Alaska Medicaid pays for home and community care through the Alaskans Living Independently (ALI) waiver, the home- and community-based services (HCBS) waiver that serves older adults.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - Alaska Waiver Factsheet (Alaskans Living Independently HCBS waiver). medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AK Alaska Medicaid HCBS waivers let people who would otherwise need a nursing home receive that same level of care in their own home or community instead. The ALI waiver serves adults 21 and older who meet a nursing-facility level of care.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - Alaska Waiver Factsheet (Alaskans Living Independently HCBS waiver). medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AK
In This Guide
- What Are Alaska Medicaid HCBS Waivers?
- The Alaskans Living Independently (ALI) Waiver in Detail
- Who Qualifies for Alaska Medicaid HCBS Waivers?
- What the ALI Waiver Covers
- How to Apply for the ALI Waiver
What Are Alaska Medicaid HCBS Waivers?
Home- and community-based services, usually shortened to HCBS, are Medicaid long-term care delivered in your own home or community rather than inside an institution. The federal authority behind them is Section 1915(c) of the Social Security Act, which lets a state ask the federal government for a 1915(c) HCBS waiver. The waiver "waives" the rule that Medicaid long-term care has to happen in a facility, so a person who would otherwise qualify for a nursing home can receive that same level of care at home instead.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - Alaska Waiver Factsheet (Alaskans Living Independently HCBS waiver). medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AK
Alaska operates five Medicaid HCBS waivers, and the one built for seniors and adults with physical disabilities is the Alaskans Living Independently (ALI) waiver.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - Alaska Waiver Factsheet (Alaskans Living Independently HCBS waiver). medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AK The state runs it through the Alaska Department of Health, Division of Senior and Disabilities Services (SDS). The rest of this guide focuses on the ALI waiver.
The Alaskans Living Independently (ALI) Waiver in Detail
The Alaskans Living Independently (ALI) waiver is a 1915(c) HCBS waiver that pays for the supports an older adult or a person with a physical disability needs to stay in the community instead of moving into a nursing facility.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - Alaska Waiver Factsheet (Alaskans Living Independently HCBS waiver). medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AK It is administered by the Division of Senior and Disabilities Services (SDS), and each participant's care is built around a support plan.
Here is how that works in practice. A care team helps the participant put together a plan describing the services they need, and SDS reviews and approves that support plan before the services begin.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - Alaska Waiver Factsheet (Alaskans Living Independently HCBS waiver). medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AK Because the plan is individual, two people on the same waiver can receive very different mixes of help depending on what they need to live safely at home.
Who Qualifies for Alaska Medicaid HCBS Waivers?
Qualifying for the ALI waiver has two separate parts, and you have to clear both.
First, financial eligibility. You must meet Medicaid's income and resource limits, which the Alaska Division of Public Assistance (DPA) determines through an application and interview.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - Alaska Waiver Factsheet (Alaskans Living Independently HCBS waiver). medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AK For nursing-home and HCBS-waiver coverage, Alaska applies its Long Term Care Income Standard, a gross-income ceiling of $2,982 per month in 2026, with no income disregard applied.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - Alaska Waiver Factsheet (Alaskans Living Independently HCBS waiver). medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AK On resources, an unmarried applicant must stay within SSI's countable-resource limit of $2,000 for an individual, and the home you live in and one vehicle used for transportation are not counted.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - Alaska Waiver Factsheet (Alaskans Living Independently HCBS waiver). medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AK Home equity is capped, though: for 2026, an applicant whose home equity is above $752,000 is not eligible for waiver services unless a spouse living in the community, a child under 21, or a blind or disabled child of any age lives in the home.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - Alaska Waiver Factsheet (Alaskans Living Independently HCBS waiver). medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AK If you are married and your spouse lives in the community, there is no separate couple limit. Alaska pools the countable resources either of you owns, lets your spouse keep up to $162,660 in 2026, and compares what remains to the one-person limit.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - Alaska Waiver Factsheet (Alaskans Living Independently HCBS waiver). medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AK For a fuller walkthrough of the income and asset rules, see our guide to Alaska Medicaid income and asset limits.
