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

Last updated: January 10, 2022

 

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. Specifically, it focuses on Medicaid for long term care. 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.

  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 varying financial and medical (functional) eligibility requirements, as well as 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; 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) – This is not an entitlement program; Waivers limit the number of program participants and wait 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) – This is an entitlement program; 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.

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.

2022 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 $2,523 / month* $2,000 Nursing Home $5,046 / month ($2,523 / month per spouse)* $3,000 Nursing Home $2,523 / month for applicant* $2,000 for applicant & $137,400 for non-applicant Nursing Home
Medicaid Waivers / Home and Community Based Services $2,523 / month $2,000 Nursing Home $5,046 / month ($2,523 / month per spouse)† $3,000 Nursing Home $2,523 / month for applicant† $2,000 for applicant & $137,400 for non-applicant Nursing Home
Regular Medicaid / Aged Blind and Disabled $1,561 / month $2,000 Help with ADLs $2,312 / month $3,000 Help with ADLs $2,312 / month $3,000 Help with ADLs
*All of a beneficiary’s monthly income, with the exception of a personal needs allowance of $200, Medicare premiums, and a monthly maintenance needs allowance for a non-applicant spouse (if applicable), must go towards nursing home costs.
Based on one’s living setting, a program beneficiary may not be able keep monthly income up to this level.

 

What Defines “Income”

Any income from any source that a Medicaid applicant receives is counted. 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. Holocaust restitution payments and Covid-19 stimulus checks are not considered income and do not impact one’s eligibility for Medicaid.

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 Minimum Monthly Maintenance Needs Allowance (MMMNA) from the applicant spouse to prevent spousal impoverishment. In 2022, the MMMNA in AK is $3,435 / month. If a non-applicant spouse has monthly income under this amount, income can be transferred from the applicant spouse to the non-applicant spouse to bring their monthly income up to this level. A non-applicant spouse who already has a monthly income of $3,435 or more is not entitled to a MMMNA / spousal income allowance.

Income is counted differently when only one spouse applies for Regular Medicaid / ABD Medicaid; The income of both the applicant spouse and non-applicant spouse is calculated towards the applicant’s income eligibility. Learn more about how Medicaid counts income here.

 

What Defines “Assets”

Countable assets are ones 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. Medicaid also considers many assets to be exempt. This means 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. For home exemption, the Medicaid applicant must live in their home or have intent to return, and in 2022, their home equity interest must be no greater than $636,000. Equity interest is the amount of the home’s value owned by the applicant after subtracting any home debt. If a non-applicant spouse lives in the home, it is exempt regardless of where the applicant lives or the applicant’s home equity interest. AK Medicaid also considers the IRA of a non-applicant spouse to be exempt. Learn more about Medicaid and IRAs.

 While one’s 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 care rather than going to family as inheritance.

All assets of a married couple are considered jointly owned regardless of the long-term care Medicaid program for which one is applying. However, the non-applicant spouse of a nursing home Medicaid or HCBS Medicaid Waiver applicant is permitted a Community Spouse Resource Allowance (CSRA). In 2022, the community spouse (the non-applicant spouse) can retain up to $137,400 of the couple’s joint assets, as shown in the chart above.

Alaska has a 60-month (5 year) Medicaid Look-Back Period that immediately precedes the date on one’s Medicaid application. During the “look back”, Medicaid checks all past asset transfers to ensure no assets were gifted or sold under fair market value. This is done to discourage applicants from giving away assets to meet Medicaid’s asset limit. Persons who violate the look-back period are penalized with a period of Medicaid ineligibility.

 Non-Financial Eligibility Requirements – For Alaska long-term care Medicaid eligibility, an applicant must have a functional need. 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. 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 is required, but a NFLOC is not necessarily required.

 

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 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 qualify 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. In very simple terms, 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 qualify for Medicaid 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 the look back rule was not violated.

3) 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 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. 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.

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) Community First Choice

 

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. Local offices can be found by clicking here.  Alternatively, one can contact their local Aging and Disability Resource Center (ADRC) for assistance. Persons can also 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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