Alaska
Alaska’s Medicaid agency and its state plan are the official source for these rules. This page summarizes them as researched in October 2026; check the state’s own documents, listed under Sources, before relying on them.
At a glance
- Rate method
- Cost-based
- Case-mix level
- None
- Classification
- None
- Rate updates
- Once a year
- Managed care (LTC)
- No
- Quality program
- None
- Paid outside the rate
- None
- Bed hold
- Leave only
- Published rates
- Rates only
- Assisted living
- Covered
- Personal needs allowance
- $200 / month
Overview
- Each home gets its own prospective per-day rate built from its own Medicare cost report (base year), set by the Department of Health's Office of Rate Review under 7 AAC 150.160(g).
- The rate has four parts: routine non-capital cost, routine capital cost, ancillary capital cost and ancillary non-capital cost, each divided by base-year days and inflated each year by CMS market baskets.
- There are no peer-group ceilings, no medians and no case mix; the only caps are the lower of Medicaid cost or charges, and an 85% occupancy floor on routine capital.
- The 7/1/2026 ORR rate memo lists 20 Alaska homes with long-term care rates from $553.56 to $2,201.70 per day (median about $1,236); 12 of the 20 are units of hospitals.
What matters in Alaska
- Median Alaska Medicaid nursing home rate is about $1,236/day (range $554-$2,202), each home paid its own audited cost.
- No case mix: one per-day rate per home for every Medicaid resident; a 2017-2020 acuity-payment project was dropped in November 2020.
- No provider tax, no quality add-on and no supplemental nursing home payments; the posted rate is essentially all the money.
- 12 of 20 homes are hospital units with combined rates; 4 small facilities take 4-year rate agreements at 3% yearly growth.
- Rates are rebased at least every 4 years and inflated yearly by the CMS nursing home market basket.
- Bed holds: up to 12 days a year paid for home visits; hospital leave is not paid.
Frequently asked
Does Alaska Medicaid adjust nursing home rates for resident acuity or case mix?
No. Each home gets one cost-based per-day rate for all Medicaid residents. The Office of Rate Review studied acuity-based payment for nursing homes but ended that project on November 17, 2020.
Why are Alaska Medicaid nursing home rates so much higher than in other states?
Rates are each home's own audited cost with no ceilings, and most homes are small or hospital-attached. The 7/1/2026 memo shows a median near $1,236/day, from $554 to $2,202.
Does Alaska charge nursing homes a provider tax or bed tax?
No. Alaska has no nursing facility provider tax, so posted rates carry no tax pass-through or add-on, and intergovernmental transfers are not an allowable cost in rate setting (7 AAC 150.170(b)(8)).
How much is paid outside the posted rate in Alaska?
None found for nursing homes; Alaska's supplemental payments (DSH, proportionate share, ambulance) go to hospitals and EMS.
What does Alaska Medicaid pay on Medicare coinsurance days?
Full: regulation says Medicaid pays the Part A coinsurance for days 21-100; Alaska rates usually exceed Medicare's anyway.
Does Alaska require a minimum share of spending on care?
None found.
How the rate is set
How the method got here
| Effective | From | To | Change | Headline | Source |
|---|---|---|---|---|---|
| 2004-01-01 | Earlier facility-specific prospective cost-based rates | Four-component facility cost-based prospective per diem (routine/ancillary x capital/non-capital) from the Medicare cost report, CMS market-basket inflation, rebasing at least every four years, plus optional 4-year small-facility rate agreements | Alaska's current 4.19-D structure dates from 2003-2004 (source dates in MACPAC 2019) and is still the method in 7 AAC 150.160(g) today. | Four-component facility cost-based per diem adopted | https://www.macpac.gov/publication/nursing-facility-payment-p… |
| 2017-07-01 | Rebasing at least every four years | Rebasing freeze for SFY2018 (except first cost-based rates and homes on exceptional relief); no 3% small-facility growth that year | During the state budget crisis Alaska froze nursing home rebasing for SFY2018. | SFY2018 rebasing freeze | https://www.akleg.gov/basis/aac.asp#7.150.190 |
| 2020-11-17 | Facility cost-based per diem with no acuity adjustment | Unchanged: the Skilled Nursing Facility Payment project (acuity-based payment) was ended | The Office of Rate Review ended its project to pay nursing homes based on each patient's care needs, keeping the cost-based per diem. | Acuity-based nursing home payment project ended | https://health.alaska.gov/en/office-of-the-commissioner/offic… |
Verified October 11, 2026
Cost basis
- Uses cost reports
Yes
- Cost report
Medicare cost report (CMS-2540 for freestanding homes; CMS-2552 for hospital-based/combined facilities), adjusted by the department, plus the state year-end report forms from the Medicaid Hospital and Long-Term Care Facility Reporting Manual and the MR-0-14 utilization/payment report (7 AAC 150.130, 150.160, 150.170).
