[{"_1":2,"_88":-5,"_89":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6328585,"mediaKeyId","2318581-ae3336335f91103ff9fa85b10756f91b","parentId",2318581,"title","Committee reviews Medicaid waivers: home- and community-based services, IDD wait list and behavioral health expansion","audioSeconds",1002,"startMs",3682000,"endMs",4684000,"viewUrl","/Search/View?dp=1&key=2318581-ae3336335f91103ff9fa85b10756f91b&start=3682&end=4684","thumbnailUrl","https://assets.pipeline.soar.com/2318581-ae3336335f91103ff9fa85b10756f91b/thumbnail_3682000.jpg","articleUrl","/articles/6328585/Alaska/Committee-reviews-Medicaid-waivers-home-and-community-based-services-IDD-wait-list-and-behavioral-health-expansion","mediaUrl","https://secure.pipeline.soar.com/6328585-0f0efde33267a560553374f0c383eb88/orig.mp4?Expires=1775538742&Signature=hsCj2waR3tqwG0Y6f0sxY-eIZcUIV3ZQyxdVt4Js8rADwXWq2gfwYEVaFAGs8RovSilw0yNdoauMbkpQDUeFlVKUhnxKzED12xJqHvurGxLXt3SAyktx771j7bhtTWMZ~yKaJUT2lbOPwR9~FQjwbQRvBt76AvsKHm-zk38-cT9oZB9mq-JSzLsjsjgGD5-xXU2TcLhGTFSCiyW34MbPy8c36~sU8KF1e1k~bOLi7pJNrgMKAtDuMcmmW5XGkpqKHylqEtf01q0ggLQn3nC7TBdzv0VeBcBl~To-ObBnOw207eNZShh1HP~WpJ0Cj3KAcm13Mil75q9~2epZzL5ryA__&Key-Pair-Id=KUT5TJCACFTXG","author","Alaska Legislature","date","2025-02-13T00:00:00Z","article","Juneau — Directors who manage Alaska’s Medicaid waiver programs told the House Finance Committee on Feb. 13 that home- and community-based services (HCBS) and behavioral health demonstration waivers have expanded services statewide but that wait lists and workforce limits remain barriers to serving everyone eligible.

Tony Newman, director of the Division of Senior and Disability Services, told the committee Alaska operates five 1915(c) HCBS waivers that together serve roughly 5,500 people. “Waivers are savers because without them Alaska would have to rely on more and more expensive care and nursing homes and institutions for people with disabilities,” Newman said, describing both fiscal and quality‑of‑life reasons the waivers are used.

Why it matters: Waivers keep many Alaskans in homes and communities rather than institutional settings. Directors and members discussed the size of the IDD wait list, the cost to eliminate it, and how workforce limits affect actual service delivery.

Key waiver details and numbers
- The state’s five 1915(c) waivers and approximate enrollment cited by the department: individuals with intellectual and developmental disabilities (IDD) — about 2,100 people; Alaskans Living Independently (senior-serving) — about 2,400; children with complex medical conditions — about 240; individualized supports (lighter menu) — about 600 (capped); and adults with physical and developmental disabilities — about 76.
- The IDD waiver carried a wait list the director said was about 323 individuals in late January; the individualized supports waiver is capped at 600 and had a small wait list (about 45 people) at the time of the briefing.
- Newman described a 2022 legislative plan that estimated the cost to eliminate the IDD wait list; the department said that the plan is available online and that additional appropriations would be required beyond funding already provided to implement assessment tools.

Assessment tool, workforce and service constraints
- The division is implementing the interRAI assessment instrument with legislative funding (FY24–FY26) to modernize assessments and reduce costs to eliminate the wait list. Newman said the tool should make serving people more cost‑effective but that eliminating the wait list would still require appropriations and available provider workforce and residential capacity.
- Committee members pressed on workforce availability; Newman said eliminating the wait list without additional workforce and provider capacity could simply create another access bottleneck.

Behavioral health 1115 demonstration waiver
- Tracy Dompling, director of the Division of Behavioral Health, reviewed the state’s 1115 demonstration waiver work that began after SB 74 (2016) and resulted in substance use disorder and mental health services being covered through demonstration waivers beginning in FY20–FY21.
- Dompling said the combination of Medicaid and grants produced roughly a $120 million increase in behavioral health system funding from state fiscal years 2018 to 2024 (about a 48% increase) and that the current 1115 demonstration waiver was renewed through Dec. 31, 2028, allowing for further amendments.

Follow-ups and requests
- Legislators asked the department to provide the 2022 plan that detailed costs to eliminate the IDD wait list; the department agreed to provide that report to the committee. Newman also said the department can provide the average time people spend on the wait list.

Ending note
- Directors emphasized that waivers generally reduce institutional spending and improve quality of life but that fiscal appropriations, administrative capacity and workforce availability all constrain how quickly the state can expand services to those waiting.

