How Alaska pays for disability services

Waiver inventory

No 1915(i) or 1915(b)(3) authority serving people with IDD was identified on the Alaska HCBS waivers page or the CMS Alaska waiver factsheet. Waiver numbers from medicaid.gov

State-only funded programs

• Senior and Disabilities Community Based Grants, administered by the Division of Senior and Disabilities Services Grants Unit. Funds the Developmental Disabilities Resource Connection (DDRC), Adult Day Services, and short-term supports for people waiting for or needing minimal Medicaid support. Annual appropriation not published on the program page. health.alaska.gov
• General Relief Assisted Living Home Program, a state-funded temporary assisted living benefit for low-income Alaskans, administered by Senior and Disabilities Services. Annual appropriation not published on the program page. health.alaska.gov
• Early Intervention / Infant Learning Program, administered by Senior and Disabilities Services, blending IDEA Part C with state funds. health.alaska.gov

Appropriation amounts for these programs were not found. The FY2027 enacted operating bill (HB 263) is published as a scanned image PDF with no extractable text, and the Legislative Finance Division reports are behind interactive selectors. omb.alaska.gov

County / regional / local funding

None identified. Alaska has no counties. Boroughs and municipalities were not found as a funding source for developmental disabilities services in the Senior and Disabilities Services grants pages, the waiver applications, or the IDD registration and review report. Alaska does apply geographic differentials to Medicaid rates by region rather than raising local revenue: adjustments run from 1.00 in Anchorage and Mat-Su up to 1.50 in the Aleutian Region, 1.49 in Bethel/Dillingham, 1.48 in the Arctic Region, 1.44 in Southwest Small Communities, and 1.31 in the Roadless Interior. health.alaska.gov

Funding scale

• Projected IDD Waiver service costs (Factor D basis), year 1 beginning 7/1/2026: $286,730,989.22 for 2,160 participants, or $132,745.83 per participant. Year 2: $297,824,525.86 and $137,246.33 per participant. Average length of stay on the waiver: 341 days. health.alaska.gov
• Institutional comparison, IDD Waiver year 1: Factor G $446,055.97 per person per year, against a combined waiver cost (D plus D') of $146,800.22. Alaska calculated Factor G from an FY2026 estimated Alaska-based ICF/IID annual rate of $415,322.13, inflated 7.4 percent per year.
• ISW individual cost limit: $38,412 in waiver year 1, indexed to service rate inflation thereafter, inclusive of geographic differentials. health.alaska.gov
• Projected annual cost to serve everyone currently on the registries: IDD registry $65,107,793.96 total, with an estimated state cost of $32,553,896.98 at 50 percent FMAP; ISW registry $5,939,292.54 total, state cost $2,969,646.27. health.alaska.gov
• State vs federal share: the state's own IDD registry report uses a 50 percent FMAP, that is a 50/50 split. KFF lists Alaska's FY2027 FMAP at 51.37 percent. kff.org
• People served: 2,160 IDD Waiver participants approved for FY2027; 620 ISW participants, capped at 600 at any point in time.
• Waiting list (the "Registry"), as of 6/30/2025: 512 people on the IDD Registry and 222 on the ISW Registry, with 353 people appearing on both. Average time on the IDD Registry: 28 months. Average on the ISW Registry: 8 months. People waiting 90+ days: 464 on IDD, 161 on ISW. In FY2025 (7/1/2024 to 6/30/2025), 123 people were selected for IDD waiver services after an average 8 months on the registry, and 150 were selected for ISW after an average 14 months. Children ages 4 to 17 are 54.7 percent of the IDD Registry (280 people). health.alaska.gov
• Statewide DD spending across all funds and a state-versus-federal split for the DD system as a whole were not found. Alaska does not publish a consolidated DD budget line in an extractable format.

Residential funding detail

Residential Habilitation is the dominant cost in the IDD Waiver: $214,920,170.46 of the $286,730,989.22 year 1 total, roughly 75 percent. That splits into a daily component ($171,632,831.00 for 1,081 people averaging 350.63 days at $452.82 per day) and a 15-minute component ($43,287,339.46 for 767 people averaging 3,627.07 units at $15.56).

Settings and payment structure, from the FY2027 rate chart: - Group Home Habilitation, adult 18+, T2016, per day, $483.15 statewide base. This is a straight per diem, not acuity-tiered on its face. - Family Home Habilitation, the host home / shared living model. Adult (18+), S5140, per day, $201.30. Child (17 or younger), S5145, per day, $217.84. - Acuity add-ons for both group home and family home habilitation are billed separately per 8 hours: $169.82 for 1 recipient to 1 direct care staff (T2025 CG), $339.63 for 1 recipient to 2 direct care staff (T2025 TG). Per 7 AAC 130.267 the add-on requires dedicated 1:1 or 2:1 staffing. - Supported Living Habilitation, adult 18+, T2017, per 15 minutes, $15.46. In-Home Supports Habilitation, 17 or younger, T2017 U4, per 15 minutes, $15.46. These are the in-home and own-home tiers and are hourly rather than per diem. - Host Home Care, per day, is an IDD Waiver service (in the waiver services list) but shows zero users and zero cost in the year 1 estimate at an assumed $169.12 per day. Adult Host Home Care was newly added to the ISW effective 9/1/2024 and is priced through the ISW Cost Calculator rather than the waiver rate chart. - Residential Supported Living (RSL) on the ALI and APDD waivers is bed-size tiered: $230.53 per day base, $231.13 for 5-or-fewer-bed and 6-to-16-bed non-state-government owned homes, and an RSL Acuity Add-on of $509.46 per day. - Every rate is multiplied by a regional geographic differential ranging from 1.00 to 1.50.

