Not Eligible
The following resources are provided to help you become Medicaid eligible, if possible, or to provide alternatives.
How to Become Medicaid Eligible
Veteran Not Eligible
Often Veterans will receive retirement compensation that is higher than the Medicaid criteria for benefits which creates a denial due to being over resources for the Medicaid program. The veterans may utilize an Irrevocable Income, Asset Trust, or ABLE account to assist with redirecting monthly and asset income to qualify for Medicaid programming. The veteran who due to their injury, illness, or condition who is not able to work or have limitations to employment can file a disability claim with the VA. The VA disability claim will determine the level of support the VA will provide to the veteran in monthly income and additional medical/health services. The VA will pay for the cost of care in an Assisted Living Facility or Skilled Nursing facility level of care only if the veteran has a rating of 75-100% service-connected disability. The VA Voices program is for all Alaskan veterans regardless of disability determination or rating and provides in-home care.
How to Enroll in VA Health Care
VA Disability Claim:
The Department of Veteran Affairs has a disability process that you can submit a disability claim if you believe you have suffered a permanent injury, illness, or condition that is associated or a result of your military service.
How to File a VA disability Claim
Juneau VA Clinic Provides to veterans supports for benefit determination and navigation to community services.
Placement:
The State of Alaska Department of Health Division of Senior and Disabilities Services (DSDS) provides a General Relief Program that pays for the cost of care in Assisted Living facility for an interim period while an individual is pending Medicaid Wavier.
The Alaska Veterans and Pioneer Home is a State of Alaska Assisted Living Facility that offers a veteran’s program. The facility is located in Palmer, Alaska.
VA In-Home Care:
As an Alaska Resident and veteran, you are eligible to apply for the VA Voices which is a program to assist with the costs associated with in-home care. A VA disability determination is not required for this program to provide aid. It is open to all service men and woman that have served in the U.S. armed forces.
Va Voices: Veterans Options for Independence, Choice and Empowerment
Alaska Native Not Eligible
If you are Alaska Native and found to be not eligible for Department of Public Assistance. Review your denial. You can request an appeal of the decision.
Often receiving large cooperation dividends (over $2000 annually) results in being over income or having income mixed in the same account. Review the option to establish a Native Dividend Account to help qualify you for benefits.
You can get additional assistance with benefits through your local tribal office or the following regional agencies:
- Southeast Alaska Independent Living (SAIL)
- Southeast Alaska Regional Health Consortium (SEARHC)
- Catholic Community Services Care Coordination
- Ketchikan Indian Community (KIC) Elder Services offers in-home supports within the city limits of Ketchikan, Alaska.
- Alaska Legal Services
- Disability Law Center of Alaska
POA – SOA, VA
A Power of Attorney is a legal document that allows someone else to make decisions on your behalf. The person you appiont is known as a legal decision maker. The point of time when your appionted 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 at:
https://health.alaska.gov/dsds/Documents/pca/Limited_POA.pdf
For assistance with completing a Power of Attorney
Alaska Legal Services – https://alaskalawhelp.org/issues/life-planning/powers-of-attorneyadvance-directives
Other possible resources private legal counsel, case manager, or hospital social worker.
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 Brouchure Miller Trust: http://dpaweb.hss.state.ak.us/e-forms/pdf/MED-23.pdf
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.
Native Dividend Account
The State of Alaska allows for recipients of Alaska Native Corporations to save income associated with their membership with one of several corporations. A bank account needs to be established by you, utilizing income received through a cooperation dividend. The account can only hold dividend related money. Up to $2000 per year can be held in the account and is not counted towards your total asset limit for State of Alaska benefits. Any amount received in the year over $2000 is subject to the resource limits by Department of Public Assistance. If your native dividends are mingled with other income, the funds are considered a resource and could make you ineligible for benefits. Other monthly income, such as Social Security VA, retirement should be held seperately from you Native Dividend account and are also subject to a $2000 resoucre limit. the utilizing a Native Dividend account and some planning you can have up to $4000 per month is income on hand without penality by the Department of Public Assistance.
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.
