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Alaska - Case Management Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

Alaska’s Division of Senior & Disabilities Services (SDS) certifies providers of Targeted Case Management (TCM) and Care Coordination under 7 AAC 130.220(b)(2) to authorize and monitor Long-Term Services and Supports (LTSS). The state does not issue a traditional facility license for this service; instead, individuals and agencies must obtain SDS certification before they can bill Medicaid.

Applicants must secure this SDS certification by completing a state-approved training course and passing a comprehension examination before they can submit a Medicaid enrollment application through the Alaska Medicaid Provider Enrollment Portal. The state requires an annual application fee, set at $750 for calendar year 2026, to finalize the provider agreement.

1. Service Definition and Scope

Targeted Case Management in Alaska involves evaluating participant needs, developing support plans, and coordinating medical, behavioral, and habilitative services. Care coordinators assist eligible individuals in accessing necessary resources across their full service package.

Providers do not exercise the state's authority to authorize or deny other Medicaid services, ensuring freedom of choice. Individuals cannot be compelled to receive case management as a condition of receiving other Medicaid services.

2. Regulatory and Oversight Agencies

The Department of Health (DOH) oversees Medicaid enrollment and service delivery across the state. Within the DOH, specific divisions handle different aspects of provider approval and claims.

The Division of Senior & Disabilities Services (SDS) handles the actual certification of care coordinators, while the Division of Health Care Services (DHCS) manages the broader Medicaid program, utilization management, and provider enrollment.

3. Gatekeeping Prerequisites: Who Can Even Apply

Alaska operates an open enrollment model for Care Coordination and TCM, meaning there are no closed networks, Requests for Proposals (RFPs), or moratoria blocking new applicants. Any individual or agency meeting the qualifications may apply.

However, individuals must meet strict educational and training prerequisites before an application for certification is accepted. The state requires completion of a specific training course and examination prior to submission.

4. Licensure and Certification Requirements

Alaska does not issue a traditional facility license for case management. Instead, the SDS Provider Certification & Compliance Unit certifies individuals and agencies as Care Coordinators.

Certification is governed by state regulations that dictate the required knowledge base, skill set, and business documentation needed to operate legally in the state.

5. Medicaid Provider Enrollment

After obtaining SDS certification, providers must enroll via the Alaska Medicaid Provider Enrollment Portal. The state utilizes Conduent as its fiscal agent for the enrollment system.

The state requires a non-refundable application fee prior to executing a provider agreement, though hardship waivers are available under specific circumstances.

6. Staffing, Training and Background Checks

Care coordinators must maintain ongoing education and pass strict background checks to ensure the safety of vulnerable populations. The state mandates specific knowledge bases, including Medicaid policies and human services terminology.

Agencies must verify the employment and education history of all potential employees to ensure they possess the skills required for the position.

7. Documentation, Policies and Records

Providers must maintain comprehensive case records in English, documenting all contacts and assessments. These records must be legible and understandable to a reviewer.

Agencies must also maintain specific administrative records and report organizational changes to the state within strict timeframes.

8. Billing, Rates and Claims

Targeted Case Management for LTSS is reimbursed on a fee-for-service basis. Rates are calculated based on specific cost components rather than a flat statewide fee schedule.

Providers submit claims through the Conduent State Healthcare provider portal. Payment cannot duplicate funds received from other public or private entities for the same purpose.

9. Approval Sequence and Timeline

The approval process is sequential, starting with mandatory training and ending with Medicaid enrollment. Providers cannot bill for services provided before the effective date of their Medicaid provider agreement.

Applications remain pending until all required documentation, including proof of certification and the exact application fee, are received and verified by the state.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to incomplete documentation or failure to meet exact fee requirements. The state strictly enforces the application fee amount.

During compliance reviews, inadequate case documentation and failure to maintain current background checks are primary findings that can lead to certification revocation.

11. Key Contacts and Resources

Providers should utilize the official state portals and contact the designated units for assistance with certification and enrollment. The Conduent portal is the primary hub for eligibility and claims.

For policy updates and announcements, providers are encouraged to subscribe to the HCS-Connect electronic mailing list.

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