In 2006, nearly 40% of Medicaid clients in Alaska were Alaska Natives, and a like amount of program expenditures were made on their behalf. Almost all Alaska Native elders participate in the Medicare program. For those who are eligible, Medicaid is also utilized for a variety of health care needs. Community-based health and social programs are usually free or offered at a nominal rate.
In the past, tribal health systems billed small amounts of the cost of health care for Alaska Natives to Medicaid. That changed in 1996 when the State of Alaska began to work with the tribes to submit itemized claims which resulted in dramatic increases. In 1991, $9.6 million was paid to tribal providers, and by 2003 payments increased to $149 million due to improved reimbursement, maximization of billing, and aggressive enrollment of Alaska Natives in program expansions.
A projected increase in the growth of older adults (65 years and older) will change the overall shift in Medicaid funding from a child-based program to a program focusing on the needs of the older adults, in particular personal care and Home and Community Based Waiver programs. These waiver programs can be used to pay for services such as home modifications, respite, and transportation.