Alaskans Living Independently (ALI) Medicaid Waiver

Page Reviewed / Updated - Dec. 2018

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 the care outside of a nursing home needs to be less than the cost of care in a nursing home.

Program Description

The Alaskans Living Independently (ALI) Medicaid Waiver is intended to assist seniors 65 years of age and older or adults 21 years of age to 64 years of age who are physically disabled, and in need of a Nursing Facility Level of Care (NFLOC). Through this statewide waiver program, services are provided, such as care coordination, adult day care, and respite care, which allow the individual to continue to live at home, while also providing support to the caregivers. Modifications to the home to help promote independence, like wheelchair ramps and widening of the doorways, home delivered meals, and personal response systems, are also covered benefits of this waiver.

ALI allows eligible individuals to choose their own care providers, given the providers are qualified to provide such care. Care providers can be family members, including an adult child and in some cases, a sibling. Spouses are not able to provide care. However, there are some restrictions to this self-directed care.

It is not a requirement of the program that the participants 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). Alaskans Living Independently was created as a replacement for two previous state Medicaid programs: Older Alaskans Program and the Adults with Physical Disabilities Medicaid Waiver. To avoid confusion, it is worth mentioning that Medicaid in the state of Alaska is sometimes referred to as DenaliCare.

Eligibility Guidelines

Medicaid eligibility is complicated and the requirements change based on individual criteria, such as age and marital status. What follows is accurate for 2019 for Alaskan residents who are aged 65 or older and those under 65 years of age who are physically disabled as designated by Social Security. To be eligible for the Alaskans Living Independently wavier, an individual must:

1) Care Needs - Require a nursing facility level care of care. In other words, if not for the services provided by this wavier, it would be necessary for the individual to reside in a nursing home.

2a) Assets - 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 reside in the home and the value of their home equity does not exceed $585,000. Other assets that are exempt (non-countable) include a vehicle, personal effects, a burial plot, and household items.

2b) Assets - 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 $126,420 of their joint assets. This is called the Community Spouse Resource Allowance (CSRA). For married couples, all assets are considered jointly owned.

2c) Assets – If married, and both spouse’s are seeking Medicaid, the couple is able to retain up to $3,000 in assets.

3a) Income - If single, an applicant must not have monthly income not exceeding $2,313. This amount is equivalent to 300% of the SSI Federal Benefit Rate.

3b) Income - If married, the Medicaid applicant is permitted up to $2,313 in monthly income and their non-applicant spouse, often referred to as the community spouse, may be permitted up to an additional $3,160.50 per month transferred from his/her applicant spouse. This is called the Minimum Monthly Maintenance Needs Allowance (MMMNA) 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.

3c) Income – If married, and both spouses are applying for services, the couple’s income cannot exceed $4,626. (Each spouse is allowed up to $2,313 / month in income.) Again, this figure is calculated at 300% of the SSI Federal Benefit Rate.

4) Asset Transfers - Individuals cannot have gifted or sold assets under market value in the preceding 60 months for the purposes of lowering their assets 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.

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.  

Benefits and Services

  • Adult Day Care - Also referred to as Adult Day Services
  • Care Coordination
  • Respite Care - May be in-home or out-of-home, such as a nursing home or an assisted living facility 
  • Chore Services - Scrubbing floors/walls, moving furniture, snow removal, chopping firewood, etc.
  • Environmental Modifications – Also referred to as home modifications – Wheelchair ramps, grab-bars, walk-in tubs, etc.
  • Meals - home delivered or served in a group setting
  • Residential Supported Living - 24 hour care access in a setting that is not an institution
  • Specialized Medical Equipment and Supplies 
  • Personal Emergency Response System 
  • In-home Specialized Private Duty Nursing
  • Transportation – Medical and Non-Medical

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.