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

Last updated: January 27, 2021

 

Alaska Medicaid Definition

In Alaska, the Medicaid program is also called DenaliCare. The agency that administers it is the Alaska Department of Health and Social Services’ Division of Public Assistance.

Medicaid is a wide-ranging, jointly funded state and federal health care program for low-income individuals of all ages. While there are several different eligibility groups, the focus of this page is strictly on Medicaid eligibility for elderly Alaska residents, aged 65 and over. Narrowing it down even further, the focal point will be specifically on Medicaid for long term care, whether that is at home, in a nursing home, or in an assisted living facility.

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

 

Income & Asset Limits for Eligibility

There are several different Medicaid long-term care programs for which Alaska seniors may be eligible. These programs have slightly different financial and medical (functional) eligibility requirements, as well as varying benefits. Further complicating eligibility are the facts that the criteria vary with marital status and that Alaska offers several pathways towards eligibility.

1) Institutional / Nursing Home Medicaid – This is an entitlement program. This means 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) – Waivers limit the number of program participants, which means wait lists may exist. Services are provided at home, adult day care, or in assisted living.
3) Regular Medicaid / Aged Blind and Disabled (ABD) – This is an entitlement program. This means anyone who meets the program requirements is able to receive benefits. Services are available at home or adult day 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, take the Medicaid Eligibility TestIMPORTANT, not meeting all the criteria below does not mean one is not eligible or cannot become eligible. More.

2021 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 $2,382 / month** $2,000 Nursing Home $4,764 / month (Each spouse is allowed up to $2,382 / month)** $3,000 Nursing Home $2,382 / month for applicant** $2,000 for applicant & $130,380 for non-applicant Nursing Home
Medicaid Waivers / Home and Community Based Services $2,382 / month $2,000 Nursing Home $4,764 / month (Each spouse is allowed up to $2,382 / month) $3,000 Nursing Home $2,382 / month for applicant $2,000 for applicant & $130,380 for non-applicant Nursing Home
Regular Medicaid / Aged Blind and Disabled $1,474 / month $2,000 None $2,183 / month $3,000 None $2,183 / month $3,000 None
What Defines “Income”

For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. To clarify, this income can come from any source. Examples include cash from family and friends, Veteran’s benefits, employment wages, alimony payments, pension payments, annuity payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. An exception exists for Covid-19 stimulus checks, which do not count as income, and therefore, do not impact one’s eligibility for Medicaid.

When only one spouse of a married couple is applying 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 is disregarded. However, when only one spouse of a married couple applies for regular Medicaid, the income of both spouses is counted towards the applicant spouse’s eligibility. Learn more about how Medicaid counts income here.

A Minimum Monthly Maintenance Needs Allowance (MMMNA), which is the minimum amount of monthly income to which a non-applicant spouse is entitled, is in place to prevent spousal impoverishment. From July 1, 2020 – June 30, 2021, this figure is $2,693.75 / month. If the non-applicant spouse has a monthly income under $2,693.75, the applicant spouse can transfer income in his / her name to the non-applicant spouse to bring that spouse’s monthly income up to this amount. There is also a maximum monthly maintenance needs allowance, which allows a greater transfer of income under specific circumstances, such as high rent / mortgage and utility costs. From January, 1, 2021 – December 31, 2021, the Medicaid applicant can transfer as much as $3,259.50 / month in income to the non-applicant spouse to ensure he / she has sufficient funds with which to live. Please note that this spousal allowance rule only extends to couples in which only one spouse is applying for nursing home Medicaid or a HCBS Medicaid Waiver. (This rule does not apply for regular Medicaid for the aged, blind and disabled).

**Although there is an income limit for Medicaid nursing home care, nearly all of a recipient’s monthly income must go to the nursing home. Allowable deductions include a monthly personal needs allowance of $200 and potentially a monthly maintenance needs allowance for a non-applicant spouse.

 

What Defines “Assets”

Countable assets are assets that can easily be converted to cash to help cover the cost of long-term care. This includes cash, stocks, bonds, investments, credit union, savings, and checking accounts, and real estate in which one does not reside. For Medicaid eligibility purposes, there are many assets that are considered exempt, or said another way, 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 one’s primary home, given the Medicaid applicant lives in it, or has “intent” to return to it, and his / her home equity interest is no greater than $603,000 (in 2021). (Equity interest is the amount of the home’s value owned by the applicant). If there is a non-applicant spouse who lives in the home, it is exempt regardless of where the applicant lives or the applicant’s equity interest in the home.

