Overview of the Alaskans Living Independently (ALI) Medicaid Waiver
The Alaskans Living Independently Waiver, or ALI Waiver, is a statewide Medicaid program for seniors and physically disabled adults who are at risk of institutionalization (nursing home admission). Intended to prevent and delay the need for nursing home care, a variety of long-term services and supports are available to assist persons in living independently. Examples include adult day care, home modifications for safety and accessibility, respite care to relieve an informal (unpaid) caregiver, and specialized private duty nursing services.
Program participants can live at home, the home of a loved one, or an assisted living residence. Alaska does not offer adult foster care homes.
Many long-term care Medicaid programs offer a participant-directed option, allowing program participants to select and manage the caregiver of their choosing. This, unfortunately, is not an option through the ALI Waiver. Instead, all services and supports are provided by agency providers.
The Alaskans Living Independently Waiver is a 1915(c) Home and Community Based Services (HCBS) Medicaid Waiver. It is not an entitlement program. The number of participant enrollment slots are limited, and when these slots are full, a waiting list for program participation forms.
Historically Medicaid only paid for long-term care in nursing homes. 1915(c) HCBS Medicaid Waivers, also known as Home and Community Based Services Waivers, allow states to offer benefits outside of these institutions. The goal of HCBS is to delay or prevent institutionalization, and to that end, care may be provided in one’s home, the home of a relative, assisted living, or adult foster care / adult family living. Waivers target specific groups of persons, such as the elderly, disabled, or persons with Alzheimer’s, who require a Nursing Home Level of Care and are at risk of institutionalization. Waivers are not entitlements. Instead, there are a limited number of program participant slots, and when they are full, a waitlist is established.
Benefits of the Alaskans Living Independently Waiver
Follows is a list of Home and Community Based Services available via the ALI Waiver. An individualized care plan determines which benefits a program participant receives.
– Adult Day Care
– Case Management
– Home Modifications – i.e., wheelchair ramps, grab bars, widening of doorways
– Meal Services – congregate settings / home delivered (max. of two meals per day)
– Nursing Oversight and Care Management
– Residential Supported Living Services – assisted living services
– Respite Care – in-home and out-of-home care to relieve a primary caregiver
– Specialized Medical Equipment
– Specialized Private Duty Nursing
– Transportation – non-medical
While a program participant can reside in an assisted living residence, the ALI Waiver does not cover the cost of room and board.
Eligibility Requirements for the Alaskans Living Independently (ALI) Medicaid Waiver
The ALI Waiver is for Alaska residents who are elderly (65+ years old), or physically disabled and between 21 and 64 years old. Persons who enroll as a disabled adult can continue to receive waiver services under the aged category when turning 65. Additional eligibility criteria follows.
Financial Criteria: Income, Assets & Home Ownership
Income
The applicant income limit is equivalent to 300% of the Federal Benefit Rate (FBR), which changes annually in January. In 2026, an applicant, regardless of marital status, can have a monthly income up to $2,982. When both spouses are applicants, each spouse is considered individually, with each spouse allowed income up to $2,982 / month. When only one spouse is an applicant, the income of the non-applicant spouse is not counted towards the income-eligibility of their spouse. Furthermore, in some cases, income can be allocated to the non-applicant spouse from their applicant spouse as a Spousal Income Allowance, also called a Monthly Maintenance Needs Allowance (MMNA).
In Alaska, in 2026, the maximum amount of income that can be transferred to the non-applicant spouse is $4,066.50 / month. This allowance is intended to bring a non-applicant’s monthly income up to this amount. If a non-applicant’s own income is equal to or greater than $4,066.50 / month, they are not entitled to a Spousal Income Allowance.
Assets
In 2026, 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 spouses 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 up to $162,660 (in 2026) of the couple’s assets as a Community Spouse Resource Allowance (CSRA) to prevent spousal impoverishment.
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 within 60-months of long-term care Medicaid application. Medicaid has a Look-Back Rule and violating it results in a Penalty Period of Medicaid ineligibility.
Home Ownership
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, Medicaid in Alaska considers the home exempt (non-countable) in the following circumstances.
– The applicant lives in the home or has Intent to Return, and in 2026, their home equity interest is no greater than $752,000. 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 years old) living in the home.
– The applicant has a disabled or blind child (of any age) living in the home.
While one’s home is generally safe from Medicaid’s asset limit, it is not safe from Medicaid’s Estate Recovery Program. More about the potential of Medicaid taking the home.
Medical Criteria: Functional Need
An applicant must require a Nursing Facility Level of Care (NFLOC). For the ALI Waiver, the Consumer Assessment Tool (CAT) is utilized to determine if one meets this level of care need. One’s ability / inability to complete Activities of Daily Living (ADLs), such as bathing, dressing, mobility, eating, and toiletry, and Instrumental Activities of Daily Living (IADLs), like meal preparation, laundry, and shopping for essentials, is considered. Other considerations include the need, and frequency of need, for medications, professional nursing services, and treatments. Relevant to many persons with Alzheimer’s disease or a related dementia, memory, cognition, and behavioral issues (i.e., wandering) are also considered. To be clear, a diagnosis of dementia in and of itself does not mean one will 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 AK 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 limit, Irrevocable Funeral Trusts (IFTs) are an option. IFTs are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Medicaid Asset Protection Trusts (MAPTs), which must be implemented well in advance of the need for care, are another option. MAPTs protect assets from both Medicaid and Medicaid’s Estate Recovery Program. For persons who do not have a significant amount of excess assets, “spending down” countable assets on ones that are exempt might be a good option. Examples include purchasing household furnishings, appliances, and clothing. There are additional planning strategies available 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 Alaska to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Some of the strategies violate Medicaid’s 60-month Look-Back Rule, and therefore, should only be implemented with careful planning. 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 Certified Medicaid Planner.
How to Apply for the Alaskans Living Independently (ALI) Medicaid Waiver
Before You Apply
Prior to submitting an application for the ALI Waiver, applicants need to ensure they meet the eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria.
As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security cards, Medicare cards, life insurance policies, property deeds, pre-need burial contracts, bank statements up to 60-months prior to application, and proof of income. Unfortunately, a common reason applications are delayed is required documentation is missing or not submitted in a timely manner.
Since the Alaskans Living Independently Waiver is not an entitlement program, there could potentially be a waiting list for program participation. However, this waiver is approved for 3,054 beneficiaries per year, and the current number of participants is below this figure. If the state becomes close to approved capacity, rules will be implemented as to how applicants are placed on a waiting list and how the slots are filled as they became available.
Application Process
Persons can begin the application process for the ALI Waiver by contacting the Aging and Disability Resource Center (ADRC) in their area. Persons can also call ADRC’s statewide number at 855-565-2017. If it seems likely one would be eligible for waiver services, they will receive a list of care coordinators who can provide application assistance.
See limited information about the ALI Waiver. Persons can also call the Division of Senior and Disabilities Services (SDS) at 1-800-478-9996 to learn more.
The ALI Waiver is administered by the Alaska Department of Health (DOH) and is operated by the Department’s Division of Senior and Disabilities Services (SDS).
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. Furthermore, if a waiting list were to exist, approved applicants could spend an even greater amount of time waiting to receive benefits.