Alaska proposes first Medicaid rates for crisis stabilization and residential facilities

Alaska Medicaid would pay $1,833.33 a day to hold an adult in a licensed crisis facility, and $2,197.15 a day for an adolescent, under rates the Alaska Department of Health opened for public comment Thursday. They are the first prices the state has attached to the crisis facilities the Alaska State Legislature created four years ago.

The proposal also sets an hourly rate of $81.16 for subacute stabilization, capped at 23 hours and 59 minutes, about 36 percent lower than the $126.89 the current chart pays for 23-hour crisis observation. The two daily rates run the other direction, roughly 87 and 124 percent above the $982.82 a day now paid for crisis residential and stabilization services, making them the highest daily rates on the chart, above the $1,694.06 paid for medically managed intensive inpatient treatment. Across the seven days allowed without prior authorization, the adult rate totals $12,833.31 and the adolescent rate $15,380.05. All three services are listed with procedure codes marked TBD.

House Bill 172, signed by Gov. Mike Dunleavy on July 15, 2022, defined a crisis stabilization center as a subacute facility with a 23-hour-59-minute maximum stay, and a crisis residential center as one with a seven-day maximum for involuntary admission. Its fiscal note describes the first as observation for acute emotional distress and the second as medically monitored psychiatric stabilization.

The department's fiscal note said the bill was required to fulfill a settlement with the Disability Law Center in Case No. 3AN-18-9814 CI, entered September 3, 2020, six years to the day before this notice.

That fiscal note set a deadline: "The department will adopt regulations as soon as possible, on or before 7/1/2024." The proposal arrives more than two years later.

The department reports no cost, listing $0 in annual compliance cost to a private person, another state agency and a municipality, and $0 in operating, capital, federal and general fund cost. Commissioner Heidi Hedberg signed the notice. "The proposed regulation changes are not expected to require an increased appropriation," it says. The 2022 note explained that projected Medicaid use of the new facilities was "already been included as part of the Medicaid budget."

No entry on the department's June 7 list of 190 licensed facilities is identified as a subacute mental health facility, crisis stabilization center or crisis residential center, though the list does not state scope and facilities may operate under earlier licenses. Separately, the Alaska Mental Health Trust Authority's second-quarter FY2026 grants included $2,955,983 to the Southcentral Foundation for its Yeshjesh T'uh Crisis Stabilization Center Launch Project in Anchorage, the quarter's largest award. That grant funds a project under development; it does not establish licensing or eligibility for the new rates.

Written comments are due by 5 p.m. October 21 to the Division of Behavioral Health in Anchorage or at [email protected]. An oral hearing runs from 2 to 2:30 p.m. October 6 by Zoom and toll-free line, with no in-person attendance. Anyone needing a disability accommodation must ask by September 30.