Alaska Medicaid (DenaliCare) Eligibility for Long Term Care: Income & Asset Limits

Last updated: January 02, 2024


Alaska Medicaid Long-Term Care Definition

Medicaid is a health care program for low-income individuals of all ages. While there are various coverage groups, the focus here is strictly on long-term care Medicaid eligibility for elderly Alaska residents, aged 65 and over. In addition to care services in nursing homes and assisted living facilities, AK Medicaid pays for non-medical services and supports to help frail seniors remain living in their homes. There are three categories of Medicaid long-term care programs for which Alaska seniors may be eligible.

1) Institutional / Nursing Home Medicaid – An entitlement; anyone who meets the eligibility requirements is able to receive assistance. Benefits are provided only in nursing home facilities.

2) Medicaid Waivers / Home and Community Based Services (HCBS) – Not an entitlement; the number of program participants are limited and waiting lists may exist. Intended to delay nursing home placements, services are provided at home, adult day care, or in assisted living. More on Waivers.

3) Regular Medicaid / Aged Blind and Disabled (ABD) – An entitlement; anyone who meets the program requirements is able to receive benefits. Various long-term care services, such as personal care assistance or adult day care, may be available.

Alaska’s Medicaid program is called DenaliCare. While it is jointly funded by the state and federal government, it is administered by the state under federally set parameters. The administering agency is the Alaska Department of Health and Social Services’ Division of Public Assistance.

  The American Council on Aging now offers a free, quick and easy Medicaid Eligibility Test for seniors.


Income & Asset Limits for Eligibility

The three categories of Medicaid long-term care programs have varying financial and medical (functional) eligibility requirements. Further complicating eligibility is that the financial criteria changes annually, varies based on marital status, and that Alaska offers alternative pathways towards eligibility.

 Simplified Eligibility Criteria: Single Nursing Home Applicant
AK seniors must have limited income and assets, and a medical need to qualify for Medicaid long-term care. In 2024, a single Nursing Home Medicaid applicant must meet the following criteria: 1) Income under $2,829 / month 2) Assets under $2,000 3) Require a Nursing Home Level of Care.

The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long-term care from an Alaska Medicaid program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT: Not meeting all the criteria does not mean one is ineligible or cannot become eligible for AK Medicaid. More.

2024 Alaska Medicaid Long-Term Care Eligibility for Seniors
Type of Medicaid Single Married (both spouses applying) Married (one spouse applying)
Income Limit Asset Limit Level of Care Required Income Limit Asset Limit Level of Care Required Income Limit Asset Limit Level of Care Required
Institutional / Nursing Home Medicaid $2,829 / month* $2,000 Nursing Home $5,658 / month ($2,829 / month per spouse)* $3,000 Nursing Home $2,829 / month for applicant* $2,000 for applicant & $154,140 for non-applicant Nursing Home
Medicaid Waivers / Home and Community Based Services $2,829 / month† $2,000 Nursing Home $5,658 / month ($2,829 / month per spouse)† $3,000 Nursing Home $2,829 / month for applicant† $2,000 for applicant & $154,140 for non-applicant Nursing Home
Regular Medicaid / Aged Blind and Disabled $1,751 / month $2,000 Help with ADLs $2,593 / month $3,000 Help with ADLs $2,593 / month $3,000 Help with ADLs
*All of a beneficiary’s monthly income, with the exception of a Personal Needs Allowance of $200 / month, Medicare premiums, and possibly a Needs Allowance for a non-applicant spouse (if applicable), must go towards nursing home costs. This is called a Patient Liability.

†Based on one’s living setting, a program beneficiary may not be able keep monthly income up to this level.


Income Definition & Exceptions

Countable vs. Non-Countable Income
Nearly any income from any source received is counted towards the income limit. Examples include cash from family and friends, employment wages, alimony payments, pension payments, annuity payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. Nationally, Holocaust restitution payments are not counted as income. In AK, VA Aid & Attendance, which is above and beyond the Basic VA Pension, does not count as income.