Alaskan Memorial Park & Legacy Funeral Homes Homes https://www.legacyalaska.com/
Over Resource
The resource levels for the various Department of Public Assistance programs change annually. If you have received a letter that indicated that you have been found to be over the resource limits and ineligible there are several things that you can do to resolve the problem.
Spend Down – a process to reduce your saving (assets) to the resource limit for your household. You can spend down funds on bills owed, household repairs and needs, medical care, clothing, etc. Spending down does not mean that you give your money away. Giving money away is viewed as fraud to qualify for Medicaid benefits. You may also be able to save funds in specialized accounts.
- Miller Trust Account – could be established to help direct your income so that you would be no longer over the income resource limits. http://dpaweb.hss.state.ak.us/e-forms/pdf/MED-23.pdf
- Asset Trust – Special Needs and Pooled Trust – could be used if you are under the age of 65 years to help manage assets. http://dpaweb.hss.state.ak.us/e-forms/pdf/MED-22.pdf
- Irrevocable Burial Account – Special account created with the mortuary to plan for your future burial. Funds can be placed into an account for end-of-life expenses. Alaskan Memorial Park & Legacy Funeral Homes Homes https://www.legacyalaska.com/
Missing Documents
If you have received a notice that you are missing documents:
Start my reviewing the letter to see if you have the missing document. Often it is a bank statement or policy letter.
Let your Medicaid Case Worker know that you are seeking the document that is missing. You may ask questions specifically about the type of document needed. It is very important that you stay in contact with your Medicaid Case Worker, so they know the status of your efforts to obtain the missing record.
Keep copies of all documents sent. There are times when documents will need to be sent repeatedly. Having copies on hand and knowing when they were previviously sent will assist you in working with your case manager in a more timely fashion.
For additional assistance:
Other Resources
- Additional resources for support
Private Pay
Most in-home care and social service agencies offer a private pay option for support. If looking for personal care utilizing an agency has its advantages in that the caregiver has been vetted, may have previous experience and knowledge, background checked, and the agency provides advocacy and oversight as your care needs may change. Rates will vary and some programs offer sliding scales for fees. Most programs offer support during the day and not overnight.
Alternatives are building your support as needed through hiring professional services such as a private cleaner, gardener, ordering home delivered groceries, establishing Meals on Wheels through your local Senior Center or an Alert One lifeline service. Some individuals choose to develop a plan with friends and neighbors. When planning in-home care, it is important to keep a schedule to know when supports are coming to assist in the home. Managing a scheduling app or utilizing even a wall calendar may help keep you care team organized. If you choose to privately hire utilizing a contract with your caregiver could help with a clear expectation for your daily needs.
Carezone This worry-free app lets you store and manage important documents in one secure place. You can upload files. You can even scan pill bottles with your smartphone’s camera to create a detailed list of medications and dosages. There is a shareable calendar with automatic reminders. There is to-do section where you can coordinate care with friends and family members. Available for free at the App Store and Google Play.
AARP Caregiving This caregiver app provides information and resources on how to effectively care for the aging. Keep track of medications, appointments, and communicate with family members and other caregivers. It features a help center where caregivers can find quick answers to urgent or commonly asked questions with answers from AARP professionals. Available for free at the App Store and Google Play.
Private Long Term Care Insurance
Long-Term Care Insurance is a specific type of insurance coverage that covers the expenses for skilled nursing placement, hospice home care, and in-home care services. Some policies will cover Assisted Living placement. Most policies go into effect following a 90-day grace period for the first day that you enter a skilled nursing facility for rehabilitative care. Often the insurance provider will require that you pay for the first 90 days of care. Note that Skilled Nursing/Rehabilitative care are covered expenses under Medicare for up to 100 days. You or your representative will need to contact the long-term care provider upon entry into a skilled nursing facility. The insurance provider will likely request to conduct a physical and cognitive assessment to determine eligibility to activate the policy.
Long-Term Care insurance policies vary greatly. Many have financial caps for the costs associated with the care that you may need. The policy coverage will often not cover all the expenses that are accrued through the course of care needed. Medicaid or other secondary insurance coverage may be required depending on the level of care and support you need ongoing.
Long Term Care policies have variable costs. They tend to have lower premium costs, if established prior to retirement age. Some employers offer the Long-Term Care insurance as a supplement to health insurance.