- Base year and rebasing
Base year = an adjusted Medicare cost report chosen by the department. Rebasing at least every four years, possibly sooner, for the first fiscal year after notice to facilities; the first cost-based rate does not count as a rebase (7 AAC 150.160(a)(3)-(4)). Small facilities on rate agreements (7 AAC 150.190) are rebased when an agreement is renewed. The date of the last statewide nursing home rebase was not found.
- Components
Component Method Notes routine non-capital Long-term care non-capital routine costs from the base-year adjusted Medicare cost report / total long-term care patient days, inflated to the rate year. Nursing staff cost is routine only, never ancillary (7 AAC 150.170(b)(2)). No ceiling or peer-group limit. routine capital Long-term care routine capital costs / the greater of actual long-term care patient days or 85% of licensed capacity days. Capital in service under a certificate of need of $5,000,000 or more can be added to the rate mid-cycle (7 AAC 150.160(h)). ancillary capital Capital share of each ancillary cost center x Medicaid long-term care ancillary costs, summed, / Medicaid long-term care days from the base year. ancillary non-capital Medicaid long-term care non-capital ancillary costs / Medicaid long-term care days from the base year, inflated to the rate year. Medicaid days are covered days from the MR-0-14 report. - Inflation
Applied each facility fiscal year from the most recent Global Insight (IHS Markit) Healthcare Cost Review available 60 days before the year starts: CMS Nursing Home without Capital Market Basket for non-capital costs; SNF Total Market Basket capital cost component for capital and home-office capital (7 AAC 150.150(a)(3)-(4)). The inflation update is delayed 90 or 180 days, or lost for the year, if the year-end report is filed late (7 AAC 150.150(c)-(f)). Total rate is limited to the lower of Medicaid cost or 100% of charges to the general public (7 AAC 150.160(g)(7), (m)).
Verified October 11, 2026
Case mix
- System
None
- Applied at
None
- How it works
Each home has one per-day long-term care rate for every Medicaid resident; 7 AAC 150.160(g) contains no acuity term, and the ORR rate memo lists one rate per home.
- Classification
none
- Applies to
none
- Acuity measured from
none
- Updated
none
- Move to PDPM
Not applicable. The Office of Rate Review ran a Skilled Nursing Facility Payment project to base payments on each patient's care needs; ORR says the project 'ended on November 17, 2020' after stakeholder work, and no case mix was adopted.
Verified October 11, 2026
Low-acuity residents
None. There is no case-mix system, so there are no reduced rates for low-acuity groups. Residents are authorized at ICF or SNF level of care (7 AAC 140.505-.515), but both are paid the facility's single all-inclusive long-term care rate (7 AAC 145.640-.650). Checked: 7 AAC 140, 145, 150.
Verified October 11, 2026
Capital
Actual cost, facility-specific: routine capital / greater of actual days or 85% of licensed capacity days, plus an ancillary capital piece; inflated by the SNF market basket capital component. Capital costs are allowed only up to the amounts approved in a certificate of need (7 AAC 150.170(b)(6)), and CON projects of $5,000,000 or more can be added when placed in service (7 AAC 150.160(h)). No fair rental value system.
Verified October 11, 2026
Budget adjustment factor
No standing across-the-board factor. Budget limits have been applied as one-year freezes written into the rules, e.g. no rebasing for SFY2018 (MACPAC 2019 quoting the 4.19-D) and no 3% small-facility growth for SFY2018 (still in 7 AAC 150.190(g)(1)). 7 AAC 150.150(g)-(h) were repealed 1/1/2024; the department described removing 'actions taken in previous years' from inflation language in the matching 2023 state plan rewrite. Small-facility rate agreements require the department to find appropriations are expected to be adequate (7 AAC 150.190(d)(2)(B)).
