How to start an assisted living facility in Alaska

Alaska requires a Assisted living home license from Alaska Department of Health, Residential Licensing to operate an assisted living facility. Fee: An application fee must go with the application; the amount is not printed on the licensing page or application form reviewed.

License required

Yes

License

Assisted living home license

Issuing agency

Alaska Department of Health, Residential Licensing

Fee

An application fee must go with the application; the amount is not printed on the licensing page or application form reviewed.

Survey and inspection

Residential Licensing inspects all licensed homes every year.

Medicaid waiver coverage

A license is required for any home serving 3 or more unrelated adults, or any home that receives state or federal payment. HHS's 2015 compendium reported that the Alaskans Living Independently and Adults with Physical and Developmental Disabilities 1915(c) waivers paid for residential supported living in assisted living homes.

Regulation

AS 47.33; AS 47.32; 7 AAC 75; 7 AAC 10

1. Download and complete the New Home Application packet
2. Have the application notarized and include the fee
3. Attach required plans (staff plan, disaster and evacuation plans, assisted living plan forms, and a business plan for 11+ residents or multiple homes)
4. Set up background checks through the Background Check Program
5. Submit to Residential Licensing

Program

Alaska Medicaid (Alaska Medical Assistance)

Enrollment portal

Alaska Medicaid Health Enterprise portal (online provider enrollment)

Fiscal agent

HMS Gainwell (Gainwell Technologies) — provider enrollment and fiscal agent services; the Health Enterprise MMIS is a Conduent system

Application fee

Alaska requires group providers and sole proprietors to pay the application fee (with an attestation form) at enrollment and again at revalidation, subject to the federal exceptions; a hardship waiver can be requested with a justification letter and financial records. Federal rule (42 CFR 455.460): the state must collect the CMS application fee from institutional providers that are newly enrolling or re-enrolling; individual physicians and non-physician practitioners are exempt, as are providers already enrolled in (or that already paid the fee to) Medicare or another state's Medicaid/CHIP. CMS set the fee at $750 for calendar year 2026.

Fingerprinting

Federal rule (42 CFR 455.434, 455.450(c)): providers the state places in the 'high' categorical risk level, and anyone owning 5% or more of such a provider, must submit fingerprints for a criminal background check.

Site visit

Alaska applies pre- and post-enrollment site visits to moderate- and high-risk group providers and sole proprietors at enrollment, revalidation and service-location changes; the site-visit date feeds into the enrollment effective date. Federal rule (42 CFR 455.432, 455.450(b)-(c)): the state must do site visits before and after enrollment for providers in the 'moderate' or 'high' risk levels, and any enrolled provider must allow unannounced on-site inspections.

Revalidation

Alaska sets each provider's revalidation timing by its risk level; providers that miss their due date have payments held until the revalidation is processed. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Alaska Medicaid enrollment guide →

CON program

Yes

Program

Certificate of Need

Agency

Alaska Department of Health (decision by the commissioner)

Services covered

• hospitals (including psychiatric and tuberculosis hospitals)
• skilled nursing facilities / nursing home beds
• intermediate care facilities
• residential psychiatric treatment centers
• ambulatory surgical facilities
• kidney disease treatment centers / freestanding dialysis
• independent diagnostic testing facilities

Alaska certificate of need details →

State minimum wage

$14.00 an hour

Effective

2026-07-01

Scheduled increases

Rises to $15.00 on 2027-07-01 under Ballot Measure 1 (2024); annual inflation adjustments begin 2028-01-01.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Assisted living facilities — active organization NPIs (NPPES)

586 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

206,739 (as of Jun 1, 2026)

All Alaska Home care Medicaid rates, ranked →

• Alaskans Living Independently (1915(c))
• Adults with Physical and Developmental Disabilities Waiver (1915(c))
• Children with Complex Medical Conditions Waiver (1915(c))
• Community First Choice (CFC) (1915(k))
• Individualized Supports Waiver (1915(c))
• People with Intellectual and Developmental Disabilities Waiver (1915(c))

Alaska waivers and waiting lists →