H.R. 1 Medicaid Frequently Asked Questions

A new federal law changes which citizenship and immigration statuses can qualify for full Medicaid beginning October 1, 2026. Alaska must review people who may be affected and apply the new federal rules.

What you should do:

• Make sure your address, phone number and email address are up to date so we can contact you
• Open and respond to any renewal form or request for information by the date shown

What you need to know:

• DPA will check records we already have first and we will only ask for documents if we have to
• A change for one person does not automatically end Medicaid for everyone in the household

Changes to the federal program which citizenship and immigration statuses can qualify for full Medicaid beginning October 1, 2026. Alaska must review people who may be affected and apply the new federal rules.

Some immigration statuses that currently qualify for full Medicaid may no longer qualify under the new federal law. U.S. citizens and U.S. nationals are not affected by this change. Some noncitizens will remain eligible, including people in certain federally recognized categories. Because the rules are detailed and each person’s situation is different, DPA must review each case before making a decision.

People enrolled in Medicaid whose immigration status may no longer qualify for full Medicaid under the new federal rules may be affected. Receiving a letter or renewal form does not mean a final decision has been made.

The letter gives advance notice that the federal rules are changing and that DPA may need to review Medicaid eligibility for you or someone in your household.

No. The Director’s letter is for information only. Please watch your mail. If DPA sends you a renewal form or a request for information, read it and reply by the date shown.

No. First, DPA will check the information the State already has. Some people will not need to do anything. Others will get a renewal form or be asked to send more information.

Read it carefully and reply by the date shown. Send the information requested. Call DPA if you need help, need a language interpreter, did not receive the form, or cannot get a requested document.

DPA will first check the information the State already has. DPA should not ask you for the same information again unless something is missing, unclear, outdated, or conflicts with another record.

SAVE is a federal system that checks citizenship or immigration information for benefit programs. If SAVE cannot confirm your information right away, it does not mean you are not eligible for benefits. DPA may just need more information or more time to finish reviewing your case.

DPA will complete a full Medicaid review. This may include citizenship or immigration status, income, household information, age, pregnancy, and other Medicaid rules. DPA must also consider any other Medicaid coverage that may apply before changing coverage.

Call DPA as soon as you can. Do not assume your benefits will stop. DPA will check whether the information can be verified through records already available or whether another document may be accepted. If you are having difficulty getting the requested information, tell DPA so staff can explain your options and determine whether additional time may apply.

It is extra time to verify citizenship or an eligible immigration status when a person says they have an eligible status but DPA cannot verify it right away. When federal rules require it, Medicaid continues during this period.

No. It means DPA needs to review eligibility. DPA must complete the review, consider available information, and send a written notice explaining the outcome. Medicaid will not change unless DPA completes the review and sends the required notice.

Yes. Medicaid eligibility is reviewed for each person. A change for one person does not automatically end Medicaid for everyone in the household.

Yes. DPA will send a written notice explaining the outcome of the review. If your Medicaid continues, the notice will explain your eligibility. If DPA changes or ends coverage, the notice will also explain the reason, effective date, appeal rights, and how to get help.

Yes. The formal eligibility notice will explain how and when to request a fair hearing and whether coverage may continue while the appeal is pending.

Emergency Medicaid is limited coverage for treatment of an emergency medical condition for a person who meets other Medicaid rules but does not qualify for full Medicaid because of citizenship or immigration status. It does not cover all ongoing or routine health care.

Call the Alaska Division of Public Assistance at 1-800-478-7778. Free interpreters are available. For Alaska Relay, call 7-1-1.

This change does not apply to Alaska Native and American Indian individuals in the Medicaid expansion group or people who qualify for “traditional” Medicaid based on circumstances such as age, disability, or pregnancy.

Your review schedule depends on the Medicaid eligibility group you are enrolled in. 

6-month Medicaid renewals and Medicaid work and community engagement rules are separate requirements. 

Being excluded from the Medicaid Work and Community Engagement Rules does not automatically mean you are excluded from 6-month Medicaid renewals.

Not necessarily. The Division of Public Assistance (DPA) will first use information available – such as Medicaid claims, income verification, and other records – to determine whether your Medicaid can be renewed without asking you for additional information.

If DPA needs information from you to complete the renewal, you will receive a renewal form or notice explaining what information is needed and when it is due.

No. A 6-month renewal means the Division of Public Assistance will review your eligibility every 6 months if the rule applies to you.

If you remain eligible at your renewal, your Medicaid coverage can continue into the next eligibility period.

