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

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.