Treatment of Income for a Couple
When only one spouse of a married couple applies for Nursing Home Medicaid or a HCBS Medicaid Waiver, only the income of the applicant is counted. This means the income of the non-applicant spouse does not impact the applicant spouse’s Medicaid eligibility. The non-applicant spouse, however, may be entitled to a Monthly Maintenance Needs Allowance (MMNA) from their applicant spouse to prevent spousal impoverishment. In 2024, the MMNA in AK is $3,853.50 / month. If a non-applicant spouse has monthly income under this amount, income can be transferred to them from their applicant spouse to bring their monthly income up to this level. A non-applicant spouse who already has a monthly income of $3,853.50 or more is not entitled to a MMNA / Spousal Income Allowance.

Income is counted differently when only one spouse applies for Regular Medicaid / ABD Medicaid; the income of both the applicant and non-applicant spouse is calculated towards the applicant’s income eligibility. There is no Minimum Monthly Maintenance Needs Allowance for a non-applicant spouse. More on how Medicaid counts income.


Asset Definition & Exceptions

Countable vs. Non-Countable Assets
Countable assets are counted towards the asset limit. This includes cash, stocks, bonds, investments, bank accounts (credit union, savings, and checking), and real estate in which one does not reside. In Alaska, an applicant’s IRA / 401K is counted. Medicaid also considers many assets to be non-countable (exempt); they are not counted towards the eligibility limit. Exemptions include personal belongings, such as clothing and jewelry, household goods / furnishings, an automobile, a burial plot, and generally, one’s primary home. In AK, the IRA / 401K of a non-applicant spouse is not counted.

Treatment of Assets for a Couple
All assets of a married couple are considered jointly owned. This is true regardless of the long-term care Medicaid program for which one is applying and regardless of if one or both spouses are applicants. There is, however, a Community Spouse Resource Allowance (CSRA) that protects a larger amount of a couple’s countable assets for the non-applicant spouse (community spouse) of a Nursing Home Medicaid or HCBS Medicaid Waiver applicant. In 2024, the CSRA allows the community spouse to keep to up $154,140 of the couple’s assets. There is no CSRA for a non-applicant spouse of a Regular Medicaid applicant.

Medicaid’s Look-Back Rule
Alaska has a 60-month (5 year) Medicaid Look-Back Period that immediately precedes the date on one’s Nursing Home Medicaid or Medicaid Waiver application. During the “look back”, Medicaid checks all past asset transfers to ensure no assets were gifted or sold under fair market value. This includes asset transfers made by one’s spouse. The Look-Back Rule is meant to discourage persons from giving away assets to meet Medicaid’s asset limit. Violating this rule results in a Penalty Period of Medicaid ineligibility.

The U.S. Federal Gift Tax Rule does not extend to Medicaid eligibility. In 2024, this rule allows one to gift up to $18,000 per recipient without filing a Gift Tax Return. Gifting under this rule violates Medicaid’s Look-Back Period.


Alaska Medicaid Home Exemption Rules

For home exemption, the Medicaid applicant or their spouse must live in their home. If there is no spouse in the home, there is a home equity interest limit of $713,000 (in 2024). Home equity is the value of the home, minus any outstanding debt against it. Equity interest is the amount of the home’s equity that is owned by the applicant. Furthermore, if there is not a spouse in the home, and the Medicaid applicant does not live there, the applicant must have Intent to Return. For Regular Medicaid, there is no home equity interest limit. Other exemptions exist.

While the home is generally exempt from Medicaid’s asset limit, it is not exempt from Medicaid’s Estate Recovery Program. Following a long-term care Medicaid beneficiary’s death, Alaska’s Medicaid agency attempts reimbursement of care costs through whatever estate of the deceased still remains. This is often the home. Without proper planning strategies in place, the home will be used to reimburse Medicaid for providing long-term care rather than going to family as inheritance.


Medical / Functional Need Requirements

An applicant must have a medical need for long-term care Medicaid. For Nursing Home Medicaid and HCBS Medicaid Waivers, a Nursing Facility Level of Care (NFLOC) is required. Furthermore, some benefits may require additional eligibility criteria specific to the particular benefit be met. For instance, for a Medicaid Waiver to pay for home modifications, it may be required that an applicant be unable to safely live at home without this benefit. For long-term care services via the Regular Medicaid program, a functional need with the Activities of Daily Living (ADLs) is required, but a NFLOC is not necessarily required.