Verified October 11, 2026
Add-ons and money outside the rate
Paid outside the posted rate
- Level
none
- Estimate
No supplemental, UPL, IGT or directed payments to nursing facilities were found. Exceptional relief, when granted, is a rate increase, not a separate payment. Hospital-attached homes' parent hospitals may receive DSH/proportionate share money, but that is hospital payment, not nursing home payment.
- Components
None for nursing facilities.
Verified October 11, 2026
Payments by owner type
- Applies
no
- Detail
Tribal, hospital-owned, municipal and private homes are all paid under the same 7 AAC 150.160(g) cost-based method. About 5 of the 20 homes on the 7/1/2026 memo are run by tribal health organizations; they appear with ORR-set rates like any other home. Proportionate share and DSH payments (7 AAC 150.100-.180) are for hospitals only. Services by IHS/tribal facilities to American Indian/Alaska Native members earn 100% federal match, but that changes the state's cost, not the home's rate.
- Funding
Not applicable.
Verified October 11, 2026
Quality program
- Active
No
- Notes
No nursing facility quality incentive program found in 7 AAC 150, 7 AAC 145, AS 47.07 or the ORR pages.
Verified October 11, 2026
Provider tax
- Charged
none
- Standard amount
None.
- Lower for high-Medicaid homes
no
- Returned in the rate
Not applicable.
Verified October 11, 2026
Provider tax notes
None. Alaska has no nursing facility quality assessment or bed tax; none appears in AS 47.07 or 7 AAC 150. Intergovernmental transfers are not an allowable cost for rate setting (7 AAC 150.170(b)(8)).
Verified October 11, 2026
Supplemental payments
None for nursing facilities found. Alaska's supplemental programs are hospital proportionate share payments (7 AAC 150.100-.120), disproportionate share hospital payments (7 AAC 150.180), and SEMT for public ambulance services (7 AAC 145.750-.790). Exceptional relief (7 AAC 150.240) is a rate increase for a home that shows the cost-based rate does not allow reasonable access; it is granted case by case, for the rest of the rate year only, and not carried into future rates.
Verified October 11, 2026
Other add-ons
(1) Certificate-of-need capital add-on for assets of $5,000,000 or more placed in service after the base year (7 AAC 150.160(h)). (2) Exceptional relief rate increases (7 AAC 150.240), one rate year at a time. (3) Continuous heavy oxygen paid at the facility's cost outside the rate, with prior authorization (7 AAC 140.580(b)). No COVID-era add-on found in the current rules.
Verified October 11, 2026
Units paid separately
(1) Combined hospital-nursing facilities (hospital long-term care units) get a long-term care per diem under the same 7 AAC 150.160(g) method alongside their hospital rates; 12 of 20 homes on the 7/1/2026 memo are hospital units. (2) Small facilities (15,000 or fewer Medicaid NF days if freestanding; 4,000 or fewer acute days if combined) may sign 4-year rate agreements: first-year cost-based rate, then non-capital +3%/yr and capital +1.1%/yr, with no market-basket update and limited appeal rights (7 AAC 150.190); 4 homes are flagged 'Small Facility Agreement'. (3) New facilities: the statewide swing-bed rate less its average capital, plus the new home's capital at the greater of CON occupancy or 80% of beds, until two full years of cost data exist (7 AAC 150.160(i)(3)). (4) Swing beds: a statewide rate based on the prior year's average long-term care rate, $961.15/day for CY2026 (7 AAC 150.160(k); ORR memo). (5) Out-of-state nursing facilities are paid the host state's Medicaid rate (7 AAC 145.640(d)). No ventilator, behavioral or bariatric rate found.
Verified October 11, 2026
Payment rules
Managed care for long-term care
- Status
no
- Detail
Nursing facility care is paid fee-for-service by the department at the facility's all-inclusive rate (7 AAC 145.640(a)). No managed care plan pays nursing home days. AS 47.07.039 allows coordinated care demonstration projects, but none covering nursing home payment was found.
Verified October 11, 2026
Who pays
fee_for_service: the Department of Health pays nursing facilities directly at the per-day rate set under 7 AAC 150 (7 AAC 145.640). Alaska has no comprehensive Medicaid managed care; AS 47.07.039 authorizes only coordinated care demonstration projects.
Verified October 11, 2026
Managed care rate floor
Not applicable: no Medicaid managed care for nursing facility care.
