The Anchorage Pioneer Home is one of several state-run assisted living facilities. According to the Alaska Department of Health, the state paid $96 million from Medicaid to assisted living homes last year. The One Big Beautiful Bill Act, passed earlier this year, is destined to change Medicaid and Medicare.
The Anchorage Pioneer Home is located in downtown Anchorage. It's one of a number of assisted living homes operated by the State of Alaska.
Brian Studstill, the communications director for the Alaska Department of Family and Community Services, said in an email that of the 164 residents in Anchorage Pioneer Home, 49 of them are eligible for Medicaid.
Medicaid helps pay for services not covered by Medicare, including long-term care. According to the Alaska Department of health, the state paid $96 million from Medicaid to assisted living homes last year.
Federal spending on health care to decrease
Following the passage of the One Big Beautiful Bill Act earlier this year, there are changes coming to Medicare, Medicaid and the Affordable Care Act.
Studstill said Alaska Pioneer Homes are not expecting an impact from the bill or funding loss, but the changes are still under review.
According to KFF, a health policy research organization, Alaska is projected to lose $2 billion in Medicaid spending over the next 10 years.
Alice Burns is the associate director with KFF's program on Medicaid and uninsured. She said in an email that the estimate is based states' characteristics.
The Congressional Budget Office projects a reduction of $911 billion in Medicaid spending across the U.S. over the next 10 years.
Burns said the Congressional Budget Office expects losses from people who cannot meet paperwork requirements for new Medicaid work requirements-even if they are working or have an exemption.
Emily Ricci, the deputy commissioner for the Alaska Department of health, said it's hard to estimate the actual impact of the bill on Alaska and they are working on their own analysis.
She said many of the Medicaid changes won't be immediate, either.
"I would not expect anybody to be going out of business right now," she said.
But Medicare, on the other hand, did have changes that went into effect with the passage of the bill.
There are about 118,000 people in Alaska using Medicare, according to KFF.
The bill pauses a requirement for nursing homes to meet minimum staffing levels. According to University of Pennsylvania researchers, increased staffing "would save approximately 13,000 lives per year."
There is also a pause to make it easier to enroll in Medicare Savings Programs and Medicaid. And the bill places restrictions on Medicare eligibility, affecting some lawfully present immigrants.
Ricci said the bill allows for the creation of waivers for home and community-based services, but the state won't be able to take advantage of those until 2028.
Affordable Care Act changes
Starting at the end of this year, there are changes impacting the nearly 12,000 Alaskans who are 45 and older with an Affordable Care Act marketplace plan.
Ending are the enhanced premium tax credits, which allowed individuals with income above the normal limit to receive the credit.
While the premium tax credit will still be available for those who meet the income requirements, it will be a smaller amount for many, according to KFF. https://www.kff.org/affordable-care-act/inflation-reduction-act-health-insurance-subsidies-what-is-their-impact-and-what-would-happen-if-they-expire/
Also, the premium tax credit will be unavailable to lawfully present immigrants who cannot qualify for Medicaid.
Big effects coming to Medicaid
For changes to Medicaid, they are among the most sweeping in the bill.
There are about 41,000 Alaskans who are 50 or older enrolled in Medicaid about 11,000 who are duel-eligible for Medicare as well, according to the Alaska Department of health.
One of the biggest changes are work requirements for adults in the Medicaid expansion population. They will need to demonstrate they are working, attending school or participating in community service for at least 80 hours a month.
There are exemptions to the requirement and flexibility for people with seasonal work.
Ricci said they are still waiting for guidance from the Centers for Medicaid and Medicare Services for a final determination on who is exempt.
Caregivers can get an exemption for the work requirements if they can show the person they are caring for has a disability, said Ricci, but whether that applies to caregivers for someone without a disability remains to be seen.
States must implement the work requirements by the end of 2026, but that deadline can be extended if states can show they are making a good-faith effort to enact changes.
Ricci said Alaska has applied for the extension.
Act will add to State of Alaska's workload
Another change: increased frequency of eligibility reviews.
The bill requires members in the Medicaid expansion population to have their eligibility reviewed every six months instead of once a year.
Alaskan Natives and people 65 and older are exempt from both the work requirements and six-month reviews.
Ricci said there will be an increased workload for the department to verify applicants' eligibility with the all the changes.
Alaska is already dealing with backlogs in processing applications for SNAP, adult public assistance and Medicaid.
According to the Anchorage Daily News, a judge ruled that the Alaska Department of health was violating state law by not processing adult public assistance applications on time.
Also, there was a backlog of 30,000 Medicaid applications in July this year, according to Alaska Public Media.
Ricci said the department was already working on a new system to address the backlog issues and there is funding in the bill to help update the state's Medicaid application system.
"The federal government would pay 90% of the cost for those activities, and the state would pay 10%," she said.
Ricci said they expect to have the final changes done by 2028, and they will be making new features available as they are they are ready.
More uninsured Alaskans predicted
Another impact of the bill is fewer insured Alaskans.
The Congressional Budget Office projects that 10 million Americans will lose insurance over the next 10 years as a result of the bill.
Sen. Cathy Giessel is the leader of the Alaska Senate Majority and vice-chair for the Senate health and Social Service Committee.
Giessel said she heard the CEO of the Alaska Hospital & Healthcare Association, Jared Kosin, speak at a panel about Medicaid on Sept. 11.
"The Hospital Association is, of course, exceedingly concerned and very, very apprehensive about the losses of revenue," Giessel said.
Giessel said just because someone doesn't have insurance it doesn't mean they won't be using hospital services.
"That's where the burden is going to fall," she said, "It's going to fall on our hospitals."
Hospitals are required to provide emergency care whether a patient has insurance or not.
"Those folks who have insurance will now see their bills go up, because somewhere the hospital has to balance all this out," she said.
Alaska may see an increase in some health care funding from the bill via the Rural health Transformation Fund. According to an announcement from Sen. Dan Sullivan, Alaska could see $200 million a year over the next five years.
The Alaska Department of health is responsible for putting together applications for the funds.
Betsy Wood is the associate director of the office of health savings at the Alaska Department of health. She said they requested feedback from partners across Alaska for how to use the funds.
"We have over 425 responses that we're working through to kind of build what I'm calling an idea laboratory," she said.
While direct payments to rural health providers is listed among possible uses for funds, states are not necessarily required to spend money directly on rural hospitals, according to Georgetown University McCourt School of Public Policy.
Final approval of applications rests with the administrator of the Center for Medicaid and Medicare Services, Dr. Mehmet Oz.
In an interview with "Face the Nation," Oz gave some indication of what the federal government is looking for in applications: "workforce development, right-sizing the system and using technology to provide things like telehealth," he said.
Matthew Schmitz is a UAA student, and the former editor of The Northern Light.
