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Alaska and the ACA’s Medicaid expansion

More than 56,000 are covered under Alaska'a expanded Medicaid eligibility rules that took effect September 2015

Key takeaways

Medicaid eligibility in Alaska was expanded under the Affordable Care Act (ACA), but not until September 2015 (in most of the states that have expanded coverage, expansion took effect in January 2014).

By August 31, 2020, enrollment in Alaska’s expanded Medicaid had grown to 60,810 .The U.S. Census Bureau reported that the uninsured rate in Alaska dropped from 18.5 percent in 2013 to 12.6 percent in 2018. However, the uninsured rate jumped to 17 percent between 2018 and May 2020 due to widespread job losses stemming from the COVID-19 pandemic.

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Federal funds paid 100 percent of the cost of expansion through 2016. The state began paying 5 percent of the cost in 2017, gradually ramping up to 10 percent by 2020. The 90/10 split will remain in place going forward, with the federal government paying the lion’s share of the cost of Medicaid expansion. In the first three years, from the fall of 2015 to the fall of 2018, nearly $1 billion in federal funding flowed into Alaska’s health care industry as a result of Medicaid expansion.

More than 231,000 people were covered under Alaska’s Medicaid and CHIP programs as of June 2020 (including those newly eligible due to Medicaid expansion, as well as those who were eligible under the prior guidelines). For perspective, total Medicaid/CHIP enrollment in Alaska at the end of July 2015 was 123,335. Two years earlier, in mid-late 2013, the total had been just 122,334; enrollment had grown very little prior to Medicaid expansion, but has grown considerably since then.

Governor Walker moved forward with Medicaid expansion

The ACA allowed for Medicaid expansion starting in January 2014. But Alaska was one of the states that initially resisted expansion and continued to use pre-ACA eligibility guidelines for Medicaid, leaving about 10,500 non-elderly adult Alaskans in the coverage gap according to the Kaiser Family Foundation.

But Gov. Bill Walker took office Dec. 1, 2014, and expressed his commitment to expansion in his first speech.

Walker’s administration hoped to launch Medicaid expansion by July 2015. However, technology problems with existing eligibility and payment systems were a barrier, and legislative support and funding presented additional challenges. Walker noted early on that he was willing to bypass the Legislature and authorize Medicaid expansion by executive order, but he tried various legislative avenues for Medicaid expansion during the first half of 2015.

With Alaska’s budget problem, triggered by the drop in oil prices, legislators warned that additional budget requests would be difficult or impossible to grant, and it’s no secret that Republican lawmakers in the state tend to be opposed to all things related to Obamacare. Lawmakers rejected the Medicaid expansion proposal that Walker included in his budget, and they didn’t vote on a bill that would have expanded Medicaid.

Ultimately, Governor Walker decided to expand Medicaid by executive order, and he announced his intent to do so on July 16. On July 21, the state health department hired a consultant to assist with the Medicaid expansion process and recommend how the state should proceed, both with expansion and with reforming the existing Medicaid program.

With Walker’s announcement, Alaska became the 30th state (31st counting DC) to expand Medicaid. Walker’s proposal to accept $150 million in federal funding for Medicaid expansion was sent to the Legislative Budget and Audit Committee for their review, and the committee chair, Rep. Mike Hawker, gave a detailed account of how that process works. But Walker made it clear that he intended to proceed with Medicaid expansion regardless of the committee’s recommendation.

Alaska has accepted federal Medicaid expansion

  • 209,491 – Number of Alaskans covered by Medicaid/CHIP as of July 2018
  • 87,157 – Increase in the number of Alaskans covered by Medicaid/CHIP fall 2013 to July 2018
  • 26% – Reduction in the uninsured rate from 2013 to 2017

Medicaid expansion took effect despite a lawsuit from Republican lawmakers

In August 2015, Republican lawmakers announced they were filing a lawsuit against Walker over his decision to expand Medicaid. Walker noted that the lawsuit would cost the state about a million dollars, and expressed disappointment that the legislature chose that course of action. Lawmakers requested that the scheduled September 1 start date for Medicaid expansion be postponed while the lawsuit made its way through the legal system, but on August 28, a judge denied their request. And on August 31, the Alaska Supreme Court came to the same conclusion, refusing to delay the implementation of Medicaid expansion.

