Alaskans Living Independently (ALI) Waiver
The Alaskans Living Independently (ALI) Waiver is Alaska’s Medicaid home and community-based waiver for older adults and adults with physical disabilities who need a nursing home level of care but want to live at home or in a small community setting. This page is part of our Alaska Long-Term Care Medicaid guide.
Figures change periodically. Double-check current amounts before relying on them.
At a glance
| Item | Details |
|---|---|
| Type of program | Medicaid home and community-based services (HCBS) waiver |
| Who runs it | Alaska Department of Health, Division of Senior and Disabilities Services (SDS) |
| Age | 21 and older |
| Care need | Needs a nursing facility level of care |
| Alaska 2026 income rule (long-term care) | $2,982 a month (300% of the SSI rate) |
| Alaska 2026 asset limit (single applicant) | $2,000 |
| Waiting list | No waiting list reported for 2026; enrollment is capped each waiver year |
The ALI Waiver in brief
In short, the ALI Waiver is run by Alaska Department of Health, Division of Senior and Disabilities Services (SDS). Its target group is 21 and older; on care need, the rule is: Needs a nursing facility level of care. Waiting list status in 2026: No waiting list reported for 2026; enrollment is capped each waiver year. The sections below repeat these points with more detail, and our state guide covers the Alaska rules that apply to every long-term care program. If the ALI Waiver is not the right fit, the related pages at the end point to other Alaska programs and general guides.
What the program is
The ALI Waiver is run by the Division of Senior and Disabilities Services. The process starts at an Aging and Disability Resource Center (ADRC). The person then chooses a certified care coordinator, who helps with the application and builds a support plan. The ALI Waiver can be used together with Community First Choice personal care, so a person can receive hands-on help at home and other waiver services at the same time.
The ALI Waiver is a “waiver” because federal Medicaid lets Alaska waive certain rules in order to pay for care at home and in the community. Slots are limited each year, every participant has an individual care plan, and a case manager or coordinator puts services in place. They do not replace regular Medicaid: a person on a waiver still has ordinary Medicaid coverage for doctor visits, hospital care and prescriptions, with Medicare paying first for people who have it. See our overview of HCBS waivers.
Who qualifies in 2026
A person generally must meet all of these conditions:
- Is 21 or older
- Is eligible for Alaska Medicaid
- Needs a nursing facility level of care
- Lives in Alaska and is a U.S. citizen or qualified non-citizen
- Can be served safely in the community with waiver services
Income and assets. The person must qualify for full Medicaid under Alaska’s rules for long-term care. Figures shown above are the 2026 Alaska long-term care limits from our state guide. Exempt items generally include the home within the equity cap, a car, household goods and a modest burial fund. If only one spouse needs the ALI Waiver, spousal impoverishment rules protect assets and income for the other. See Spousal impoverishment rules.
How the care assessment works. Alaska Senior and Disabilities Services’s assessment covers daily activities, from bathing and dressing to toileting and medications, plus memory and safety. For the ALI Waiver, an assessor, usually a nurse or social worker, visits the person at home, in the hospital or in the facility. Before a the ALI Waiver assessment, it helps to line up a family member who can describe a typical bad day, and to have a list of diagnoses and medications ready. See Nursing home level of care and Activities of daily living.
What services it can pay for
The plan of care decides which services are used. The ALI Waiver can cover:
- Care coordination
- Adult day care
- Respite
- Adult host-home care (living with a trained host)
- Residential supported living (assisted living homes)
- Home changes to make the home accessible
- Meals
- Specialized medical equipment
- Private-duty nursing
- Transportation
Not every participant gets every service; the plan reflects assessed need and the help family already gives. If needs change, ask for a new assessment.
How to apply
Getting the ALI Waiver means passing a money test and a care test. Step by step:
- Contact an ADRC to discuss options and start the screening.
- Choose a certified care coordinator from the list SDS provides.
- Apply for Medicaid through the Alaska Division of Public Assistance if not already enrolled.
- The care coordinator helps submit the waiver application; SDS assesses the level of care.
- After approval, the care coordinator writes a support plan and services begin.
For the paperwork, use our documents checklist before applying for the ALI Waiver; Applying for a waiver explains the general process.
Waiting lists
Alaska has not reported a waiting list for older adults or people with physical disabilities on the ALI Waiver in 2026, but the waiver has a cap on the number of people it can serve each year.
More on how lists work: Waiver waiting lists.
How it relates to nursing home Medicaid
ALI uses the same nursing facility level of care as nursing home Medicaid and the same 2026 income rule ($2,982 a month) and asset limit. For many families, ALI combined with CFC personal care is the main alternative to a nursing home in Alaska. ALI can also pay for care services in an assisted living home (residential supported living), though not room and board.
What is the same as nursing home Medicaid. Alaska’s financial rules for the ALI Waiver track the nursing home rules closely. The five-year look-back still matters: a transfer for less than fair value can delay payment for long-term care services. Estate recovery also applies: the state can seek repayment from the estate of a person who received long-term care services after age 55. Under the ALI Waiver, income above an allowance may go toward the cost of care each month.
Personal needs allowance. If the person does move to a nursing home, Alaska’s 2026 personal needs allowance is $200 a month. Most of the rest of their income goes toward the cost of care. The state guide explains the nursing home side.
Tips for families
- Start early. If there is a waiting list or a slow assessment, the clock usually starts when you ask, not when the crisis comes.
- Document everything, from forms and letters to who you spoke with at Alaska Senior and Disabilities Services and when.
- Watch the deadlines on notices. A denial or cut can be appealed through a fair hearing, and a timely request can keep services going meanwhile.
- Tell Alaska Senior and Disabilities Services about changes in money, address or household as they happen.
- Expect yearly reviews of both Medicaid eligibility and the care assessment. See Renewals.
- Think about the spouse at home. Couples have extra protections, but they have to be claimed. A certified Medicaid planner or a legal aid office can explain how the rules apply to a particular family.
Common questions
Does ALI pay for assisted living? It can pay for residential supported living services in a licensed assisted living home. The resident pays room and board.
Do I have to choose between ALI and CFC? No. Many people use both: CFC for personal care and ALI for other services.
Who is a care coordinator? A certified professional you choose who helps with applications, writes the support plan and checks that services are working.
Related pages
- Alaska Long-Term Care Medicaid guide
- Alaska Community First Choice
- HCBS waivers
- Three kinds of Long-Term Care Medicaid
- PACE programs
Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.