No formal votes or actions were taken during the presentation; the committee scheduled a follow-up FY26 budget session with the Department of Health for the afternoon.","mediaType","Video","parentTitle","House FINANCE 02/13/2025 (PM)","oneSentenceSummary","Division directors described Alaska’s 1915(c) waivers that help keep people at home, the size and cost of those waivers, the IDD wait list and the growth in behavioral health spending tied to 1115 demonstration waivers launched after SB 74.","taxTitle","2025 Legislature Alaska, Alaska","taxId",78559,"location","Alaska","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6328589,"House Finance Committee hears Medicaid 101: program scope, funding and system challenges",3017,450000,3467000,"/Search/View?dp=1&key=2318581-ae3336335f91103ff9fa85b10756f91b&start=450&end=3467","https://assets.pipeline.soar.com/2318581-ae3336335f91103ff9fa85b10756f91b/thumbnail_450000.jpg","/articles/6328589/Alaska/House-Finance-Committee-hears-Medicaid-101-program-scope-funding-and-system-challenges","https://secure.pipeline.soar.com/6328589-dd9fa07d7ca8f81f4e71fa62e613521c/orig.mp4?Expires=1775538742&Signature=lpsoSM7PKfVVHAAw2DVRrSFSU67~s5t9VAvLrhK1yPvy7qSgBPmIrGMTRBi1P2n5vhok10KZVUsi4qji3NsAYZ7DI2G~zHLOAU3oid373Zv5saJhXArEcTHvIVKArzlDoQbhzH1vNNe1fYS-KbJUxpQKsKaAZj6fRiVY-nGVSLnmuH7O~ZwBxtD615RaxO0eDSCKqK692CORrMI9Ye3QMcjlLWx4S4fFsbUnfB3l9l2WZ1n-rP6lxUzrRkartTTAolzZm5KE1xBdF2D8nj2Zd2J8I5OOCsS9EeqsdbcI3ImNGeVi7xlkub7ym-yaYMgVLELdeweQkLeyOFuegfHugg__&Key-Pair-Id=KUT5TJCACFTXG","Juneau — The Alaska House Finance Committee on Feb. 13 received a Medicaid 101 briefing from the Department of Health that outlined the program’s scale, how federal and state dollars flow through the system, recent enrollment trends and operational challenges.

The presentation, delivered by Deputy Commissioner Emily Ritchie of the Department of Health, included a summary of the program’s financial footprint: “Alaska’s Medicaid program is essential to Alaskans and to our health care delivery system,” Ritchie said, noting the program pays about $2.8 billion in federal and state funds annually and provides coverage for roughly 246,000 Alaskans.

Why it matters: Medicaid is both a major health insurer for low-income Alaskans and a large payer in the state economy. Committee members probed which parts of Medicaid are funded by federal dollars and which by the state general fund, how federal matching rates (FMAP) are applied, and how claims and payments are processed.

Most important facts — funding and flows
- The Department said Alaska’s Medicaid program pays roughly $2.8 billion a year and distributes weekly provider payments in the hundreds of millions of dollars (department slide: about $252 million per week). Those payments are later reconciled with federal draws.
- Federal Medicaid Assistance Percentage (FMAP) determines the federal share. Ritchie cited a regular FMAP floor for Alaska at about 51.54% for many services; certain services and populations (for example, some tribal health services) can receive higher federal matches.
- The department told the committee it has reclaimed higher federal match in some cases (tribal reclaiming) and that effort yielded about $138 million in general‑fund relief in FY 2024.

Enrollment, eligibility and recent redetermination
- Deputy Commissioner Ritchie and Deb Etheridge, director of the Division of Public Assistance, described how Alaskans apply (myalaska.gov, healthcare.gov, in-person offices, phone, mail, local “fee agents” in rural areas) and the two main eligibility buckets: disability-related categories and modified adjusted gross income (MAGI) categories.
- The department showed enrollment changes since the COVID-era continuous coverage conditions: monthly enrollment peaked around 280,000 in FY 2024 on a yearly-count basis, but the department reported about 253,000 enrollees in April 2023 when redeterminations began and about 246,000 enrollees in December 2024.
- On postpartum coverage, Ritchie confirmed the Legislature passed a bill extending Medicaid enrollment for mothers after birth from 60 days to 12 months; she said the child’s eligibility rules were unchanged and children were already eligible for the first year.

Operational issues raised by legislators
- Provider payment timing and claims delays: several legislators said they hear frequent complaints that providers do not receive timely payments; the department acknowledged individual and systemic issues can occur and said some delays relate to upstream clearinghouse or data‑transmission problems rather than the MMIS itself.
- IT modernization: Ritchie said the department is working on a Medicaid modernization plan that will include automation to reduce manual work and, officials said, should improve provider payment timeliness. The committee was told the department will return in the afternoon for a FY26 budget overview and to discuss proposed IT changes.
- State plan amendments and statutory limits: Ritchie explained that changes to eligibility, covered services or administration typically require state plan amendments (SPAs) and sometimes statutory changes. She told the panel that some services listed as “optional” in state statute are effectively required in practice because of federal rules or system expectations. The department identified AS 47.07.030 and federal Medicaid authorities (Title XIX of the Social Security Act) as the legal framework that define mandatory and optional services.

Follow-up, data requests and next steps
- Committee members asked the department to supply a written breakout of federal versus state expenditures by service category. The department agreed to follow up in writing.
- The department said it will present more detailed IT modernization and FY26 budget materials later in the day.

Less-critical details and context
- The department said about 31,000 providers are enrolled to receive Medicaid payments. It also noted that not every enrollee uses services each month; department charts showed a smaller “users” curve beneath total enrollment figures.

The committee adjourned after scheduling the department’s FY26 budget overview for the afternoon session.","Department of Health officials briefed the House Finance Committee on Medicaid’s size, how federal matching (FMAP) works, enrollment trends after redeterminations, provider payment issues and planned IT modernization.","actionData","errors"]

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Committee reviews Medicaid waivers: home- and community-based services, IDD wait list and behavioral health expansion

House Finance Committee hears Medicaid 101: program scope, funding and system challenges