Qualifying When Over the Limits

For Alaska elderly residents (aged 65 and over) who do not meet the financial eligibility requirements above, there are other ways to qualify for long-term care Medicaid.

1) Qualified Income Trusts (QIT’s) – Also called a Miller Trust, or specific to Alaska, an Irrevocable Income Trust, this special trust offers a way for Medicaid applicants who are over the income limit to still become income-eligible for Nursing Home Medicaid or a Medicaid Waiver. Irrevocable means the terms of the trust cannot be changed or cancelled. For Medicaid eligibility purposes, monthly income put into an Irrevocable Income Trust no longer counts as income. Essentially, income over the Medicaid limit is deposited into the trust in which a trustee has legal control. Trust funds can only be used for very specific purposes, such as paying long-term care services / medical expenses accrued by the Medicaid enrollee. Furthermore, the state of Alaska must be listed as the remainder beneficiary.

2) Asset Spend Down – Persons who have assets over Medicaid’s asset limit can still become asset-eligible by “spending down” their extra assets on non-countable ones. Examples include making home modifications (wheelchair ramps, roll-in showers, and stair lifts), home improvements (replacing faulty electrical wiring, updating plumbing, and replacing old water heaters), vehicle modifications (wheelchair lifts, adaptive control devices, and floor modifications to allow one to drive from a wheelchair), prepaying funeral and burial expenses, and paying off debt. Remember, assets cannot be gifted or sold under fair market value. Doing so violates Medicaid’s Look-Back Rule and can result in a Penalty Period of Medicaid ineligibility. It is recommended one keep documentation of how assets were spent as proof this rule was not violated.

 Our Spend Down Calculator can assist persons in determining if they might have a spend down, and if so, provide an estimate of the amount.

3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” and / or “over-asset”, but they still are unable to pay for their care. For these persons, Medicaid planning exists. By working with a Medicaid Planning Professional, families can employ a variety of strategies to not only help them become Medicaid-eligible, but also to protect their home from Medicaid’s Estate Recovery Program. Connect with a Medicaid Planner.


Specific Alaska Medicaid Programs

In addition to paying for nursing home care, Alaska Medicaid offers the following programs relevant to the elderly that helps them to remain living at home or in assisted living residences.

1) Personal Care Services (PCS) Program – Formerly named the Personal Care Assistance (PCA) Program, PCS is available under the state Medicaid plan for Alaska residents who are disabled and elderly. As the name implies, personal care services are provided for those who require assistance with daily living activities. Program participants are able to hire the caregiver of their choosing, including select family members.

2) Alaskans Living Independently (ALI) – This Medicaid Waiver provides assistance for seniors and adults who are disabled to prevent and delay nursing home placements. Benefits vary based on if one lives at home or in an assisted living residence, but may include adult day care, respite care, meal delivery, home modifications, private duty nursing, and more.

3) Community First Choice – Through this Medicaid state plan option, a suite of long-term services and supports are available for persons who are aged or disabled and require the level of care that is provided in a nursing home. Benefits may include personal care assistance, chore services, basic housekeeping, and skills training.


How to Apply for Alaska Medicaid

To apply for AK Medicaid / DenaliCare, one should contact the Alaska Department of Health and Social Services Senior and Disability Services office. Find local offices. Alternatively, one can contact their local Aging and Disability Resource Center (ADRC) for assistance. Persons can also apply online at Alaska’s Resource for Integrated Eligibility Services (ARIES) Self-Service Portal. The application process may vary based on the program for which one is applying.

Before applying for long-term care Medicaid, it is imperative that Alaska seniors be certain that all eligibility requirements are met. If one is over the income and / or asset limit(s), or are unsure if they meet the eligibility criteria, Medicaid planning can be invaluable. The application process, which can be lengthy, is also complicated. Familiarizing oneself with general information about the application process for long-term care Medicaid can be helpful.

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