Alternative Decision Makers
Alternative Decision Makers
An alternative decision maker is a person that you appoint or is appointed to act on your behavior through a court. It is a general term that covers several different contractual relationships between people. Below you can explore some of the common alternative decision makers seen in Alaska: Representative Payee, Power of Attorney, and Guardianship/Conservator. There is also information for different types of estate-planning accounts that assist with Medicaid eligibility that also require an alternative decision maker known as a Trustee.
Power of Attorney – State of Alaska, Veterans Administration
A Power of Attorney is a legal document that allows someone else to make decisions on your behalf. The person you appoint is known as a legal decision maker. The point of time when your appointed person begins making decisions for you is outlined in the legal document for example, upon your signature (immediately), certain dates, or upon your incapacity (when you can no longer make your own decision per a court). In Alaska, two physicians or a psychiatrist can complete an affidavit that states that you lack capacity to make your own decisions at which time your Power of Attorney would be able to make all the decisions you have outlined in the Power of Attorney document to assist you.
Power of Attorney or sometimes known as a durable Power of Attorney tend to be able to make decisions about financial matters such as accessing bank statements, paying bills, or establishing insurance benefits.
A Power of Attorney is also the name associated with a personal decision maker for an Advance Directive. An Advanced Directive is a legal document that allows you to choose a decision maker for your medical care needs and end of life decisions.
The State of Alaska Division of Senior and Disabilities Services will sometimes require a client of Personal Care Services or Medicaid Wavier to have to have a limited Power of Attorney. This type of appointment is limited to very specific duties like signing timesheet for services.
You can choose a person to act on your behalf as your primary decision maker as well as an alternative representative who can assist you if your first choose is unable to provide the assistance. You will want to choose someone who you trust with your information and who knows what kind of decisions you would make for yourself, if you could express your own wishes.
To obtain Alaska Power of Attorney documents: See Alaska Legal Services Family Self-Help at: https://alaskalawhelp.org/issues/life-planning/powers-of-attorneyadvance-directives
To obtain the State of Alaska Division of Senior and Disability Services Limited Power of Attorney: pca-09_limited_poa
For assistance with completing a Power of Attorney
Other possible resources private legal counsel, case manager, hospital social worker or Adult Protective Services.
Guardianship/Conservatorship
Guardianship is a legal process to appoint a decision maker for decisions regarding medical/dental care, placement (where you live), employeement services and supports, and the services associated with your personal care needs.
Conservator is a legal process to appoint a decision maker for decisions regarding your financial affairs, benefits, and assets.
Guardianship and Conservatorship can be appointed in combined as a Full Guardianship, one or the other, or limited to very specific duties and timeframes.
Guardianship and Conservatorships require a petition to the State of Alaska Superior Court for consideration. The court has 180 days to schedule a court hearing after the receipt of a petition. If there is immediate risk of serious illness, injury, or death without court intervention, a petition for an emergency hearing can be filed with the court. If accepted, the court has 72 hours to schedule a hearing date.
The State of Alaska website has a self-help section for guardianship and conservatorship that provides the required petitioning forms and reporting documents. pg-510 Guardianship Duties is a very useful document for outlining the guardianship process and requirements.
Representative Payee
The Social Security Administration offers recipients to appoint someone else to assist with financial management of income received by Social Security. Social Security does not recognize an appointed Power of Attorney, Guardian, or Conservator as a decision maker unless the decision maker has been approved as a Representative Payee. In limited situations a professional representative payee may be available. In most cases, Social Security will task the recipient in choosing a family or friend to act on their behalf.
Social Security Administration will require a Representative Payee at times to receive financial benefits. In this situation, often a physician has documented that a decision maker is needed to assist with financial decision making. If the medical condition changes or improves additional medical documentation can be submitted to request to end the representative payee relationship.
If for some reason the appionted Representative Payee is not available or needs to be changed. Contact Social Security Administration immediately. You may be required to have an alternative Represenative Payee to continue to recieve monthly cash funds.
Miller Trust
A Miller Trust is an legal document known as an Irrevocable Income Trust. This is a trust that is created with an attorney to divert monthly income to qualify for Medicaid or other benefits. All individuals seeking benefits are eligible. The income placed into the trust can be utilized for non-Medicaid covered medical expenses, travel, entertainment, phone and internet services, vehicle, pet services, and much more. The funds are restricted to not be used for cash, food, monthly utility bills (electricity), or rent. The trust document does require a third-party decision maker to monitor the trust Accounting should be managed for annual reporting to the Department of Public Assistance. Upon death, the proceeds remaining in the trust are returned to the Department of Public Assistance to off-set your medical care received while benefited under Medicaid.
DPA Miller Trust Brochure Form MED 23
Alaska Legal Services can assist with the development of a Miller Trust document. They require an application at which time they will request from the applicant the Department of Public Assistance – Medicaid notification/denial letter for “being over resource.”
Asset Trust – Special Needs and Pooled Trusts
An Irrevocable Asset Trust is a legal document created by an attorney to secure assets (savings, property, high valued items etc.) to be diverted into Trust to qualify for Medicaid or other federal benefits. Asset Trusts must be created before the age of 65 years, disability determination is required, and the Trust must be managed by a third-party non-profit agency. In Alaska, the State of Alaska Office of Public Advocacy manages asset trust under a Conservatorship. The cash Assets placed into the trust can be utilized for non-Medicaid covered medical expenses, travel, entertainment, phone and internet services, vehicle, pet services, and much more. The funds are restricted to not be used for cash, food, monthly utility bills (electricity), or rent. Accounting must be managed for annual reporting to the Department of Public Assistance. Upon death, the proceeds remaining in the trust are returned to the Department of Public Assistance to off-set your medical care received while benefited under Medicaid.
ABLE Account
ABLE Accounts are legal document that is often created by an attorney to help divert income into a specialized trust account for continued eligibility for Medicaid and other Federal and State benefits. Funds can be used for household items, travel, pets, etc. Accounting must be managed by a third party and for annual reporting to the Department of Public Assistance.
The Governor’s Council on Disabilities & Special Education presents the following information from the ABLE National Resource Center:
Countdown for the ABLE Age Adjustment Act
On January 1, 2026, ABLE eligibility expands. If someone has a disability that began before age 46, they may be eligible to open an ABLE account in 2026.
Review The ABLE Age Adjustment Act Fact Sheet to learn more about this new opportunity to save for an additional 6 million Americans with disabilities.
Be sure to visit WEBINAR: Millions More Can Start Their ABLE Journey in 2026 – ABLE National Resource Center for the recording, transcripts and slides of our November webinar about the ABLE Age Adjustment Act. Two ABLE account owners shared how ABLE has helped them to save for short-term needs and long-term goals. An individual who will become eligible in 2026 shared steps he has taken to prepare for opening his ABLE account and provided insight about what this new opportunity means to him.
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Irrevocable Burial Account
Irrevocable Burial Account – Special Trust account created with the mortuary to plan for your future burial. Funds can be placed into an account for end-of-life expenses. When funds are placed into the Trust they can not be removed until your passing.