Yes. The Division of Public Assistance will send you a renewal notice or request for information when action is needed.

Keep your contact information current and respond by the date shown on the notice.

You will receive a notice telling you the result of your renewal and you will not need to provide additional information. 

Not necessarily. Alaska is transitioning people to 6-month renewals using their existing renewal schedule when possible.

If your renewal schedule changes, the Division of Public Assistance will notify you.

An exclusion means the Work and Community Engagement Rules (WCER) do not apply to you because you meet a specific federal category. DPA must determine whether an exclusion applies before deciding whether you must meet WCER or whether another exception or temporary hardship applies. DPA will first review information it already has to determine whether an exclusion applies. If the available information is not enough (i.e., it’s unavailable, inconsistent, or insufficient), DPA may ask you for additional information to establish the exclusion.

Examples of people who may qualify for an exclusion include:

• Alaska Native and American Indian individuals;
• Certain former foster care individuals under age 26;
• Certain parents, guardians, caretaker relatives, or family caregivers;
• Certain veterans with a total disability rating;
• People who are medically frail or have other special medical needs;
• Certain people subject to SNAP work rules;
• Certain people complying with Temporary Assistance for Needy Families (TANF) work rules;
• People participating in a qualifying drug or alcohol treatment and rehabilitation program;
• Individuals who are inmates of a public institution; and
• Pregnant individuals or individuals entitled to postpartum medical assistance. 

The specific rules are different for each exclusion. Some exclusions may need to be checked again later, while others may not.

If an exclusion applies to you, the Division of Public Assistance will not require you to show that you meet WCER for the period the exclusion applies. 

No. Alaska Native and American Indian individuals who meet the applicable federal definition are excluded from WCER.  The Division of Public Assistance (DPA) will first use information it already has, including previously established Alaska Native or American Indian status. If the status cannot be established from available information, self-attestation may be accepted. 

Once Alaska Native or American Indian status has been established, DPA will retain that determination for future Medicaid eligibility reviews. The individual will not be required to reestablish or reverify that status.

No. An individual who is pregnant or entitled to postpartum medical assistance during the applicable period is excluded from WCER.  The Division of Public Assistance (DPA) will use information already available and will accept self-attestation of pregnancy or postpartum status. Additional documentation is not required to establish this exclusion.

Yes. The caregiver exclusion may apply to a parent, guardian, caretaker relative, or family caregiver of a dependent child age 13 or younger or a disabled individual. The specific rules depend on the caregiving situation. 

The Division of Public Assistance (DPA) will first use information already available, such as household composition, relationship, residence, and the age of a dependent child. When the caregiving relationship or other required information cannot be established through available records, self-attestation may be used as allowed by policy.

Some caregiving may still count as unpaid work toward Work and Community Engagement Rules (WCER) even when it does not qualify the person for the caregiver exclusion. Qualifying caregiving hours may be combined with other qualifying activities when allowed by Alaska policy.

Caring for a child age 13 or younger or for a disabled person may mean WCER does not apply to you.

A person who is medically frail or otherwise has special medical needs may qualify for an exclusion when the applicable criteria are met. The condition must meet the applicable medical-frailty category and significantly impair the person’s ability to reliably and consistently meet Work and Community Engagement Rules (WCER). 

A condition does not have to be visible to be considered.

A serious health condition may mean WCER does not apply to you, even if the condition is not obvious to others.

You do not have to be receiving Social Security disability benefits to be considered for this exclusion.

Not receiving Social Security disability benefits does not, by itself, prevent someone from qualifying for the medically frail or special-medical-needs exclusion. The Division of Public Assistance (DPA) will use the applicable medical and functional criteria to review the person’s circumstances. 

The Division of Public Assistance (DPA) will first use reliable information already available, including Medicaid claims, diagnoses, services, treatments, functional information, and other administrative information. If more information is needed, DPA will request only the information necessary to complete the determination.

How often the exclusion must be reviewed will depend on how long the exclusion applies.

You should not have to provide the same medical information again unless it is needed to review the exclusion.

Current participation in a qualifying drug or alcohol treatment and rehabilitation program qualifies you for an exclusion from Work and Community Engagement Rules (WCER).  The Division of Public Assistance (DPA) will first use information already available and may ask for additional information only when needed. 

You may qualify for an exclusion from WCER if you are a member of a household receiving Supplemental Nutrition Assistance Program (SNAP) benefits and are subject to an applicable SNAP work rule.

Certain veterans are. A veteran with a permanent or temporary 100% disability rating from the Department of Veterans Affairs, or who receives total disability compensation based on individual unemployability, qualifies for the exclusion. 

