Alaska - Assisted Living Facility — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The Alaska Department of Health (DOH), Division of Health Care Services, Residential Licensing unit licenses Assisted Living Homes (ALHs) under 7 AAC 75. Medicaid reimbursement for these services is funded through the state's Home and Community-Based Services (HCBS) waivers, including the Alaskans Living Independently (ALI) and Intellectual and Developmental Disabilities (IDD) waivers, requiring providers to obtain dual approval: an ALH license followed by Medicaid Provider Certification under 7 AAC 130.220.

Applicants must first secure a physical location and pass a pre-licensure fire and life safety inspection before submitting the New Home Application Packet. Once licensed, the facility must apply for HCBS certification through the Senior and Disabilities Services (SDS) Provider Certification and Compliance Unit and enroll via the Alaska Medical Assistance Health Enterprise Portal managed by Gainwell Technologies.

1. Service Definition and Scope

In Alaska, an Assisted Living Home (ALH) provides housing, food services, and personal assistance to adults who need help with activities of daily living (ADLs). The state distinguishes between homes serving 1-2 residents (if receiving state or federal funds) and those serving 3 or more unrelated adults, both of which require licensure.

Medicaid HCBS waivers cover the residential supported living services provided within the ALH, but do not cover room and board costs. Providers must establish a residential services contract with each resident detailing the specific services, fee structure, and discharge criteria.

• Service Name: Assisted Living Home (ALH) and HCBS Residential Supported Living.
• Licensure Threshold: Mandatory for facilities serving 3 or more unrelated adults, or 1-2 adults if receiving Medicaid or state funds.
• Covered Services: Assistance with ADLs, medication administration (if trained), and supervision.
• Excluded Costs: Room and board are not covered by Medicaid HCBS waivers and must be paid via private funds or the Optional State Supplement (OSS).
• Specialized Care: Facilities offering Alzheimer's Disease or related dementia care must meet additional disclosure and programming requirements under 7 AAC 75.

2. Regulatory and Oversight Agencies

The Alaska Department of Health (DOH) oversees both the licensure of the physical home and the certification of the Medicaid provider. Responsibilities are divided between the Division of Health Care Services (DHCS) for licensing and the Division of Senior and Disabilities Services (SDS) for waiver certification.

Medicaid claims and provider enrollment are managed through the Alaska Medical Assistance Health Enterprise Portal, operated by the state's fiscal agent, Gainwell Technologies.

• Licensing Agency: DOH Division of Health Care Services, Residential Licensing (https://health.alaska.gov/en/division-of-health-care-services/residential-licensing/).
• Medicaid Certification: DOH Senior and Disabilities Services (SDS), Provider Certification and Compliance Unit (https://health.alaska.gov/en/senior-and-disabilities-services/provider-certification-and-compliance/).
• Medicaid Enrollment Portal: Alaska Medical Assistance Health Enterprise Portal (https://www.medicaidalaska.com/portals/wps/portal/ProviderEnrollment).
• Background Checks: New Alaska Background Check System (NABCS) (https://health.alaska.gov/en/services/background-checks/).

3. Gatekeeping Prerequisites: Who Can Even Apply

Alaska does not require a Certificate of Need (CON) for Assisted Living Homes. There are no regional moratoria, closed networks, or mandatory managed care network affiliations required to submit an initial application.

The primary structural precondition is that an applicant must secure a physical facility and obtain an active ALH license from DHCS before they can apply for Medicaid HCBS provider certification. Medicaid enrollment cannot proceed concurrently with initial licensure.

• Certificate of Need (CON): None required for assisted living in Alaska.
• RFP/Procurement: None; open enrollment for qualified providers.
• Licensure Prerequisite: An active ALH license from DHCS is strictly required before submitting the HCBS waiver certification application to SDS.
• Facility Control: Applicants must have ownership or a valid lease for the physical property at the time of the licensing application.
• Fire Safety Approval: A fire and life safety inspection approval from the State Fire Marshal or local jurisdiction must be secured prior to licensure.

4. Licensure and Certification Requirements

Prospective providers must submit the New Home Application Packet to DHCS Residential Licensing. The application requires detailed operational plans, including staffing patterns, house rules, and emergency evacuation procedures.

After obtaining the ALH license, the provider applies for HCBS certification through SDS. This requires demonstrating compliance with the CMS HCBS Settings Rule, ensuring residents have privacy, access to food at any time, and freedom to control their schedules.

• Application Packet: New Home Application Packet submitted to DHCS Residential Licensing.
• Regulatory Authority: 7 AAC 75 (Assisted Living Homes) and 7 AAC 130 (Medicaid HCBS Provider Certification).
• Administrator Qualifications: Must be at least 21 years old, possess sufficient experience or education, and pass a background check.
• Financial Solvency: Applicants must provide a projected operating budget and proof of sufficient funds to operate the home.
• HCBS Settings Rule: Facilities must pass an SDS settings validation to ensure non-institutional, community-integrated characteristics.

5. Medicaid Provider Enrollment

Once licensed and certified by SDS, the facility must enroll as a billing provider through the Alaska Medical Assistance Health Enterprise Portal. ALHs typically enroll as Group Providers if incorporated, or Individual Providers if operating as a sole proprietorship with billing privileges.

The enrollment process requires submitting the SDS certification letter, a W-9, and paying the federal Medicaid application fee unless waived via Medicare or another state's Medicaid enrollment.