Verified October 11, 2026
Included in the daily rate
All-inclusive rate (7 AAC 145.650) covers rehabilitative/restorative nursing, non-prescription drugs, physician-prescribed PT and OT, therapist consultation, periodic oxygen, facility-vehicle transport, and an annual physical. Paid separately: legend drugs and biologicals (pharmacy), continuous heavy oxygen (at facility cost, prior authorized), x-ray and lab by outside providers, outside practitioners, and essential medical transport (paid to the carrier). Physician costs are excluded from rates (7 AAC 150.170(b)(3)).
Verified October 11, 2026
Bed hold
- Hospital stays
Not paid: 'If a recipient leaves a nursing facility for hospitalization, the department will not pay to reserve the recipient's bed' (7 AAC 140.585(d)).
- Leave days
Paid (full per diem implied; no percentage stated) for planned absences of up to 12 consecutive days and 12 days in a 12-month period, for visits with family/friends and therapeutic or rehabilitative leave; longer absences need written prior authorization (7 AAC 140.585(a)-(b)).
- Occupancy rule
None.
- Notes
Purpose of therapeutic leave must be documented in the plan of care. The payment percentage is not stated in the rule.
Verified October 11, 2026
Personal needs allowance
- Per month
200
- Effective
$200 for 2023 through 2026 per the Division of Public Assistance Medicaid Income Eligibility Standards (Long Term Care Standards table, revised 04/26). The 7 AAC 100.558(b) text on akleg.gov still prints $75; the DPA standards sheet is the amount applied.
- Notes
$90 for a veteran with no spouse or dependent child who gets the $90 VA pension (7 AAC 100.558(c)). SSI recipients get a state top-up to $75 (7 AAC 40.390). Increased for taxes, child-support garnishment, PASS plans, home property taxes and guardian fees up to $100/month (7 AAC 100.558(f)). Waiver recipients in assisted living keep $1,396/month; at home $1,656. Not COLA-indexed in the rule.
Verified October 12, 2026
Medicare coinsurance days
- Method
full
- Rule
7 AAC 140.590(a): 'The department will pay, on behalf of a recipient, the coinsurance established under part A of Medicare for care rendered from the 21st through the 100th day of care in a nursing facility', and the facility's Medicaid rate after day 100. No lesser-of limit was found in 7 AAC 105-160. Treatment of Medicare Advantage cost-sharing was not found.
- Effect
The home receives the full Part A coinsurance on days 21-100. Alaska Medicaid rates (median about $1,236/day) usually exceed Medicare's SNF payment, so even a lesser-of test would rarely cut the payment.
Verified October 11, 2026
Required care spending
- Applies
no
- Rule
No direct-care spending floor or recoupment rule found. Because rates are built from each home's own costs, spending is reflected in the next rebase rather than enforced.
Verified October 11, 2026
Occupancy rules
- Applies
yes
- Rule
Routine capital cost per day uses the greater of actual long-term care patient days or 85% of licensed capacity days (beds x 365) (7 AAC 150.160(g)(2)). New facilities: capital spread over the greater of CON-approved occupancy or 80% of licensed beds (7 AAC 150.160(i)(3)(B)). CON bed additions add days at base-year occupancy x 80% x added beds x 365 (7 AAC 150.160(h)(3)). Non-capital costs use actual days.
Verified October 11, 2026
MDS accuracy penalties
None; there is no case mix. The only rate penalty found is for late year-end cost reports: the annual inflation update starts 90 or 180 days late, or is lost for the year if the report is more than 90 days late (7 AAC 150.150(c)-(f)).
Verified October 11, 2026
Published rates and changes
How often rates change
- A home's rate changes
annual
- When
Each home's rate is set for its own fiscal year (7 AAC 150.160(a)(2)); in the 7/1/2026 memo rate periods start January 1, July 1 or October 1. Each year the base is re-inflated by the market baskets; full rebasing at least every four years. Rates can also change mid-year for CON capital, exceptional relief or temporary-to-final rate settlement.
Verified October 11, 2026
When rates change
Facility fiscal year (calendar year, July-June or October-September in the current memo). Temporary rates may be set and later trued up to the final rate (7 AAC 150.030(c)).
Verified October 11, 2026
Posted rates
- Home-level rates published
Yes
- Format
pdf (ORR 'Current Medicaid Payment Rates' memo: combined facilities, DRG hospitals' long-term care units, freestanding nursing facilities, swing beds)
- Cadence
Updated as rates change; the current memo is dated 07/01/2026.