A permanent total disability rating does not have to be reverified once established. A temporary total disability rating is reverified at Medicaid renewal. 

Certain former foster care individuals under age 26 qualify for an exclusion. The policy applies to individuals who were in foster care and enrolled in Medicaid on their 18th birthday and who are under age 26. 

Once former foster care status is established, the Division of Public Assistance (DPA) will retain that information. The person does not have to reestablish the underlying foster care status, and the exclusion continues until the applicable age limit is reached unless reliable information shows the prior determination was inaccurate.

If DPA has already established your former foster care status, you should not have to prove it again.

An individual who is an inmate of a public institution and meets the applicable federal criteria qualifies for an exclusion from WCER.  The Division of Public Assistance (DPA) will first use available information from approved data sources, including information from the Department of Corrections and the Division of Juvenile Justice when applicable. 

The exclusion generally applies while you meet the applicable incarceration criteria.

You also may not need to meet the work and community engagement rules if, for at least one month since your last Medicaid renewal or one month prior to your application, you: 

• Were under age 19;
• Became eligible for or enrolled in Medicare;
• Were eligible under certain other Medicaid eligibility groups; 
• Met at least one of the exclusions described above; or 
• Were recently released from incarceration. 

A temporary hardship is a circumstance that may allow you to meet Work and Community Engagement Rules (WCER) without completing the usual work or community engagement activities.

Examples of temporary hardships may include:

• Receiving inpatient or institutional care; 
• Receiving certain intensive services that are similar to inpatient or institutional care; 
• Traveling outside your community for necessary medical care for you or a dependent; 
• Living in an area affected by a qualifying emergency or disaster; or 
• Living in an area that meets the federal high-unemployment standard. 

Some hardships must be requested, while others may be applied automatically based on where you live and the circumstances affecting your area.

What if I am in the hospital or receiving intensive medical care?
Certain inpatient, institutional, or similar-acuity services may qualify as a temporary hardship. This can include inpatient hospital care, nursing-facility care, certain psychiatric or behavioral-health services, and some intensive services provided outside a hospital when those services are being used instead of inpatient or institutional care. 

You may still qualify even if the care is not provided in a hospital.

Medical travel may qualify as a temporary hardship when you or your dependent must travel outside your community for necessary care that is not reasonably available where you live. Qualifying care may include medical, dental, behavioral-health, diagnostic, treatment, monitoring, or follow-up services.

Travel by air, ferry, marine transportation, or extended ground travel may qualify. An overnight stay is not always required.

A temporary hardship may apply if you live in an area affected by a qualifying federal emergency or major disaster. It may also apply if you were displaced from the affected area because of the event.

You generally will not have to prove how the emergency or disaster affected you individually if the Division of Public Assistance (DPA) can confirm that you live in, or were displaced from, the affected area.

A temporary hardship may apply if your area meets the federal high-unemployment standard and the hardship has been approved for that area. 

An area meets the federal standard when its unemployment rate is 8 percent or higher, or at least 1.5 times the national unemployment rate, whichever is lower. 

If your area qualifies, the Division of Public Assistance (DPA) will apply the hardship automatically. You will not have to show that unemployment personally prevented you from meeting WCER. 

The Division of Public Assistance (DPA) will use information it already has to determine whether the rules apply to you and whether you already meet them or do not have to meet them. If DPA needs more information, it will send you a notice explaining what is needed and when it is due.

You will not have to figure this out on your own. DPA will review your information and let you know if you need to take any action via mail and the second notification method that you’ve chosen (such as email or text). It is important to keep your contact information updated. 

If WCER applies to you, you may be able to meet the rules through qualifying work or other activities, education, or income. Different qualifying activities may also be combined.

There is more than one way to meet WCER.

The federal standard generally requires at least 80 hours of qualifying activities in a month. You may also meet WCER if you are enrolled in school at least half-time or if your qualifying household income meets the federal income standard.

The income standard is equal to 80 hours multiplied by the federal minimum hourly wage. At the current federal minimum wage of $7.25 per hour, the income standard is $580 per month.

Qualifying activities may include:

• Paid work;
• Certain work or job-training programs;
• Volunteer or community service;
• Education; and
• Other qualifying activities allowed under federal and Alaska policy.

Yes. Qualifying activities can be combined to reach the 80-hour standard.

Yes. Education can count toward Work and Community Engagement Rules (WCER). If you are enrolled at least half-time, as defined by your school, you may meet the education pathway. If you attend less than half-time, qualifying education hours may count toward the 80-hour standard.