So on September 1, 2015, thousands of Alaska residents became newly-eligible for Medicaid, and were able to start enrolling in the program. In March 2016, the GOP lawmakers’ case was dismissed in Superior Court. But in May 2016, the Alaska House of Representatives filed an appeal. However, the proverbial horse was already miles from the barn, given that Medicaid expansion had taken effect months earlier, and the House dropped their appeal in June 2016.

Walker’s office has said that roughly 42,000 people would be newly-eligible for coverage under the expanded guidelines. By February 2017, more than 30,000 had enrolled, and enrollment had reached more than 44,000 by August 2018 — slightly higher than initially projected, but still within the general range of expectations. By May 2020, there were nearly 57,000 people enrolled in expanded Medicaid in Alaska, with increased enrollment due to the COVID-19 pandemic.

In September 2018, three years after Medicaid expansion took effect in Alaska, Governor Walker expressed his ongoing support for Medicaid expansion, and reiterated how Medicaid expansion has been a financial boon to Alaska.

Representative Mike Hawker, a Republican from Anchorage, introduced HB219 in January 2016, to repeal Medicaid expansion if any of a variety of circumstances were to occur in the next five years. Hawker also introduced HB222, which would let the legislature control whether the governor could accept new Medicaid funds from the federal government. Neither bill passed in the 2016 session.

Who is eligible for Medicaid in Alaska?

Alaska’s eligibility guidelines for Medicaid were fairly generous for children, pregnant women, young adults (age 19 – 20) and parents, even before Medicaid expansion went into effect. However, non-elderly Alaskan adults without children were not eligible for Medicaid prior to September 1, 2015.

Children from birth to age 18 are eligible if their family income is 203 percent or less of the federal poverty level (FPL). Pregnant women with family income of up to 200 percent of FPL are eligible. Because Medicaid has been expanded in Alaska, all adults are now eligible with household income up to 138 percent of the poverty level. See the FPL limits presented as annual income amounts, which vary based on family size (note that Alaska has its own poverty level, which is higher than the poverty level in the continental US and listed in the second table displayed at that link).

Aged, blind or disabled individuals who qualify for Alaska Adult Public Assistance (APA) also qualify for Medicaid.

How does Medicaid provide financial help to Medicare beneficiaries in Alaska?

Many Medicare beneficiaries receive help through Medicaid with the cost of Medicare premiums, prescription drug expenses, and costs that aren’t covered by Medicare — such as long-term care.

Our guide to financial resources for Medicare enrollees in Alaska includes overviews of those programs, including Medicare Savings Programs, long-term care benefits, and income guidelines for assistance.

How do I enroll in Medicaid in Alaska?

The recommended way for most people to enroll in Medicaid in Alaska is online, through But you can also enroll online through (click the link for “ARIES-Public Assistance”). You’ll need to create an account if you don’t already have one.

There is also an option to complete a paper application and submit it by mail or fax to a local office. Note Alaska uses a single application form for several programs; not all sections of the form are required to apply for Medicaid. Also, the form refers to a personal interview, which is NOT required for a Medicaid application.

Call a local office for enrollment assistance over the phone or to schedule an appointment for in-person assistance and enrollment. Both local and toll-free numbers are included on this contact list.

Alaska Medicaid history

Alaska’s Medicaid program is administered by the Department of Health and Human Service’s Division of Public Assistance (DPA).

The federal Medicaid program was established through Title XIX of the Social Security Act in 1965, with Alaska authorizing its program in September 1972.

While many states cover beneficiaries through Medicaid managed care, Alaska does not. The state is currently working to redesign and overhaul the existing Medicaid program to ensure that Alaska Medicaid can continue to provide high-quality health care in a manner that keeps the program sustainable for future generations.

Prior to the first open enrollment period on the health insurance marketplace (September 2013), Alaska’s Medicaid/CHIP enrollment was about 122,000. By the end of July 2015, total enrollment had increased by just one percent, to 123,335.

Alaska did not expand Medicaid until September 2015, but enrollment grew significantly after that. By June 2016, total enrollment was 28 percent higher than it had been at the end of 2013. And by December 2016, it was up 42 percent over where it had been in late 2013.

Despite the fact that Alaska didn’t expand Medicaid until the summer of 2015, the uninsured rate in the state fell from 18.9 percent in 2013 to 10.3 percent in the first half of 2015 – a 46 percent reduction.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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