Alaska ALI Waiver Family Caregiver Pay: Who Can Be Paid (2026)

Under Alaska's Alaskans Living Independently (ALI) waiver, a certified provider can hire a relative to earn family caregiver pay for respite, meals and rides, but a spouse generally can't be paid.1 The ALI waiver is an Alaska Medicaid program for people 65 and older and adults 21 to 64 with physical disabilities who need nursing-home-level care.2,1

Who Can Get Family Caregiver Pay Through the Alaska ALI Waiver?

Before anyone in your family cuts back at work, it's worth knowing where you fit. Alaska's approved ALI waiver (AK.0261.R07.00, effective July 1, 2026) says the department may allow relatives to provide specific waiver services if they meet the conditions in regulation and the service's employment and training qualifications. Under Alaska's ALI waiver, a relative is anyone related to the participant by blood, marriage or adoption with no state-law duty to support them, and an SDS-certified provider may employ that relative.1

The waiver counts a spouse as a legally responsible individual, and legally responsible individuals can't provide any ALI service. The one exception under Alaska's ALI waiver is a court-appointed legal guardian the court explicitly authorizes to provide ALI waiver services, and that guardian may be a spouse, adult child, sibling or other relative.1

Adult children aren't named separately. Alaska Statute 25.20.030 says each child is bound to maintain a parent who is poor and unable to work, and the waiver doesn't say whether that duty puts an adult child outside its definition of relative. Ask SDS before you count on the pay.1

ALI care coordination stays outside the family: Alaska's ALI waiver bars immediate family members, court-appointed guardians, legally responsible individuals, a power of attorney holder, the participant's personal care assistant and anyone with a legal duty to support the participant from providing it.1

Who Qualifies for Alaska's ALI Waiver?

If you're checking whether your relative can get ALI at all, start with who it serves: people 65 or older and adults 21 to 64 with physical disabilities who need nursing-facility-level care. The Division of Public Assistance (DPA) decides whether your relative meets Medicaid's income and resource limits. For 2026, Alaska's Long Term Care Income Standard caps gross income at $2,982 a month, and an unmarried applicant can have no more than $2,000 in countable resources. The SDS Intake and Assessment Unit decides the level of care through a functional assessment by a nurse or other trained staff, in person or by video call.2 Your relative has to qualify for Alaska Medicaid before anyone can be paid through ALI, so check these limits first.5 For married couples, see Medicaid spousal impoverishment and how it applies in Alaska.

What Paid Family Work Looks Like on the ALI Waiver

Hoping to be paid for the hands-on care you already give? Alaska's ALI waiver pays a relative only for listed services, and personal care isn't one. The ALI waiver lists the services a relative or court-appointed guardian may provide, with limitations:1

• Adult Day
• Environmental Modifications
• Meals
• Nursing Oversight and Care Management
• Respite
• Specialized Medical Equipment
• Specialized Private Duty Nursing
• Transportation

Relatives may also provide two more ALI services, Host Home Care and Residential Supported Living, with limitations. Host Home Care is given in a licensed host care home by a primary caregiver who lives there.1

ALI respite relieves a primary unpaid caregiver, so a relative such as a sibling may be the paid respite worker while the main caregiver takes a break; a spouse generally can't be. Under Alaska regulation 7 AAC 130.280(c), the department won't pay for more than 520 hours of hourly ALI respite a year unless it approves more because the person would otherwise risk going into an institution, or for more than 14 days of daily respite a year. Respite may also be family-directed, with the primary unpaid caregiver training and supervising the people chosen to step in, helped by a certified respite provider.5

A spouse, who generally can't be paid under ALI, may still be paid for personal care through Community First Choice.1,3 Under Alaska regulation 7 AAC 127.015, CFC personal care may be provided by a legally responsible individual, including the recipient's spouse, who is qualified and employed by a certified provider. The regulation caps that work at 40 paid hours in any seven-day period, but SDS says it won't enforce that limit and will remove it. Under Alaska regulation 7 AAC 127.115(d), the recipient may also select a recipient's representative to provide CFC personal care. That representative must name a designee who is at least 18, present in the recipient's community, involved in day-to-day care and willing to manage and evaluate the services.3 See Alaska's personal care family caregiver rules.

You'd work for the certified provider that hires you, so ask it what it pays. Typical pay: about $19.11 an hour (estimate based on home care aide wages in Alaska, BLS, May 2025), not a rate any program pays a family caregiver.4,1

How to Start Getting Family Caregiver Pay Through Alaska's ALI Waiver

Learn More

Find personalized help getting paid through Alaska's ALI waiver at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.