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Comprehensive Person-Centered State Work Incentive Initiatives:

A Resource Center for Developing & Implementing Medicaid Buy In Programs
Related Employment Initiatives for Persons with Disabilities


I. Overview of a State’s Comprehensive Person-Centered Employment Initiatives

Alaska was the first state to pass legislation authorizing a Medicaid Buy-In program (1998) and the second state to implement its program (1999). The Medicaid Buy-In program is part of a comprehensive work incentive initiative called Alaska Works, that also includes benefits counseling and efforts to establish a unified, seamless workforce investment system with public vocational rehabilitation programs as an integral component.

New - Download file of two summary charts
Chart contents:

State's Medicaid Buy-In Program Design Features
- Income Eligibility Criteria
- Resource Limits and Exclusions
- Cost Sharing - Minimum Income Level and Premium or Cost Share Methods
- Work Related Policies and Protections
State's SSI and Other Medicaid Income Standards for Adults with Disabilities

II. What’s New and Persons to Contact

Millie Ryan
Executive Director
AK Dept. of Health and
Social Services
Governor's Council on Disabilities and Special Education
P.O. Box 240249
Anchorage, AK 99524
Phone (voice): (907) 269-8992
Fax: (907) 269-8995


III. Program Development - Past and Present

  • Executive Branch Leadership, Cross Disability Coalition Leadership and Interagency Working Groups
  • Initial Planning, Information Gathering and Program and Fiscal Estimates
    For a description of the development of the Alaska program go to the Alaska Case Study prepared by the George Washington University Work Incentives Project with support from ASPE at the Department of Health and Human Services and scroll down and click on to the Alaska study in the Table of Contents

    or Download Word version of the Alaska Case Study

    Summary of the results of a survey of SSA beneficiaries receiving Medicaid conducted in 1999 regarding characteristics and barriers to work.
    Download copy of Summary (.doc) -


IV. State Legislation - Adopted and Pending

Alaska was the first state to pass legislation authorizing a Medicaid Buy-In program (1998)
HB 459 20th Legislature


V. Current State Policies and Program Descriptions

  • State Policies: State Plans, Regulations and Waiver Requests to Federal Agencies - Pending and Adopted Programs
  • Ensuring Informed Choice and Person - Centered Programs: Benefits Counseling, Work Force Investment Act Implementation and Related Educational Services
  • Descriptions for Consumers and Staff Training Activities

Download PowerPoint presentation (.ppt, 1.6M) - PowerPoint Presentation by Millie Ryan on Alaska Works Program


VI. Program Data and Impact

Medicaid Buy-In Data
179 enrollees in the Medicaid Buy-In program as of June 30, 2003.

Consumer Surveys and Evaluation Studies


VII. Comprehensive Employment Initiatives

Personal Assistance Services (PAS)
Link to Alaska Personal Assistance Services (PAS) program information

Alaska's Medicaid State Plan benefit package includes personal assistance services. Alaska's personal care assistance program meets the definition of a "fully qualified" program as defined by Centers for Medicare and Medicaid Services (CMS) Infrastructure Grant guidelines. Services are available statewide, seven days a week, twenty-four hours a day, both within and outside the home and are deemed capable of supporting full-time competitive employment. The personal care assistance program includes both an agency model and an independent contractor model where the consumer hires the worker directly.

Workforce Investment Act and One-Stops
The state has worked extensively with Workforce Investment Boards and One-Stop employment centers to enhance their knowledge of the Medicaid Buy-In program. Vocational rehabilitation services are located at the One-Stop centers. Resource specialists are working with one-stop employment center staff to improve their ability to assist persons with disabilities.

Efforts to increase the availability of accessible transportation in 2003 included allocation of $412,500 from the Alaska Mental Health Trust Authority and an equal amount from the Governor and state legislature to provide additional transportation services.

Copyright 2003. Center for the Study and Advancement of Disability Policy and Center for Health Services Research and Policy at George Washington University

Supported by a grant from the Robert Wood Johnson Foundation with additional support provided by NIDRR of the US Department of Education through the RRTC on Workforce Investment and Employment Policy at the Law, Health Policy and Disability Center at the University of Iowa. (#H133B980042) 

Website created and maintained by the Law, Health Policy and Disability Center at the University of Iowa College of Law. The opinions and analyses set out in the articles on this website are those of the authors and do not necessarily reflect the positions of the Robert Wood Johnson Foundation, the US Department of Education, George Washington University or the University of Iowa.