What is a Medicaid Waiver?
Medicaid Waivers, also known as Home and Community Based Services (HCBS) Waivers and Waiver Funded Services, allow qualifying program participants to receive services outside of nursing home facilities. Medicaid’s standard benefit is to pay for nursing home residential care. However, when available, Medicaid Waivers help to provide more options for individuals. The cost of the care outside of a nursing home needs to be less than the cost of care in a nursing home.
Program Description
Alaska Adults with Physical and Developmental Disabilities (APDD) is a Home and Community Based Medicaid Waiver intended for those 21 years of age or older with autism, an intellectual disability, or a developmental disability that results in physical impairments. APDD enables individuals who cannot live independently to continue to live in their home or in an assisted living facility, rather than in a nursing home facility. Services that may be covered under this waiver include adult day care, home modifications, respite care to relieve one’s caregiver, and home-delivered meals.
Examples of conditions that might qualify an individual for this waiver include cerebral palsy, spastic hemiplegia, intracranial injury, paraplegia, and quadriplegia. While this program is not specifically for the elderly, seniors who have diagnoses such as these that manifested before the age of 21 may qualify for this program.
Alternative Programs
Another adult-only Alaskan Medicaid waiver that might be of interest to elderly individuals is Alaskans Living Independently (ALI). This waiver provides similar benefits and services as APDD, though while an intellectual or developmental disability is a qualification for APDD, it is not for ALI. ALI only requires that individuals 65 years and older need a level of care consistent with that provided in a nursing home. For those who are between the ages of 21 and 64, a physical disability is an eligibility requirement. That being said, those under the age of 65 who have a physical disability and do not have a developmental or intellectual disability should apply for the ALI wavier.
For those who strictly need assistance with their daily living activities, and do not require a nursing home level of care, the Personal Care Services (PCS) program via the state’s Medicaid plan is an option. This program provides assistance with bathing, grooming, toiletry, light housecleaning, shopping for essentials, and medication monitoring. With this program, there is an option for consumer direction, also known as self-direction.
All three programs are administered by the Alaska Department of Human and Social Services’ Division of Senior and Disability Services. In Alaska, Medicaid is also referred to as DenaliCare.
Eligibility Guidelines
To be eligible for the Adults with Physical and Developmental Disabilities Waiver, a variety of requirements (personal, medical, and financial) must be met.
General Requirements
Personal – Individuals must be at least 21 years of age and a full-time resident of Alaska. This Waiver is not intended for children.
Medical – Individuals must be diagnosed with a developmental disability or an intellectual disability, with manifestation before the age of 21. The individual must also present with physical disabilities, requiring a nursing home level of care. A care coordinator must complete an assessment of the candidate’s ability to function in order to determine if the applicant meets the required level of care need. Conditions typically eligible under this waiver include, but are not limited to autism, cerebral palsy, traumatic brain injury, paraplegia, and quadriplegia.
Financial Requirements
There are also income and asset requirements that determine eligibility for this waiver.
Income Limits
A single applicant must have a monthly income no greater than 300% of the SSI Federal Benefit Rate. For the calendar year 2024, this equals $2,829 / month. This income limit holds true for a married applicant with a non-applicant spouse. To be clear, only the applicant spouse’s income is counted; the income of the non-applicant spouse is disregarded and is not calculated toward the applicant spouse’s income eligibility.
That said, there is a monthly maintenance needs allowance that allows an applicant spouse to transfer up to $3,853.50 / month in income to the non-applicant spouse to prevent spousal impoverishment. If the non-applicant spouse already has monthly income equal to, or above, this figure, a transfer of income is not permitted from the applicant spouse. In cases of a married couple with both spouses as applicants for waiver services, the income limit is $5,658 / month.
Asset Limits
For 2024, the asset limit for a single applicant is $2,000, which includes liquid assets, such as cash, bank accounts, and stocks and bonds. For a married couple with one spouse applying for benefits, the applicant spouse is limited to $2,000 in assets, but the non-applicant spouse is entitled to up to $154,140 of the couple’s joint assets. This is called the Community Spouse Resource Allowance. For married couples with both spouses applying for services, the asset limit is $3,000.
The primary home is considered an exempt (non-countable) asset, provided the applicant lives in the home or intends to return. The applicant’s home equity interest must be under $713,000. Other assets that are considered exempt are burial plots, a vehicle, personal effects, such as an engagement and wedding ring, and household items.
Over the Financial Limits?
Being over the income and / or asset limit(s) is not automatic cause for disqualification from Medicaid. Professional Medicaid planners are well versed in restructuring income and assets to meet Medicaid’s limits without jeopardizing one’s eligibility. For example, an irrevocable funeral trust can help “spend down” excess assets, and a Miller Trust, also called a Qualified Income Trust (QIT), can convert countable income into non-countable income. Learn more about Medicaid planning.
Benefits and Services
Based on a care plan that is established by a care coordinator, various services/benefits are available as determined by an individual’s needs. Services may vary based on location.
- Adult Day Health / Adult Day Care
- Care Management
- Day Habilitation / Residential Habilitation
- Respite Care: In-home and out-of-home to provide a break for the primary caregiver
- Supported Employment
- Environmental Modifications / Home Modifications: Addition of ramps, grab bars, walk-in showers, widening doorways for wheelchair accessibility
- Intensive Active Treatment: Treatment of a condition (medical or behavioral) that if not treated may result in institutionalization
- Meals: Home-delivered or congregate (group) setting
- Residential Supported Living Services / Assisted Living: Transportation, medication management, and assistance with activities of daily living, such as walking, eating, and bathing
- Specialized Medical Equipment: Assists an individual with performing everyday activities
- Skilled Nursing
- Transportation: Medical and non-medical
How to Apply / Learn More
For additional information about this program, download this brochure. Alternatively, call the Aging at Disability Resource Center (ADRC) at 877-625-2372. You can also contact your local Senior & Disabilities Services Office. For the Anchorage office, call 800-478-9996 or 907-269-3666, for the Juneau office, call 866-465-3165 or 907-465-3372, and for the Fairbanks office, call 800-770-1672 or 907-451-5045.
Alaska Adults with Physical and Developmental Disabilities Medicaid Waiver is not an entitlement program. This means meeting the eligibility requirements does not necessarily mean one will be able to receive program services. There are approximately 149 waiver slots available each year for this program. Wait lists may exist.
