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Medicaid’s Role in Alaska

Medicaid in Alaska

  • Over 184,000 people in Alaska are covered by Medicaid. While eight in ten (80%) enrollees are children and adults, more than half (55%) of the state’s Medicaid spending is for the elderly and people with disabilities.
  • 15,100 (21%) of Alaska’s Medicare enrollees are also covered by Medicaid, which accounts for over a quarter (27%) of Medicaid spending.
  • 32% of all children in Alaska are covered by Medicaid, including 39% of children with special health care needs.
  • 79% of nursing home residents in Alaska are covered by Medicaid and 32% of Medicaid long-term care spending in Alaska is for nursing home care. Medicare beneficiaries rely on Medicaid for assistance with services not covered by Medicare, particularly long-term care.
  • Over half (59%) of people in Alaska live in rural areas, which is higher than the national average of 19%. People who live in rural areas are more likely to be dependent on Medicaid.
  • In Alaska, Medicaid covers two in three (66%) American Indian and Alaska Native children and more than one in four (28%) American Indian and Alaska Native adults.

How Many Medicaid Expansion Adults are at Risk by Ending the Enhanced Federal Matching Funds?

  • 14,400 adults (10% of total enrollees) in Alaska gained coverage under the Medicaid expansion. Alaska received $91,912 in federal funds for expansion adults in FFY15. The Better Care Reconciliation Act of 2017 phases out the enhanced federal match to states that adopted the Medicaid expansion by 2024, putting coverage at risk for these adults.
  • The Medicaid expansion has helped reduce longstanding disparities in health coverage faced by American Indians and Alaska Natives and increased Medicaid revenues for IHS- and Tribally-operated facilities, enhancing their capacity to provide services.

What is at Risk under a Per Capita Cap or Block Grant?

  • Capping Medicaid funding would reduce the federal assistance for Alaska to maintain its current Medicaid program.
    • Urban Institute estimates that federal funding for Medicaid in Alaska would be $590 million lower in 2022 under the Better Care Reconciliation Act of 2017 compared to the Affordable Care Act (ACA), a 41% decline. The gap in federal funding would widen substantially after 2025.
  • Capping Medicaid can limit states’ ability to respond to economic downturns and demographic changes in their state that affect demand for Medicaid and other public health services.
    • Alaska has one of the highest rates of unemployment in the country (7%). During an economic downturn, demand for public programs such as Medicaid increases.
    • Alaska has the highest projected growth rate of its 85+ population (135%) between 2015 and 2030, a population more likely to require nursing home care. Medicaid is the primary payer for nursing home care.
  • Capping federal Medicaid funding could jeopardize Medicaid programs designed to improve quality of life and access to long-term care for people with disabilities. 12% of Alaska’s non-institutionalized population reported a disability.
  • States with high health care costs and limited access may find it increasingly difficult to purchase services in a high cost market or make improvements in access to care under reductions or caps in federal financing. Alaska’s has the second highest health spending per capita ($11,064).
  • Reducing federal funds through a per capita cap or block grant would limit Alaska’s ability to respond to public health crises such as the opioid epidemic, HIV, or Zika.
    • Alaska’s opioid death rate is 11 deaths per 100,000 population in 2015. Between 2013 and 2015, Alaska’s opioid death rate has grown by 16%.
    • Nearly 68% of people in Alaska are overweight or obese and over one-third (37%) report poor mental health status.

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.