Aging in Place in Your State: Alaska

Photo by James Mark, Pixabay

Everybody knows Alaska is the largest U.S. state by area. But do you know how large? Alaska is enormous. It’s about as big as all of Europe. It’s larger than Texas, California, and Montana (the second, third, and fourth-largest U.S. states) put together. If it were its own country, it would be among the top 20 largest nations in the world. 

Alaska is so big that it can easily accommodate the nation’s largest forest, the Tongass, North America’s highest mountain, Denali, 130 volcanoes (90 active), 3,000 rivers, and, get this, 3 million lakes! It’s also well known that Alaska is sparsely populated, but it wouldn’t be accurate to say that its population of about 775,000 people is spread across its 665,400 square miles—an estimated 95% of that area is uninhabited, due to Alaska’s many, many mountains, lakes, and endless miles of wilderness. Add a climate that, while beautiful in the summer, produces some of the world’s most punishing winters, and Alaska definitely lives up to its nickname as “The Last Frontier”.

That makes it an interesting and often challenging place to grow old—and, historically, Alaska’s population has skewed younger than the U.S. average. In 1980, the average age of an Alaska resident was 26, at a time when the U.S. average was 30. But in the past 40 years, the number of Alaskans aged 70 and older has increased dramatically and now makes up nearly 10% pf the population, according to an article in the Alaska Journal. These days, Alaskans’ average age is 36, inching closer to the current U.S. average of about 38, and the state continues to trend older.

That change is driving increased demand for better health care systems, more local hospitals and senior centers, and, of course, a greater need for services that help aging Alaskans live independently. The state has responded to that demand by offering several programs aimed at helping seniors age in place; here’s a look at a few of them.

The Alaskans Living Independently (ALI) Medicaid waiver program is open to Alaskans aged 21 and older who “meet the threshold for a nursing home level of care,” according to the state’s Department of Health, Senior and Disabilities Services. 

The state also runs the Adults with Physical & Developmental Disabilities (APDD) waiver program for developmentally disabled adults, as well as the Child with Complex Medical Conditions waiver for children and young adults up to age 22.

The three programs offer similar benefits; ALI and APDD waivers cover services found in many similar programs in other states, such as care assessments and coordination, transportation, various meal services, supply and installation of specialized medical equipment, and environmental adaptations. 

One somewhat unique aspect of Alaska’s waiver programs is that participants in the programs can choose between receiving care in a facility or while living in a private residence. To qualify for the programs beyond their age and disability limits, applicants must meet the current standard for Medicaid eligibility regarding income and assets. As of 2023, that limit is $2,742 a moth in income and no more than $2,000 in countable assets for a single applicant. A married couple in which bath spouses seek benefits has an income limit of $5,484 per month and an asset limit of $3,000, while a couple in which only one spouse applies for services has the same income limit as a single applicant, but a more complex asset limit. In that case, the applicant spouse can retain $2,000 in countable assets, while the non-applicant spouse can hold up to $148,620 in assets. Note, too, that if one spouse does not apply for benefits, that spouse’s income is not counted towards the applicant spouse’s eligibility. This is true for assets like 401Ks or individual retirement accounts (IRAs), as well: a non-applicant spouse’s retirement income is not included in determining eligibility.

Countable assets include any cash accounts at banks or credit unions as well as cash in hand; investments such as stocks, bonds, IRAs, 401Ks, and the like; real estate that is not a primary residence, and even COVID-19 stimulus payments. But many assets are exempt, including a primary residence and its furnishings, a primary automobile, personal belongings like clothing and jewelry, household goods, burial plots, and some other assets. 

One caveat: the primary home retained as an asset must not have equity greater than $688,000. This figure  is distinct from the home’s value; it’s determined by subtracting the amount owed on the home from its assessed value. 

Besides its Medicaid waiver-based programs, Alaska has two unique programs that could help elderly Alaskans make needed home modifications. The Alaska Senior Benefits program pays a monthly cash benefit to residents aged older than 65 who meet certain income limits. Payments are made on a sliding scale according to different levels of income qualification, shifting U.S. poverty definitions, and the state’s budget in any given year. The payments aren’t huge—the largest are around $250 per month—but can be very helpful for people living on a fixed income. 

A second program, called the Environmental Modification (E-Mod) Home Accessibility Program, is open to Medicaid-eligible Alaskans who are ill, frail, or injured and “need … changes to their homes to maintain their independence,” according to the program’s website on the Alaska Department of Health home page. This unique service allows waiver program participants to get help from their care coordinator in determining what home modifications are most needed; the program then requests estimates from Medicaid-certified contractors. Once a contractor is chosen, the care coordinator manages paperwork, and the contractor bills the company that handles Alaska’s Medicaid billing. Home modifications for any individual recipient are capped at $18,500, but that cap is renewable every three years. 

One more unique aspect of this highly individual state is that Alaska has, by far, the largest population of Native Americans as a percentage of its population, with more than 20% of its residents identifying as native Alaskans. Besides the programs listed above, these Alaskans are eligible for programs open to America’s Native American and Alaska native populations; read more about them here.