Alaska's Medicaid home-care waivers renewed, but a waitlist persists

Federal regulators renewed four of Alaska's Medicaid home- and community-based care waivers for another five years, through June 2031, the state announced Tuesday. The programs let people who would otherwise qualify for a nursing home get their care at home instead.

That keeps in place the far cheaper side of an expensive choice. Alaska's median nursing home now runs $364,453 a year, the highest rate in the nation, according to the Alaska Commission on Aging's 2025 Senior Snapshot. By serving people at home instead, the commission estimated, the state avoided $691 million in costs in fiscal 2025.

The four renewed waivers cover independent living, adults with physical and developmental disabilities, children with complex medical conditions, and people with intellectual and developmental disabilities, and can serve up to 5,796 people between them in the first year. They pay for services like care coordination, respite, employment help, residential and day support, host-home care and transportation for people who qualify for institutional care but stay in the community instead.

Getting in is a separate question. The waiver for people with intellectual and developmental disabilities pulls 50 people off its waitlist each year to apply, and more when enrollment dips below the cap — 123 in the year that ended June 30, 2025. Even so, the line didn't clear — 512 people were still on the registry at year's end, most for 90 days or longer, and the average person had been waiting 28 months, according to the division's annual report.

The Governor's Council on Disabilities and Special Education, the state's mandated advocacy board, is pressing legislators to fund an end to that waitlist — a goal its 2026 position paper calls "within reach." The council wants $1 million in state money to match $1 million in federal funds for a new assessment tool, plus a phased move to new Medicaid rates.

The renewals left one thing many participants wanted untouched. Most of the 44 public comments asked the state to raise the personal needs allowance — the share of their own income participants keep rather than put toward their care. The division said it couldn't lift the figure in this renewal, since it's set in regulation and raising it costs the state money, but that it has begun talks about doing so later. A fifth waiver, the Individualized Supports Waiver, runs on its own cycle through 2028 and wasn't part of this action.