School may count even if you are not enrolled full-time.

Work does not have to be a traditional salaried job to count. Self-employment and other types of work may qualify when the work or income meets the Medicaid Work and Community Engagement rules and can be verified.

The type of job matters less than whether the work meets the rules.

Yes. You may meet WCER based on qualifying household income.

The federal income standard is based on 80 hours multiplied by the applicable federal minimum hourly wage. At the current federal minimum wage of $7.25 per hour, that amount is $580 per month.

Meeting Work and Community Engagement Rules (WCER) and meeting Medicaid income eligibility rules are separate matters. Whether your earnings affect Medicaid eligibility depends on your household and the Medicaid income rules that apply to you.

Meeting WCER does not automatically mean you are over the Medicaid income limit.

Yes. Seasonal or fluctuating work may count toward WCER. Qualifying income from seasonal work may be averaged over the applicable period when determining whether the income standard is met.

The Division of Public Assistance (DPA) was required to send the advance notice to adults in the Medicaid expansion group because that is the group that may be affected by the new rule. Not everyone in that group will be subject to Work and Community Engagement Rules (WCER).

Receiving the notice does not mean you are losing Medicaid or that DPA has determined the rules apply to you.

You do not need to respond to the advance notice. Keep your contact information current and watch for future Medicaid notices. If the Division of Public Assistance (DPA) needs information from you later, the notice will explain what is needed and when it is due.

If the Division of Public Assistance (DPA) cannot verify that you meet Work and Community Engagement Rules (WCER) using available information, you may be asked for information about your work, hours, income, education, training, volunteer or community-service activities, or other qualifying activities.

You do not need to keep the same type of records for every activity. If DPA needs additional information, the notice will explain what is needed.

The information needed will depend on what DPA is trying to verify. Examples may include employer or wage information, school or training records, or information from a volunteer or community-service organization.

DPA will not ask you to provide information that is already available to the Department.

It depends on the activity and the information DPA already has. Some information may be verified electronically. When additional information is needed, it may come from you or from another source, such as an employer, school, training program, or volunteer or community-service organization.

For some information, self-attestation may also be allowed.

DPA will first use reliable information already available, including through Medicaid claims, income verification, and other records. If that information shows that WCER does not apply to you or that you already meet the rules, DPA will not ask you to provide the same information again.

If the available information is not enough to make a determination, DPA will ask only for the additional information needed.

If DPA asks you for information, the notice will explain how to provide it and the deadline for responding. Information may be submitted through available DPA service channels, including Alaska Connect, mail, fax, telephone, or in person.

You will have an opportunity to provide updated or corrected information before DPA makes an eligibility decision based on information that is missing, outdated, or inconsistent.

If DPA needs additional information, it will tell you what is needed and when it is due.

If DPA cannot determine that you meet WCER or that WCER does not apply to you using other available information, not responding by the deadline could affect your Medicaid eligibility.

The notice will explain what information is needed, the deadline for responding, and your rights.

Sometimes. Whether self-attestation can be accepted depends on the information the Division of Public Assistance (DPA) needs to verify.

DPA will first use information already available. If more information is needed, DPA will tell you whether you can provide the information yourself or whether documentation is required.

Yes. If WCER applies to you and the Division of Public Assistance (DPA) cannot determine that you met the rules or that an exclusion, exception, or temporary hardship applies, your Medicaid application may be denied or your coverage may end at renewal.

Before taking that action, DPA must first review whether an exclusion, exception, temporary hardship, or other way of meeting WCER applies and complete the required notice steps.

Contact DPA as soon as possible by phone (1-800-478-7778) or through the Alaska Connect portal. If you have proof that you submitted the information, keep it and provide it when you contact DPA.

DPA must review information received and follow applicable notice and appeal rules before denying or ending Medicaid coverage.

Yes. Your eligibility may be reviewed again if you later meet WCER or the Division of Public Assistance (DPA) determines that an exclusion, exception, temporary hardship, or other eligibility rule applies.

Yes. A Medicaid denial based on WCER may also affect whether you qualify for financial help to purchase coverage through the Health Insurance Marketplace.

If DPA denies your Medicaid application or decides to end your coverage, the notice will explain why and tell you how to request a fair hearing.

The notice will also explain the deadline for requesting a hearing and whether your Medicaid coverage can continue while the appeal is pending.   

Yes. If WCER applies to you and the Division of Public Assistance (DPA) cannot determine that you met the rules or that an exclusion, exception, or temporary hardship applies, your Medicaid application may be denied or your coverage may end at renewal.