Links:
For State of Alaska Employees, Long-Term Care Policy
For Federal Employee, Long-Term Care
Articles:
Making Sense of Your Long-Term Insurance (aarp.org)
7 Ways to Pay for Care Without Long-Term Care Insurance (aarp.org)
Tribal Relationship
Indian Health Services that support the regional tribal health clinics do not pay for in-home services, assisted living placement, or skilled nursing/long-term care placement. Payment for these services need to be planned through other resources such as Medicare, Medicaid, private insurance, or privately paid. Most village tribal offices provide support for emergency needs or other social services to assist you until alternative benefits or options may be available to help you long–term. Each community differs widely. Check your community for Tribal Services in the Elder Directory.
Ketchikan Indian Community (KIC) Elder Services offers in-home supports, transportation, and meal services within the city limits of Ketchikan, Alaska.
SEARHC Patient Benefits provides individual assistance for your benefit needs as well as has information about Tribally Sponsored Health Insurance and other financial assistance available.
Grants
There are grants that are available to assist with costs associated with in-home care, durable medical equipment travel, and other needs. Each grant varies on what items they will cover and how many times you can apply. Often grants are intended for short-term or annual assistance while establishing alternative funding. In most granting programs, funds can be obtained to supplement non-Medicaid covered items.
Resources:
- Catholic Community Services/Southeast Senior Services, Respite and Supplemental Services are available through the Senior & Caregiver Resource Center
- Alzheimer’s Resource of Alaska Mini-Grants up to $2500 annually.
- Mental Health Trust mini grant program up to $2500 annually.
- Tlingit and Haida Central Council provides grants for burial, emergency and general assistance.
- Southeast Alaska Independent Living (SAIL) may be able to assist with application process or locating alternative funding options.
VA Voices: Veterans Options for Independence, Choice and Empowerment
As a Veteran you have choices for your in-home care needs. In-home care could help you with mobility, hygiene, bathing, dressing, grooming, and other needs. Choosing the right program to administer your care may make all the difference in terms of whether you are able to continue age in place and remain in your home. There are several Agencies throughout Southeast Alaska that offer a Personal Care Assistance program for Veterans such as Center for Community, Community Connections, and Cornerstone Home Health. There is different service model option offered by Southeast Alaska Independent Living (SAIL). Here are the differences between the programs to help you make an informed decision about which type of care you might prefer.
| Southeast Alaska Independent Living (SAIL) – Veteran-Directed Care VOICE | Agency-Based Care – HHA: Center for Community, Compass, Community Connections, and Cornerstone Home Care |
| ● Based on your physician’s assessment of your needs, you are given a monthly “budget” from the VA to pay for personal care, in-home support and other goods and services not covered by your VA benefit that you need. Your designated SAIL advocate will help you design a budget and submit it to the VA for approval. | ● Based on your physician’s assessment of your needs, an agency-based program will receive authorization from the VA to provide a specified number of hours to provide you with personal care and or respite care. |
| ● You may appoint a designee (such as your spouse, grown child or friend) to manage your budget from the VA if you feel you are not able to manage your own care. | ● an agency will work with you or your Power of Attorney to schedule your approved hours to meet your needs. |
| ● You (or your designee) hire, train and dismiss your workers | ● an agency provides trained caregivers and manages all aspects of their employment. |
| ● You (or your designee) hire whomever you would like to provide your care (including your spouse, children, grandchildren, neighbors and friends). Anyone, other than your designee, who is eligible to work in AK, can work for you. | ● An agency hires employees who provide you care; they are not able to hire your family members to provide your care. However, they strive to match you with care providers you are happy with. |
| ● You (or your designee) sign your workers timesheets and submit them to be paid | ● You sign your workers timesheets, and an agency submits them to be paid |
| ● Your workers can perform whatever tasks you mutually agree upon based on your initial assessment which measures your Activities of Daily Living needs | ● Your workers can perform many tasks related to your independent living. The tasks you receive are approved by the VA. |
| ● You (or your designee) should hire back-up employees to provide care for you in the event that your worker(s) are sick or on vacation | ● an agency arranges for staff to provide your services. |