Room and board. Not state-funded through the waiver. The IDD Waiver states: "Room and board costs are isolated from waiver costs by calculating and accounting for them separately. The State pays only for the waiver service component of the participant's care." The single exception is per diem respite, "where room and board is an allowable expense" and "the licensed facility receives room and board as part of the daily unit cost." Room and board in residential settings therefore falls to participant income, primarily SSI. Alaska does allow FFP for the rent and food attributable to an unrelated live-in personal caregiver under 42 CFR 441.310(a)(2)(ii).

ICF/IID. Alaska uses both in-state and out-of-state ICF/IID facilities. The FY2026 estimated Alaska-based ICF/IID annual rate is $415,322.13, and the inflation factors in the waiver were calculated from out-of-state ICF/IID facility rebased rates for facilities serving Alaska Medicaid recipients.

Rate structure link: health.alaska.gov

Comparable service rates

All rates below are statewide base rates before the regional geographic differential.

Official rate schedule links

• FY27 Chart of Waiver Services Rates (3.2 percent increase effective 7/1/2026): health.alaska.gov
• FY26 Chart of Waiver Services Rates (3.2 percent increase effective 7/1/2025): health.alaska.gov
• FY25 Chart of Waiver Services Rates (7.1 percent increase, 3.2 percent inflation plus 3.9 percent legislative adjustment, effective 7/1/2024): health.alaska.gov
• FY27 LTSS and Targeted Case Management Rate Chart: health.alaska.gov
• FY27 Personal Care Services and Community First Choice Rate Chart: health.alaska.gov
• Personal care services and waiver rate-setting methodology: health.alaska.gov
• ISW Cost Calculator, updated 7/1/2026: health.alaska.gov
• Payment Rates and Cost Survey Information index: health.alaska.gov

Notable features and flags

• Rate increases: 7.1 percent effective 7/1/2024 (3.2 percent inflation plus a 3.9 percent legislative adjustment), 3.2 percent effective 7/1/2025, and 3.2 percent effective 7/1/2026. Three consecutive years of inflation adjustment.
• All five 1915(c) waivers were renewed with an effective date of 7/1/2026 (application signed 7/29/2026 for the IDD waiver), except the ISW, whose current amendment took effect 9/1/2024.
• The IDD Waiver does not offer participant direction. Appendix E of the 7/1/2026 renewal records "No. This waiver does not provide participant direction opportunities." Family-Directed Respite exists as a rate variant on the CCMC, IDD, and IDD-ISW waivers but is not a formal self-direction authority.
• The ISW amendment effective 9/1/2024 added Adult Host Home Care to support transitions out of foster care and to serve adults in non-habilitative settings, and permits certified adult host home providers to deliver medication management.
• The IDD waitlist eradication plan (December 20, 2022, required by HB 281 of 2022) targets elimination by May 2028 and projects state spending rising from $72.7 million in SFY2021 to $163.6 million in SFY2034 without new cost-management infrastructure, or about $123.2 million with it. It requires approximately 24 new state positions costing $2.8 million and separate legislative funding action that had not been authorized as of the plan's publication. Projected participant growth: 2,033 in 2021 to 4,169 by 2034. Registry counts as of 6/30/2025 (512 IDD, 222 ISW) are above the 438 cited in that 2022 plan.
• Geographic differentials up to 1.50 are still keyed to the Alaska Geographic Differential Study dated April 30, 2009, now 17 years old.

Confidence

Solid: waiver structure and numbers, all published rates and their effective dates, the residential rate architecture including acuity add-ons and geographic differentials, registry counts and wait times, and room and board policy. All of this comes from the FY27 rate charts, the 7/1/2026 IDD waiver application read in full, the ISW amendment, and the FY2025 IDD Registration and Review Report. Estimated: the $286.7 million IDD waiver figure is a cost-neutrality projection, not actual expenditure. Could not find: actual Alaska DD spending by fiscal year across all funds; the state-versus-federal split for the DD system as a whole beyond the 50 percent FMAP assumption in the state's own registry report; appropriation amounts for the Senior and Disabilities Community Based Grants and the General Relief Assisted Living Home Program; and APDD, CCMC, and ALI enrollment counts. Alaska's FY2027 enacted operating bill is a scanned image with no extractable text, and the Legislative Finance Division budget reports are behind interactive selectors, which blocked retrieval of appropriation detail.

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