Before taking that action, DPA must first review whether an exclusion, exception, temporary hardship, or other way of meeting WCER applies and complete the required notice steps.

Contact DPA as soon as possible by phone (1-800-478-7778) or through the Alaska Connect portal. If you have proof that you submitted the information, keep it and provide it when you contact DPA.

DPA must review information received and follow applicable notice and appeal rules before denying or ending Medicaid coverage.

Yes. Your eligibility may be reviewed again if you later meet WCER or the Division of Public Assistance (DPA) determines that an exclusion, exception, temporary hardship, or other eligibility rule applies.

Yes. A Medicaid denial based on WCER may also affect whether you qualify for financial help to purchase coverage through the Health Insurance Marketplace.

If DPA denies your Medicaid application or decides to end your coverage, the notice will explain why and tell you how to request a fair hearing.

The notice will also explain the deadline for requesting a hearing and whether your Medicaid coverage can continue while the appeal is pending.   

You should report changes that may affect your Medicaid eligibility or that DPA requires you to report.

You do not need to report changes in your work or other Work and Community Engagement Rules (WCER) activities every month. DPA will review WCER again at your next renewal unless information is needed for another Medicaid eligibility reason.

Tell DPA about changes that may affect whether WCER applies or whether you meet the rules. Examples can include changes in work, school, caregiving, health, household circumstances, participation in another program, or a hardship.

Visit StayCovered.alaska.gov for current Alaska Medicaid Work and Community Engagement Rules (WCER) information. You can also call the Division of Public Assistance at 1-800-478-7778 if you need help understanding a notice or what the rules may mean for you.

Providers and community partners can help people understand Medicaid notices, identify when an exclusion, exception, or temporary hardship may apply, and provide information when DPA requests it.

They can also help individuals complete applications, renewals, and requests for additional information.

Providers may be able to provide information about a person’s condition, functional limitations, treatment needs, or other circumstances when DPA needs information to determine whether a medical exclusion or other Work and Community Engagement Rules (WCER) protection applies.

No. Alaska does not use provider taxes or state-directed payments (SDPs), which are financing mechanisms many other states rely on to draw down additional federal Medicaid funds. 

• Provider taxes are fees that states collect from hospitals or other healthcare providers, which can be used to increase Medicaid payments and trigger higher federal matching funds. 
• State-directed payments are special payment arrangements that allow states to direct how managed care plans pay certain providers, often resulting in higher provider reimbursement. 

Because Alaska’s Medicaid program does not use these tools, it is not affected by the bill’s provisions that restrict or reduce funding tied to provider taxes and SDPs.

Beginning July 1, 2028, states may create new “needs-based” HCBS waivers under section 1915(c) for individuals who require support but do not meet an institutional level of care. This new waiver type is intended to offer flexibility to design services around state-defined needs-based criteria. 

Services under these waivers cannot include room and board and must cost less than institutional care. States can cap enrollment but cannot use these waivers to delay access for people eligible for traditional HCBS waivers. 

Alaska already has HCBS waivers in place that provide similar services, but this bill provides support to states looking to establish a new option through implementation funding ($100 million nationally) and simplified federal review.

No. Alaska’s HCBS programs are established through long-standing Medicaid waivers that remain in place. These services are critical for helping seniors and people with disabilities receive care at home or in their communities, rather than in institutions. Alaska remains strongly committed to sustaining and expanding this model of care, and will continue investing in community-based supports as part of its overall approach to Medicaid.

The bill requires states to charge copayments for some Medicaid expansion enrollees with incomes above 100% of the federal poverty level, starting in 2028. There are limits on how much a state can charge. For example, copayments cannot be more than $35 or a certain percentage of an individual’s income.  

Alaska already has copayments in place for certain enrollees for many services, including hospital visits, outpatient care, and prescriptions. The state is assessing whether any changes to copayments are needed before the federal effective date.

Starting January 1, 2028, states can choose to raise the home equity limit used to determine eligibility for long-term care services.

Right now, Alaska’s limit is $500,000. Under the new law, Alaska could raise the limit to $1 million. This change would help more Alaskans qualify for long-term care coverage without being disqualified because their home is worth more than current limits.

Not immediately. Currently, states can avoid federal penalties for Medicaid payment errors (such as covering ineligible individuals) if they act in good faith to correct them. The bill ends this waiver in 2030.  

Starting then, states may face financial penalties if more than 3% of their Medicaid cases have errors.