- History
Only the current memo is posted on the ORR page; earlier memos were not found on the site.
- Home identifier
Facility name and city only (no CCN, NPI or Medicaid ID).
Verified October 11, 2026
Rate build-ups
- Published
No
- Where
Not posted. Rates are set in a written determination sent to each facility (7 AAC 150.210). The swing-bed memo shows a non-capital/capital split for the statewide swing-bed rate only.
- What they show
Rate memo: total long-term care per diem and rate period per home, with flags for critical access hospital, sole community hospital, small facility agreement and change of ownership.
- Format
pdf
Verified October 11, 2026
Recent changes
| Effective | Change | Headline | Direction | Size | Source |
|---|---|---|---|---|---|
| 2024-01-01 | 7 AAC 150 was amended with the hospital DRG rules; 7 AAC 150.150(g)-(h) (past-year adjustment provisions) were repealed. The nursing home per diem method was unchanged. | Rate-setting rules updated; nursing home method unchanged | structural | https://www.akleg.gov/basis/aac.asp#7.150.150 | |
| 2026-01-01 | Swing-bed rate (prior-year statewide average long-term care rate) rose 4.4%, to $961.15/day; non-capital +5.7%, capital -6.8%. | Swing-bed rate raised 4.4 percent to $961.15 | increase | $920.31 -> $961.15/day (+4.4%) | https://health.alaska.gov/media/lrxdlnk5/2026_medicaid-rate_s… |
| 2026-07-01 | A Guidehouse LTSS rate study (11/26/2025) proposed SFY2027 benchmark rates, including assisted living (residential supported-living) at $235.76/day vs $222.96-$223.38. Nursing homes were not in scope; adoption of the proposals was not confirmed. | Assisted living waiver rate increase proposed | structural | $223.38 -> $235.76/day proposed (+5.5%) | https://health.alaska.gov/media/xi1ldsoi/ak-doh-ltss-rate-eva… |
Verified October 11, 2026
Assisted living
Medicaid assisted living
- Covered
yes
- Program
Residential supported-living (RSL) services in licensed assisted living homes, under the 1915(c) Alaskans Living Independently (ALI) waiver for older adults and adults with physical disabilities, and the Adults with Physical and Developmental Disabilities (APDD) waiver (7 AAC 130.255). State-run Pioneer Homes bill a separate 'state government owned/operated' RSL rate.
- What is paid
Services only. Medicaid does not pay room and board or facility upkeep (7 AAC 130.255(c)); residents keep a $1,396/month allowance for those costs (7 AAC 100.558(e)).
- Rate
SFY2026 daily RSL rates: $223.38 (17+ beds and state-owned), $222.96 (6-16 and 5-or-fewer beds); acuity add-on $493.66/day. SFY2027 proposed benchmark $235.76 for all sizes and $506.85 acuity add-on (Guidehouse LTSS rate study, 11/26/2025); adoption not confirmed.
- Limits
Nursing facility level of care required; prior authorization and an approved support plan. No enrollment cap or waitlist found.
Verified October 11, 2026
Sources
- 7 AAC 150 Rate Setting for Health Facilities (Alaska Administrative Code, current) · regulation
- 7 AAC 140.500-.595 Nursing facility services (bed hold 140.585; Medicare coinsurance 140.590) · regulation
- 7 AAC 145.640-.670 Nursing facility payment rates and all-inclusive rate · regulation
- 7 AAC 100.558 Personal needs allowance; 7 AAC 40.390 · regulation
- 7 AAC 130.255 Residential supported-living services · regulation
- AS 47.07 Medical Assistance (47.07.039 coordinated care demonstrations; 47.07.070 facility rates) · statute
- Office of Rate Review page (SNF Payment project ended 11/17/2020; rate memos; Medicaid Rate Study) · agency page
- ORR Current Medicaid Payment Rates memo, effective 7/1/2026 · rate file
- ORR Medicaid Swing Bed Rate for Calendar Year 2026 (11/25/2025) · rate file
- Guidehouse, Alaska Rate Evaluations: Long Term Services and Supports (11/26/2025) · agency page
- Tribal consultation letter: DRG reimbursement SPA, 4.19-A update (7/20/2023) · agency page
- MACPAC Nursing Facility Payment Policies compendium (2019 baseline, Alaska tab) · secondary
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