What is a Medicaid Waiver?
Medicaid Waivers, also known as Home and Community Based Services (HCBS) Waivers and Waiver Funded Services, allow qualifying program participants to receive services outside of the nursing homes. Medicaid’s standard benefit is to pay for nursing home residential care. However, when available, Medicaid Waivers help to provide more options for individuals. The cost of care outside of a nursing home needs to be less than the cost of care in a nursing home.
The Alaskans Living Independently (ALI) Medicaid Waiver is intended to help physically disabled seniors who are in need of a nursing facility level of care. Through this statewide waiver program, services are provided that allow program participants to continue living at home, such as care coordination, adult day care, and respite care. Modifications to the home to help promote independence — like wheelchair ramps and widening of the doorways, home delivered meals, and specialized medical equipment — are also covered benefits of this waiver.
It is not a requirement of the program that the participant remain living at home. They can reside in an assisted living community (more formally referred to as “residential supportive living”), but this may limit the range of services for which they are eligible. Program participants cannot reside in a nursing home.
This Medicaid waiver program is administered by the Alaska Department of Health and Social Services’ (DHSS) Division of Senior and Disabilities Services (DSDS). To avoid confusion, it is worth mentioning that Medicaid in the state of Alaska is sometimes referred to as DenaliCare.
Medicaid eligibility is complicated, and the requirements change based on individual criteria, such as age and marital status. What follows is accurate in 2023 for Alaskan residents who are age 65 or older and those between 21 and 64 years of age who are physically disabled as designated by Social Security. To be eligible for the Alaskans Living Independently Waiver, an individual must meet the following requirements.
Participants must require a nursing facility level of care. In other words, if not for the services provided by this waiver, it would be necessary for the individual to reside in a nursing home.
If single, an applicant must not have monthly income exceeding $2,742. This amount is equivalent to 300% of the SSI Federal Benefit Rate. If married, the Medicaid applicant is permitted up to $2,742 in monthly income, while $3,715.50 per month can be transferred to their non-applicant spouse, often referred to as the community spouse. This is called the Monthly Maintenance Needs Allowance (MMNA) and is intended to protect the spouse who is not seeking Medicaid services from becoming impoverished. Unlike with assets, Medicaid does not consider income jointly owned.
If married and both spouses are applying for services, the couple’s income cannot exceed $5,484. (Each spouse is allowed up to $2,742 / month in income.) Again, this figure is calculated at 300% of the SSI Federal Benefit Rate.
If single, an applicant must have countable assets valued at no more than $2,000. This excludes the value of one’s home, provided the applicant resides in the home and his / her equity interest does not exceed $688,000. Other assets that are exempt (not countable) include a vehicle, personal effects, a burial plot, and household items.
If married and the applicant’s spouse is not also seeking Medicaid, the applicant is permitted $2,000 and their spouse is permitted to retain up to $148,620 of their joint assets. This is called the Community Spouse Resource Allowance (CSRA). For married couples, all assets are considered jointly owned.
If married and both spouses are seeking Medicaid, the couple is able to retain up to $3,000 in assets.
Over the Financial Limits?
Families who exceed these limits can very likely still become Medicaid eligible. This applies to both families exceeding the income limits or the asset limits. There are many exceptions and workarounds that help families who require care to receive that care. It is strongly suggested that families in this situation contact a Medicaid planning professional prior to applying for the program. Learn more.
Caution: Asset Transfers
Individuals cannot gift or sell their assets under market value in the preceding 60 months for the purpose of lowering their assets in order to gain Medicaid eligibility. This period of time is referred to as the Medicaid Look-Back Period, and violating this period may result in a period of Medicaid ineligibility.
How to Apply / Learn More
The Alaskans Living Independently Waiver is not an entitlement program, which means the number of people that can receive services via this waiver is limited. Therefore, there may be a wait list. Individuals on the wait list will be prioritized based on those who are most in need of services.
For more information about this waiver, click here. For additional information or to apply, call the Alaska Department of Health and Social Services Senior and Disability Services. Click here to find the number of your local office.