Overview of Alaska’s Community First Choice Medicaid
Alaska’s Community First Choice Program, or CFC Program, is a suite of long-term services and supports for elderly and disabled persons who require care equivalent to that which is provided in a nursing home. Intended to prevent and delay unnecessary nursing facility admissions, personal care services, specifically called Community First Choice Personal Care Services (CFC-PCS), are available. This includes assistance with the Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). These activities include bathing, dressing, toileting, eating, shopping for essentials, light housecleaning, and laundry. Chore services and personal emergency response systems are also potential benefits.
The services offered under this program may be provided by licensed agency workers via the Agency Based Personal Care Services Program, or program participants have the option to self-direct their care. The participant-directed option, called the Consumer Directed Personal Care Services Program (CDPCS), allows one to hire, train, supervise, and even fire, the “personal care assistant” of their choosing. Friends and relatives, such as one’s adult child, can be hired given they pass a background check and complete the required training. One’s spouse, however is prohibited from being hired. A Consumer Directed Provider Agency handles the financial aspects of employment responsibilities, such as tax withholding and caregiver payments.
Program participants must reside in a private home, either their own or that of a loved one. Services cannot be provided to persons living in an assisted living residence. Alaska does not offer adult foster care homes.
The Community First Choice Program is a Medicaid state plan option that was created by the Affordable Care Act (ACA). It is a 1915(k) State Plan Amendment. CFC services are an entitlement. This means meeting the state’s Medicaid eligibility criteria guarantees one will immediately receive assistance.
The Community First Choice (CFC) Option, established by the Affordable Care Act, allows states to provide limited home and community based services (HCBS), such as personal care assistance, via their state’s Regular State Plan Medicaid program. Previously, states mainly provided HCBS via 1915(c) Medicaid Waivers, which limit the number of participant enrollment slots. Therefore, wait lists commonly exist. In contrast, CFC benefits are an entitlement and the number of program beneficiaries are not limited. This means the availability of home and community based services via the CFC Option is open to anyone who meets the eligibility criteria.
Benefits of Alaska’s Community First Choice & Personal Care Services
Follows is a list of potential home and community based services and supports available via Community First Choice. An individual care plan will determine which services and supports a program participant will receive.
– Case Management
– Chore Services – i.e., securing loose rugs, snow removal, chopping wood
– Community First Choice Personal Care Services (CFC-PCS) – assistance with bathing, personal hygiene, dressing, meal preparation, shopping for essential items, basic housecleaning, etc.
– Personal Emergency Response Systems (PERS)
– Skills Training – to become more independent in completing daily activities
– Supervision / Reminders – for persons with cognitive impairments and behavioral issues
– Worker Supervision – training to assist persons who opt for participant directed care in selecting and managing their caregiver (personal care assistant)
Eligibility Requirements for Community First Choice Medicaid
The CFC suite of long-term care services is for Alaska residents who are eligible for Alaska’s Regular State Plan Medicaid. The additional criteria below is relevant for the elderly (65+ years of age).
Financial Criteria: Income, Assets & Home Ownership
In 2024, the individual applicant income limit is $1,751 / month, and the couple income limit with both spouses as applicants is $2,593 / month. When only one spouse is an applicant, the individual income limit of $1,751 / month is used. The income of the non-applicant spouse is not counted towards the income eligibility of their spouse. Furthermore, monthly income from the applicant spouse can be transferred to the non-applicant spouse as a Spousal Income Allowance, also called a Monthly Maintenance Needs Allowance.
In Alaska, the maximum amount of income that can be transferred to the non-applicant spouse is $3,853.50 / month. For clarification, this allowance is intended to bring a non-applicant’s total monthly income up to $3,853.50. If a non-applicant’s own income is equal to or greater than this amount, they are not entitled to a Spousal Income Allowance.
In 2024, the asset limit is $2,000 for a single applicant. For married couples, with both spouses as applicants, the asset limit is $3,000. When only one spouse is an applicant, the assets of both the applicant and non-applicant spouse are still limited. This is because Medicaid considers the assets of a married couple to be jointly owned. In this case, the applicant spouse can have $2,000 in assets, while the non-applicant spouse is allocated a larger portion of the couple’s assets as a Community Spouse Resource Allowance (CSRA) to prevent spousal impoverishment. In 2024, the CSRA allows the non-applicant spouse to keep up to $154,140 of the couple’s assets.
Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.
Assets should not be given away or sold under fair market value prior to applying for long-term care Medicaid. This is because AK Medicaid has a 60-month Look-Back Rule for applicants of long-term home and community based services. Violating this rule results in a Penalty Period of Medicaid ineligibility.
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. Fortunately, for eligibility purposes, Alaska Medicaid considers the home exempt (non-countable) in the following circumstances.
– The applicant lives in the home or has Intent to Return, and in 2024, their home equity interest is no greater than $713,000. Home equity is the current value of the home minus any outstanding mortgage. Equity interest is the portion of the home’s equity value that is owned by the applicant.
– The applicant has a spouse living in the home.
– The applicant has a minor child (under 21) living in the home.
– The applicant has a blind or disabled child of any age living in the home.
Medical Criteria: Functional Need
An applicant must require a nursing facility level of care (NFLOC). The Division of Senior and Disabilities Services’ Intake and Assessment Unit utilizes the Consumer Assessment Tool (CAT) to make this determination. An applicant’s ability / inability to complete their Activities of Daily Living (i.e., transferring from the bed to a chair, mobility, dressing, eating, toileting, bathing) and Instrumental Activities of Daily Living (i.e., housekeeping, medication management, shopping, laundry) are assessed. Other areas of consideration are nursing needs (i.e., injections, feeding tube, treatments), and relevant to some persons with Alzheimer’s disease or a related dementia, cognition (i.e., memory, recall ability, decision making) and problematic behavior (i.e., wandering, socially inappropriate behavior, resisting care). A diagnosis of dementia in and of itself does not mean one will automatically meet a NFLOC.
Qualifying When Over the Limits
Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for Medicaid. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.
When persons have income over the limits, Miller Trusts, also called Qualified Income Trusts, can help. Specific to Alaska, they are called Irrevocable Income Trusts. “Excess” income is deposited into the trust, no longer counting as income.
When persons have assets over the limits, one option is to “spend down” the extra assets. Examples include paying off debt, making home improvements (i.e., updating heating and plumbing), and purchasing pre-paid funeral and burial expense trusts called Irrevocable Funeral Trusts. Persons may also convert a lump sum of cash into a monthly income stream by purchasing a Medicaid-Compliant Annuity. There are many other options when the applicant has assets exceeding the limit.
Inadequate planning or improperly implementing a Medicaid Planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid Planners are educated in the planning strategies available in the state of Alaska to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. There are also planning strategies that not only help one meet Medicaid’s financial criteria, but also protects assets from Medicaid’s Estate Recovery Program, preserving them for family as inheritance. These strategies often violate Medicaid’s 60-month Look-Back Period, and therefore, should be implemented well in advance of the need for long-term care. However, there are some workarounds, and Medicaid planners are aware of them. For these reasons, it is highly suggested one consult a Medicaid Planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Medicaid Planner.
How to Apply for Alaska’s Community First Choice Medicaid
Before You Apply
Prior to submitting an application for CFC services, applicants need to ensure they meet the eligibility criteria for Medicaid in Alaska. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a free Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria. Take the Medicaid Eligibility Test.
As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, bank statements up to 60-months prior to application, proof of income, copies of life insurance policies, property deeds, and pre-need burial contracts. Unfortunately, a common reason applications are held up is required documentation is missing or not submitted in a timely manner.
To apply for the Community First Choice Program, seniors should contact their local Aging and Disability Resource Center (ADRC). Persons can also call ADRC’s statewide number at 855-565-2017 or 877-625-2372. If it is likely one is eligible for CFC, a list of care coordinators will be provided to assist them with the application process. This includes arranging for the functional needs assessment. Learn more about the Community First Choice Program.
The CFC Program is administered by the Alaska Department of Health (DOH). The Department’s Division of Senior and Disabilities Services (SDS) determines functional eligibility and the Division of Public Assistance determines financial eligibility.
Approval Process & Timing
Alaska’s Medicaid application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed. Based on federal law, Medicaid offices have up to 45 days to review and approve or deny one’s application (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further.