Second, level of care. You must need a nursing-facility level of care. To measure that, a nurse or other trained staff member from the SDS Intake and Assessment Unit completes a functional assessment, either in person or by video call, and a nurse supervisor reviews the results to decide whether you need nursing-facility care.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - Alaska Waiver Factsheet (Alaskans Living Independently HCBS waiver). medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AK This is the same clinical level of care a nursing home would require, which is the point of the waiver: it lets you get that care without the nursing home.
What the ALI Waiver Covers
The ALI waiver covers a broad set of home and community supports, and the exact mix a participant receives is set by their approved support plan.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - Alaska Waiver Factsheet (Alaskans Living Independently HCBS waiver). medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AK Covered services include:
- Care coordination
- Respite care, which gives a family caregiver a break
- Adult day services
- Environmental (home) modifications
- Meals
- Residential supported-living services
- Specialized medical equipment
- Specialized private-duty nursing
- Nursing oversight and care management
- Transportation
- Host home care
These are the day-to-day supports that make staying at home realistic, from a care coordinator who organizes the plan to the private-duty nursing and equipment that handle higher medical needs.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - Alaska Waiver Factsheet (Alaskans Living Independently HCBS waiver). medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AK
Can a family member be paid under the ALI waiver?
Sometimes, depending on how the person is related and which service they provide. Alaska's approved ALI waiver says the department may allow relatives, court-appointed legal guardians or legally responsible individuals to provide specific waiver services if they meet the conditions set in regulation and the employment and training qualifications for the service. It counts as a relative anyone related to the participant by blood, marriage or adoption who has no duty under state law to support the participant, and a relative must be older than 18. The department may allow an SDS-certified provider to employ a participant's relative or court-appointed legal guardian, and the provider is responsible for confirming the person meets the qualifications on the date of hire.Alaska Department of Health. (1915). Application for a 1915(c) HCBS Waiver: AK.0261.R07.00 (Alaskans Living Independently), effective July 1, 2026 — Alaska Department of Health (health.alaska.gov). health.alaska.gov. Retrieved Oct 14, 2026, from https://health.alaska.gov/media/fk4jgwvm/ali-eff-07012026.pdf The waiver lists which services each group may provide, with limitations:
- Relatives: Host Home Care and Residential Supported Living.
- Relatives and court-appointed legal guardians: Adult Day, Environmental Modifications, Meals, Nursing Oversight and Care Management, Respite, Specialized Medical Equipment, Specialized Private Duty Nursing, and Transportation.Alaska Department of Health. (1915). Application for a 1915(c) HCBS Waiver: AK.0261.R07.00 (Alaskans Living Independently), effective July 1, 2026 — Alaska Department of Health (health.alaska.gov). health.alaska.gov. Retrieved Oct 14, 2026, from https://health.alaska.gov/media/fk4jgwvm/ali-eff-07012026.pdf
A spouse generally cannot be paid under the ALI waiver, unless the spouse is a court-appointed guardian whom a court has explicitly authorized to provide waiver services. The waiver says a legally responsible individual is typically the parent or court-appointed guardian of a minor child, the spouse of a participant, or a court-appointed guardian with a legal duty to support an adult, and legally responsible individuals may not provide any ALI service unless a court has explicitly authorized a guardian to provide waiver services. Care coordination has a stricter rule: the department prohibits immediate family members, court-appointed legal guardians, legally responsible individuals, a holder of the participant's power of attorney, the participant's personal care assistant, and anyone with a legal duty to support the participant from providing it. ALI respite may be provided for a primary unpaid caregiver, meaning someone who is not paid for any other services to the participant.Alaska Department of Health. (1915). Application for a 1915(c) HCBS Waiver: AK.0261.R07.00 (Alaskans Living Independently), effective July 1, 2026 — Alaska Department of Health (health.alaska.gov). health.alaska.gov. Retrieved Oct 14, 2026, from https://health.alaska.gov/media/fk4jgwvm/ali-eff-07012026.pdf
The waiver does not name adult children 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 does not say whether that duty rules an adult child out of its definition of relative, so ask SDS before counting on being paid.Alaska Department of Health. (1915). Application for a 1915(c) HCBS Waiver: AK.0261.R07.00 (Alaskans Living Independently), effective July 1, 2026 — Alaska Department of Health (health.alaska.gov). health.alaska.gov. Retrieved Oct 14, 2026, from https://health.alaska.gov/media/fk4jgwvm/ali-eff-07012026.pdf ALI has no personal care service. If the help you give is bathing, dressing or similar personal care, see which family members can be the paid caregiver under Alaska's Personal Care Services and Community First Choice.
