Alaska has many state programs to help seniors with long-term care, including assisted living and in-home care services. There are two privately run programs to assist elderly Alaskans with their long-term care: Personal Care Assistance (PCA) and Grants Services.

  • The PCA program helps with individuals’ activities of daily living (i.e. bathing, dressing, eating) as well as instrumental activities of daily living (i.e. shopping, laundry, light housework). PCA is provided statewide in Alaska through private agencies.
  • The Grants Services program assists seniors aged 60 and over or frail/disabled seniors in need of assistance in the home. The service works by providing grants to nonprofit organizations that work with Alaskans who are either Medicaid eligible or not or awaiting enrollment in one of the Medicaid waiver programs. These grants are awarded to agencies every three or four years through a competitive process. Funding for these programs comes from the U.S. Administration on Aging, the Alaska Mental Health Trust Authority, and state general funds.

The State of Alaska Department of Health and Social Services (ADHHS), Senior and Disability Services division administers the Medicaid waiver program known as Alaskans Living Independently (ALI). The ALI waiver is available to Medicaid-eligible seniors (65+) who would otherwise require a nursing home level of care but wish to remain on their own or in a community or assisted living setting.

Medicaid Waiver Program for Assisted Living and In-Home Care

Alaska “Alaskans Living Independently” (ALI) Medicaid Waiver (HCBS Alaskans Living Independently Waiver)

The ALI waiver aims to provide effective and adequate home and community-based service to these individuals, who otherwise would reside in a skilled nursing facility for more than 30 days per year. This waiver aims to serve between 2,600 and 3,050 individuals per year (a five-year average of 2,860 per year) with appropriate home and community-based services that allow the participant to live as independently as they can while ensuring their medical and healthcare needs are met. All participants in the ALI waiver work with a care coordinator to determine which services they need and ensure their delivery.


Services included in the ALI waiver include: Residential Supported Living, Specialized Private Duty Nursing Services, Adult Day Care, Respite Care, Transportation Services, Home Modifications Services, Help with Chores at Home, Meals Delivered, Specialized Medical Equipment and Supplies, and


  • Health: The applicant to the ALI waiver must have needs that meet at least the Nursing Home Level of Care.
  • Financial: For 2022, the applicant’s income and assets must be below certain limits. The applicant’s income must be less than $2,523 (300%, or three times the Supplemental Security Income allowance) per month and countable resources less than $2,000 for a single person or $3,000 for a couple. If an applicant’s income is too high, then a Miller Trust (also known as a Qualified Income Trust) can allow them to access the benefits by funnelling their income into the trust for the purpose of paying for care. An individual cannot make more income than the total cost of care. Unique to Alaska, the monthly personal needs allowance differs depending on whether the waiver participant is living in a licensed assisted living facility. For 2022, the PNA was $1,656 unless the recipient resides in a licensed assisted living home, in which case it is $1,396. When a married individual applies and the spouse does not, a portion of the couple’s resources can be protected for the ineligible spouse and not counted toward the applicant’s resource limit. The following spousal resource rules apply: If total resources are under $24,180, the ineligible spouse gets all of the resources; If total resources are $24,180 to $48,360.00, the ineligible spouse gets $24,18; If total resources are $48,360 to $241,800.00, the ineligible spouse gets one-half; If total resources are over $241,800.00, the ineligible spouse gets $120,900.00 (the maximum, which is effective January 1, 2017).

Practical Considerations

There is no individual cost limit taken into account for participants applying for the ALI waiver. Another consideration is that the method used for determining whether an applicant needs a nursing home level of care differs from when applying for Medicaid in a nursing home facility.


Medicaid Planning specialists are a good option for Alaska residents who wish to apply for Medicaid benefits for long-term care outside a nursing home facility. The ability to use a Miller Trust to help fall below the Special Income Limit is an area where a Medicaid Planner may help with getting an applicant eligible before they otherwise would have.

Access all state Medicaid Waiver pages.