Alaska proposes new tools to decide who qualifies for two Medicaid disability waivers

The Alaska Division of Senior and Disabilities Services proposed Thursday to replace the assessment tool used to decide who qualifies for two Medicaid home-care waivers serving people with intellectual and developmental disabilities.

The change affects the Intellectual and Developmental Disabilities waiver and the Individualized Supports Waiver. Both now use the Inventory for Client and Agency Planning, known as ICAP. Under the proposed amendments, the division would move them to the Developmental Disability Assessment Tool for Children and the Developmental Disability Assessment Tool. The state says both new tools are standardized and validated by interRAI.

The state's waiver information says eligibility for these programs is assessed using ICAP. To move toward waiver services, a person must be enrolled in Medicaid, meet the state's level-of-care criteria for an intermediate care facility for people with intellectual disabilities and be placed on the Developmental Disabilities Registry. Meeting the level of care is one condition, not a guarantee of a spot. The IDD waiver selects 50 people from its waitlist each year to apply for services.

Under the current process, a care coordinator submits an ICAP packet after the division sends a notice to proceed, generally within 30 days.

The IDD waiver amendment estimates the move to the new tools would take about a year. The proposed effective date is May 1, 2027.

The ISW amendment also sets qualifications for the people who conduct reassessments. That waiver requires a yearly reassessment of each participant's level of care and caps enrollment at 600 people at any one time.

Under the state's ICAP guidelines, children ages 36 months through six years and 11 months are assessed yearly. Participants seven and older are generally assessed every three years.

The notice amends all five of Alaska's home and community-based waivers. Other changes update rate methods for specialized private duty nursing and rename the ISW's "behavioral support plan" as a "restrictive intervention plan."

Two other waivers, Alaskans Living Independently and Adults with Physical and Developmental Disabilities, are moving from the Consumer Assessment Tool to the Alaska Home Care Assessment Tool. The ALI amendment says the division would use both assessments during that transition so participants' eligibility is not disrupted. The state proposed adopting that tool on Nov. 9 in a separate regulation change, with comments due Dec. 18.

The division will accept written comments on the waiver amendments until 5 pm Dec. 21. After reviewing comments and making any changes, it will send the amendments to the federal Centers for Medicare and Medicaid Services for approval.