How to Apply for the ALI Waiver
Applying for the ALI waiver means working with two offices at once, because the two eligibility tests are handled separately.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - Alaska Waiver Factsheet (Alaskans Living Independently HCBS waiver). medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AK
- The Division of Public Assistance (DPA) handles the financial side: your Medicaid income and resource eligibility, determined through an application and interview.
- The Division of Senior and Disabilities Services (SDS) handles the level-of-care side: the functional assessment that decides whether you need nursing-facility-level care. You can reach SDS at 907-269-3666.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - Alaska Waiver Factsheet (Alaskans Living Independently HCBS waiver). medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AK
For the Medicaid application itself, federal rules require Alaska to accept it through several channels, so you can apply online, by phone, by mail, or in person.U.S. Government Publishing Office. (n.d.). 42 CFR 435.907 — Application (eCFR, current). ecfr.gov. Retrieved Jul 13, 2026, from https://www.ecfr.gov/current/title-42/section-435.907 Once your application is in, the state has a decision deadline: federal rules give it up to 45 days to decide most Medicaid applications, and up to 90 days when eligibility is based on a disability.U.S. Government Publishing Office. (2026). 42 CFR 435.912(c)(3) — Timely determination of eligibility (eCFR current text, as revised eff. July 31, 2026). ecfr.gov. Retrieved Aug 7, 2026, from https://www.ecfr.gov/current/title-42/section-435.912 For the general Alaska Medicaid application steps, see our guide on how to apply for Alaska Medicaid.
Frequently Asked Questions
How is the ALI waiver different from nursing home Medicaid?
Both require a nursing-facility level of care, and both require you to meet Medicaid's financial rules. The difference is where the care happens. The Alaskans Living Independently (ALI) waiver pays for that care in your own home or community, while nursing home Medicaid pays for it inside a facility.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - Alaska Waiver Factsheet (Alaskans Living Independently HCBS waiver). medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AK If you want to compare the institutional option, see our guide to Alaska Medicaid and nursing home care.
Do you have to be 65 to qualify for the ALI waiver?
No. The ALI waiver covers two groups of adults who need nursing-facility-level care: people 65 and older, and people ages 21 to 64 who have a physical disability. So the door is open well before 65, as long as you are at least 21 and meet that clinical level-of-care standard.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - Alaska Waiver Factsheet (Alaskans Living Independently HCBS waiver). medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AK
Is there a waiting list for the ALI waiver?
Enrollment in the ALI waiver runs through the two-part process above: the financial determination by the Division of Public Assistance (DPA) and the level-of-care assessment by SDS. Because availability and timing can change, the best way to learn the current steps and any interest-list status is to contact SDS directly at 907-269-3666.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - Alaska Waiver Factsheet (Alaskans Living Independently HCBS waiver). medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AK
Can the ALI waiver pay for care outside my own home?
Yes. Alongside in-home supports, the waiver's covered services include residential supported-living services and host home care, so the "community" in home- and community-based services can mean a supported residential setting rather than only your own house. Your approved support plan sets which of these services you receive.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - Alaska Waiver Factsheet (Alaskans Living Independently HCBS waiver). medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AK
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