is $2,829/month per spouse. For a married applicant with just one spouse applying for Alaska HCBS Waivers, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

Functional Requirements
The functional, or medical, criteria for Home and Community Based Services (HCBS) Waivers through Alaska Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with a nursing home. Alaska uses the Consumer Assessment Tool to determine if applicants require a NFLOC. This tool takes into account an applicant’s need for nursing services, treatments and medications, as well as their ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and laundry).

Alaska Aged, Blind, and Disabled Medicaid Eligibility Criteria

Financial Requirements
Alaska residents have to meet an asset limit and an income limit in order to be financially eligible for Aged, Blind, and Disabled (ABD) Medicaid. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for Alaska ABD Medicaid for a single applicant is $1,751/month. Almost all income is counted (IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc.) other than COVID-19 stimulus checks and Holocaust restitution payments.

For married applicants in 2024, the asset limit for Alaska ABD Medicaid is a combined $3,000 and the income limit is a combined $2,593/month. This applies to married couples with both spouses applying or with just one spouse applying.

There are alternative pathways to eligibility for Alaska ABD Medicaid applicants who are over the asset limit and/or the income limit, such as Medicaid Planning.

Functional Requirements
The only functional requirement for receiving basic healthcare coverage through Aged, Blind, and Disabled (ABD) Medicaid in Alaska is being age 65 or over, blind or disabled. For ABD recipients who need long-term care services and supports, the state will administer an assessment of their ability to perform the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and laundry) to determine the kind of long-term care benefits the state will cover.

How Alaska Medicaid Treats the Home for Eligibility Purposes

One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:

• If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage/debt) is less than $713,000 (as of 2024) then the home is exempt.
• If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives.
• If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $713,000.

These rules apply to all three types of Medicaid, with one important exception – ABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. To learn more about the impact of home ownership on Medicaid eligibility, click here.

Alaska Medicaid applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in Alaska and how you can protect your home from it, click here.

Applying For Alaska Medicaid Long Term Care Programs

The first step in applying for Alaska Medicaid Long Term Care coverage is deciding which of the three Medicaid programs discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Home and Community Based Service (HCBS) Waivers or Aged Blind and Disabled (ABD) Medicaid.

The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for Alaska Medicaid when not financially eligible will result in the application, and benefits, being denied.

During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Alaska Medicaid applicant. These documents will be needed for the official Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.

After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Alaska residents can apply for Alaska online at MyAlaska. They can also apply by contacting their local office for the Alaska Department of Health and Social Services Senior and Disability Services.

For step-by-step guides to applying for each of the three types of Medicaid Long Term Care, just click on the name: 1) Nursing Home Medicaid 2) HCBS Waivers 3) ABD Medicaid .

Choosing an Alaska Medicaid Nursing Home

After being approved for nursing home coverage through Alaska Medicaid, seniors need to choose which Medicaid-accepting nursing home best meets their needs. Even though Alaska Medicaid nursing home coverage is an entitlement, not all nursing homes take Medicaid, and those that do may not have available spaces.

There are only 20 nursing homes in Alaska, so choices are limited, especially when you consider the size of the state. Seven of the 20 nursing facilities in Alaska are clustered around Anchorage, the Cook Inlet and the Kenai Peninsula Borough. Five more are in the southeastern part of the state in Juneau, Wrangell, Sitka, Ketchican and Petersburg.

Getting full coverage through Nursing Home Medicaid is especially valuable in Alaska because the state has the most expensive nursing homes in the country. Average cost estimates range anywhere from $23,500 / month to $37,500 / month.

According to data collected by data collected by CMS, Alaska nursing homes averaged 29.4 health deficiencies per facility during a three-year period from 2019-2022, which is just above the national average of 25.7. The number of fire safety deficiencies was also higher in Alaska nursing homes than it was across the rest of the country during the last three years: 19.6 vs. 13.5.

On the other hand, the CMS data also showed that Alaska nursing home residents got plenty of attention from the staff. Alaska nursing homes averaged 7.28 nurse staffing hours per resident day from 2019-2021, meaning each resident received an average of 7.28 hours of nurse attention per day, which is almost twice the national average of 3.74. And Alaska nursing homes averaged 0.10 physical therapist staffing hours per resident per day from 2019-2021. That may not seem like much, but it’s 43% more than the national average of 0.07 physical therapist staffing hours per resident per day.