• Enrollment System: Alaska Medical Assistance Health Enterprise Portal managed by Gainwell Technologies.
• Provider Type: Group Provider Enrollment for incorporated entities (LLC, S-Corp); Individual Provider Enrollment for sole proprietors.
• Required Documentation: Active ALH license, SDS HCBS Certification letter, and Federal Tax Identification Number (FEIN).
• Application Fee: Subject to the standard CMS institutional provider application fee, collected via the portal.
• Trading Partner Agreement: Required to exchange EDI transactions and submit electronic claims.

6. Staffing, Training and Background Checks

All ALH administrators, staff, and household members over age 16 must clear fingerprint-based criminal and civil history checks through the New Alaska Background Check System (NABCS) before having contact with residents.

Staff must complete a minimum of 16 hours of orientation training covering emergency procedures, resident rights, and universal precautions. Medication administration requires specialized training approved by the Board of Nursing.

• Background Checks: Fingerprint-based FBI and state checks via NABCS required initially and every six years, plus name checks every two years.
• Orientation Training: Minimum 16 hours covering fire safety, resident rights, and physical plant layout before independent duties.
• Continuing Education: Minimum of 12 hours of continuing training required per year for direct care staff.
• Medication Administration: Staff assisting with medications must complete a Board of Nursing approved medication assistance course.
• First Aid/CPR: At least one staff member with valid CPR and First Aid certification must be on duty at all times.

7. Documentation, Policies and Records

ALHs must maintain comprehensive resident records, including a residential services contract, a documented plan of care, and medication administration records (MARs).

Facilities must also maintain administrative records, including a disaster preparedness plan, staff personnel files with training logs, and a log of all resident grievances and incident reports.

• Residential Services Contract: Must detail services provided, fee structure, discharge criteria, and house rules.
• Care Plans: Individualized care plans must be developed within 30 days of admission and updated at least annually or upon a significant change in condition.
• Medication Records: Management must arrange for quarterly on-site reviews of medications by an RN or pharmacist for residents self-administering.
• Incident Reporting: Critical incidents must be reported to DHCS and SDS within specified regulatory timeframes.
• Disclosure Form: Facilities serving residents with Alzheimer's must provide a specific disclosure detailing specialized care and fee structures.

8. Billing, Rates and Claims

Medicaid HCBS waiver services are billed using specific HCPCS codes through the Health Enterprise Portal. Reimbursement rates for Residential Supported Living are established by the DOH Office of Rate Review.

Because Medicaid does not pay for room and board, providers must collect these costs directly from the resident, often utilizing the resident's SSI and the Alaska Optional State Supplement (OSS).

• Billing Portal: Claims are submitted electronically via the Alaska Medical Assistance Health Enterprise Portal.
• Rate Setting: Rates are determined by the DOH Office of Rate Review and published in the SDS fee schedules.
• Room and Board: Billed directly to the resident; Medicaid HCBS funds only cover the service component.
• Optional State Supplement (OSS): Residents may receive an OSS payment to help cover room and board costs in an ALH.
• Self-Audits: Medicaid providers in Alaska must conduct a self-audit every two years and report or repay any overpayments.

9. Approval Sequence and Timeline

The approval process is sequential, beginning with local zoning and fire safety approvals, followed by the state ALH license, SDS certification, and finally Medicaid enrollment.

Processing times vary, but applicants should anticipate several months for the initial ALH license due to inspection scheduling and application review, followed by additional time for SDS certification and Gainwell enrollment.

• Step 1: Secure facility, pass local fire/life safety inspection, and clear NABCS background checks.
• Step 2: Submit New Home Application Packet to DHCS Residential Licensing.
• Step 3: Pass unannounced initial licensure survey (conducted within 90 days of initial licensure).
• Step 4: Apply for HCBS Provider Certification through SDS.
• Step 5: Complete Medicaid enrollment via the Health Enterprise Portal.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to incomplete background checks, inadequate financial solvency documentation, or failure to pass the initial fire and life safety inspection.

During post-licensure surveys, common citations include medication administration errors, incomplete resident care plans, and failure to meet the minimum required staff training hours.

• Background Check Failures: Employing staff before receiving NABCS clearance is a primary cause for citations.
• Medication Errors: Untrained staff administering medications or missing quarterly RN/pharmacist reviews.
• Incomplete Care Plans: Failure to update resident care plans following a significant change in health status.
• Settings Rule Violations: Restricting resident access to food or visitors, violating HCBS settings requirements.
• Unlicensed Operation: Operating or owning an unlicensed facility serving 3 or more adults is a felony in Alaska.

11. Key Contacts and Resources

Providers should utilize the DOH websites and the Gainwell portal for the most current forms, fee schedules, and regulatory updates.

The Residential Licensing unit and the SDS Provider Certification and Compliance Unit are the primary contacts for operational and certification inquiries.

• DHCS Residential Licensing: https://health.alaska.gov/en/division-of-health-care-services/residential-licensing/
• SDS Provider Certification: https://health.alaska.gov/en/senior-and-disabilities-services/provider-certification-and-compliance/
• Medicaid Provider Enrollment Portal: https://www.medicaidalaska.com/portals/wps/portal/ProviderEnrollment
• New Alaska Background Check System (NABCS): https://health.alaska.gov/en/services/background-checks/
• Gainwell Provider Enrollment Email: [email protected]

See all Alaska services · Alaska Medicaid consulting · book a consultation.