| ● You may use any amount of your budget from the VA for other pre-approved expenses such as home or vehicle modifications and other approved expenses related to your in-home care that are not already covered by the VA. ● Also, your VA health insurance typically covers durable medical equipment, catheter supplies, incontinence supplies, bedside commodes, lifts, etc. with a prescription from your doctor | ● Your VA health insurance typically covers durable medical equipment, catheter supplies, incontinence supplies, bedside commodes, lifts, etc. with a prescription from your doctor |
Services:
- Create your own Spending plan
- Choose where, when, and how your services are provided
- Hire and choose how much you plan to pay your staff
- Save funds in your budget for equipment, home, or vehicle modifications
Process:
- Contact SAIL
- Brochure, DD214, VA POA
Eligibility Process:
- Enrolled in VA Healthcare
- Be able to self-direct care or assign someone you trust to direct care
- Medical eligibility as determined by the Alaska VA
Links:
Assisted Living Facility
Assisted Living facilities provide 24-hour care in a homelike setting for elders and/or persons with mental health, developmental, or physical disabilities who need aid with their activities of daily living such as showering, dressing, and eating. Facility size and some annuities vary upon location. Many of the Assisted Living Facilities in Alaska are privately owned. The Pioneer Home system is owned and operated by the State of Alaska and offers Assisted Living level of care. Most of the Assisted Living Facilities are in the Anchorage, Alaska area. Planning ahead is important if you believe that your needs may reach the level for Assisted Living Placement.
The Pioneer Home system offers two waiting lists. One, known as the Inactive Waiting List, is for those who plan to enter the Pioneer Home at some time in the future and the other, Active Waiting List, is for those with an immediate desire to move into the facility within 30 days. The waiting list is free to sign up on. Once an application is received your name and application date are recorded. If you choose to move to the Active Waiting List, your application date determines your placement on the Active List. The older the application date the higher you fall on the Active Waiting List (the oldest application is #1 on the Active Waiting List). They require all applicants to be Alaska residents over the age of 65 years.
State of Alaska, Department of Family and Community Services, Division of Alaska Pioneer Homes
Medicaid Wavier will pay the Cost of Care to a facility for an individual needing Assisted Living placement. The participant is required to pay a portion to the facility for monthly rent.
For an individual who needs immediate Assisted Living facility placement but is pending a Medicaid Wavier, The State of Alaska Department of Health Division of Senior and Disabilities Services provides the General Relief Program that assists with the cost of placement for an interim period. The individual is still required to pay a portion of their monthly income to the facility with this funding.
Looking for an Assisting Living Home Facility? The State of Alaska, Department of Health, Division of Health Care Services, Assisted Living Licensing Unit provides a monthly updated list of statewide facilities.
If you have improved while residing in a facility and desire to seek community placement, the State of Alaska, Department of Health, Division of Senior and Disabilities Services offers a program to assist with the cost associated for moving out of a Skilled Nursing, Long-Term Care, or Assisted Living Facility.
Nursing Facility Transition/Assisted Living Transition Program
Skilled Nursing Facility
Skilled Nursing Facilities provide the highest level of care to an individual outside a hospital setting, known as sub-acute care. The primary focus initially in a Skilled Nursing facility is rehabilitation care through skilled therapies. Theses therapies include nursing (medication/wound care etc.), physical, occupational, and speech therapy. Rehabilitative care is covered by Medicare if the individual had a three-day qualifying hospital stay prior to needing to be moved to a skilled nursing facility. The belief at the time of admission is that the individual will be able and willing to work towards goals, if at any time this is not the case the status of the individual can be moved from Rehabilitative to Long-Term Care. This means that Medicare stops paying for the services and an alternative option is required for payment. In most cases, Medicaid is the primary funding source. Often individuals will pay privately to spend down their assets on their care needs while pending approval by Medicaid. In the case of a 75-100% service-connected veteran, the VA would cover the costs for a qualified placement. There are not alternative payment options through grants or programs to cover the costs of Skilled Nursing facility care.
The State of Alaska, Department of Health, Division of Senior and Disabilities Services does offer a program to assist with the cost associated for moving out of a Skilled Nursing, Long-Term Care, or Assisted Living Facility.
Nursing Facility Transition/Assisted Living Transition Program