For married couples, in 2021, the community spouse (the non-applicant spouse) can retain up to a maximum of $130,380 of the couple’s assets, as the chart indicates above. (Medicaid considers assets owned by either spouse as jointly owned, with the exception of a non-applicant spouse’s IRA). This, in Medicaid speak, is known as the Community Spouse Resource Allowance (CSRA). Like the MMMNA, this rule is in place to prevent spousal impoverishment of non-applicant spouses, and is only extended to couples with one spouse applying for institutional Medicaid or a HCBS Medicaid Waiver.

One should be aware that Alaska has a Medicaid Look-Back Period. This is a period of 60 months (5 years) that precedes the date on one’s Medicaid application. During the “look back”, Medicaid checks all past asset transfers to ensure no assets were sold or given away under fair market value. This is done to discourage applicants from giving away assets to meet Medicaid’s asset limit. If one violates the look-back period, a penalty period of Medicaid ineligibility will result.

 In order to be eligible for long-term care Medicaid, an applicant must have a need for such care. For nursing home Medicaid, as well as many HCBS Medicaid Waivers, a nursing facility level of care is required. Furthermore, some benefits intended to prevent and / or delay nursing home placement may require additional eligibility criteria specific to the particular benefit. For instance, in order 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. 

 

Qualifying When Over the Limits

For Alaska elderly residents (65 and over) who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.

1) Qualified Income Trusts (QIT’s) –Also called Miller Trusts, this is a special trust for Medicaid applicants who are over the income limit yet still cannot afford to pay for their long-term care. (For Alaska Medicaid purposes, a Miller Trust is also called an Irrevocable Income Trust.) QITs allow a way for individuals over the Medicaid income limit to still qualify for long-term care Medicaid, as money deposited into the trust does not count towards Medicaid’s income limit. In simple terms, one’s excess income (the amount over Medicaid’s income limit) is directly deposited into the trust, in which a trustee is named, giving that individual legal control of the money. The account must be irreversible, meaning once it has been established, it cannot be changed or canceled, and it must have the state of Alaska listed as the remainder beneficiary. The money in the account can only be used for very specific purposes, such as paying long term care services / medical expenses accrued by the Medicaid enrollee.

Unfortunately, Irrevocable Income Trusts do not assist one in qualifying for Medicaid if his / her assets are over Medicaid’s asset limit. Said another way, if one meets the income requirements for Medicaid eligibility, but not the asset requirement, the above option cannot assist one in “spending down” their extra assets. However, one can “spend down” excess assets on non-countable ones, such as 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.  More on Miller / QITs.

2) Medicaid Planning – the majority of persons considering Medicaid are “over-income”, “over-asset”, or both, but they still are unable to pay for their care. For persons in this situation, 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. Read more or connect with a Medicaid planner.

 

Specific Alaska Medicaid Programs

1) Personal Care Services (PCS) Program – Formerly named the Alaska Medicaid Personal Care Assistance (PCA) Program, this program is available under the state Medicaid plan for disabled and elderly Alaska residents. 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 family members. Click here for additional information.

2) Alaskans Living Independently (ALI) – This Medicaid Waiver provides assistance for seniors and disabled individuals 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) Adults with Physical & Developmental Disabilities (APDD) Waiver – Previously named Adults with Physical Disabilities, this home and community based services Medicaid waiver is for adults who are 21 years of age and older who have physical impairments due to autism or an intellectual or developmental disability. Benefits may include adult day care, respite care, home modifications, skilled nursing, and congregate meals.

 

How to Apply for Alaska Medicaid

To apply for DenaliCare (Institutional, HCBS Medicaid Waivers, & Aged, Blind and Disabled) in Alaska, one should contact the Alaska Department of Health and Social Services Senior and Disability Services office. One can click here to find his / her local office. Alternatively, one can contact their local Aging and Disability Resource Center (ADRC) for assistance. Finally, one can apply online at MyAlaska by clicking on “ARIES – Public Assistance” under “Services for Individuals”.

For general information about applying for long term care Medicaid, click here.

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