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. That said, the focal point of this webpage will be specifically on Medicaid for long term care, whether that is at home, in a nursing home, or in an assisted living facility.
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 Test. IMPORTANT, not meeting all the criteria below does not mean one is not eligible or cannot become eligible. More.
|2020 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||$2,349 / month**||$2,000||Nursing Home||$4,698 / month (Each spouse is allowed up to $2,349 / month)**||$3,000||Nursing Home||$2,349 / month for applicant**||$2,000 for applicant & $128,640 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,349 / month||$2,000||Nursing Home||$4,698 / month (Each spouse is allowed up to $2,349 / month)||$3,000||Nursing Home||$2,349 / month for applicant||$2,000 for applicant & $128,640 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$1,455 / month||$2,000||None||$2,155 / month||$3,000||None||$2,155 / 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. However, 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. Said another way, the income of the non-applicant spouse is disregarded. To be clear, 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.
As of July 1, 2020, this figure is $2,693.75 / month (this figure is set to increase in July of 2021). If the non-applicant spouse has a monthly income under this amount, the applicant spouse can transfer a portion, or in some cases, all of his / her income to his / her spouse to bring the non-applicant’s monthly income up to this amount. There is also a maximum monthly maintenance needs allowance. Therefore, if the non-applicant spouse has high rent / mortgage and utility costs, he / she may be entitled to a greater spousal allowance. As of January, 1, 2020, the Medicaid applicant can transfer as much as $3,216.50 / month (this figure will change again in January of 2021) 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).
**Note that although there is an income limit for Medicaid nursing home care, all of a recipient’s monthly income, minus a monthly personal needs allowance of approximately $200, and potentially a monthly maintenance needs allowance for a non-applicant spouse, must be paid to the nursing home care.
What Defines “Assets”
Countable assets are assets that can easily be converted to cash to help cover the cost of long-term care and include the following: Cash, stocks, bonds, investments, credit union, savings, and checking accounts, and real estate in which one does not reside. However, 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 $595,000 (in 2020). (Equity interest refers to 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, as of 2020, the community spouse (the non-applicant spouse) can retain up to a maximum of $128,640 of the couple’s joint assets, as the chart indicates above. 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 dates back from the date of one’s Medicaid application. During this time frame, Medicaid checks all past asset transfers to ensure no assets were sold or given away under fair market value. This is done so one does not simply give away assets to meet Medicaid’s asset limit. If one is found to be in violation of the look-back period, a period of Medicaid ineligibility will result.
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) – QIT’s, also referred to as Miller Trusts, are special trusts 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.) This type of trust offers a way for individuals over the Medicaid income limit to still qualify for long-term care Medicaid, as money deposited into a QIT 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 a 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 must have the state of Alaska listed as the remainder beneficiary. In addition, 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. As previously stated, the income in this account is exempt from Medicaid’s income limit.
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” assets by spending assets over the asset limit 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 help them become Medicaid eligible. 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 Medicaid, click here.