Self-Direction and FMS in Alaska
All states: self-direction map
In short: Self-direction is agency with choice: consumers pick, train and supervise personal care assistants who are employed by a certified agency of their choice. Change ahead: The state has said it will remove the 40 hour weekly limit on legally responsible individuals paid under Community First Choice. No date is set.
Alaska self-direction at a glance
| Self-directed programs | Consumer-Directed Personal Care Services (State Plan) and Consumer-Directed Community First Choice personal care |
|---|---|
| FMS model | Agency with choice. The state's own term is consumer-directed. |
| FMS vendors | No contracted FMS vendor. The recipient picks a certified personal care agency that offers a consumer-directed program. |
| Who is the employer | A certified agency employs the assistant. The recipient chooses, trains, schedules and supervises. |
| Can family be paid | Yes, with limits. A spouse, parent of a minor or guardian can be paid in Community First Choice, but not in State Plan personal care. |
| EVV for self-directed workers | Yes, through the employing agency's EVV system (the state Therap system or an approved third-party system) |
| Budget authority | No. Hours are set by a state service level authorization, not an individual budget. |
Last verified against state sources: 2026-10-13.
Which Medicaid programs in Alaska offer self-direction?
Alaska offers self-direction in two Medicaid personal care programs: State Plan Personal Care Services and Community First Choice personal care. The state calls the option consumer-directed. In both programs the recipient chooses, trains, schedules and supervises a personal care assistant, and a certified agency of the recipient's choice employs that assistant. Neither program gives the recipient a dollar budget to manage.
- Consumer-Directed Personal Care Services (State Plan Personal Care Services): serves Medicaid recipients of any age who have functional limitations from a physical condition and need physical help with daily activities. The recipient, or a representative, must be able to manage and train the assistant. It is run by the Alaska Department of Health, Division of Senior and Disabilities Services (SDS), under the Medicaid state plan (7 AAC 125). The recipient has employer authority but not budget authority.
- Consumer-Directed Community First Choice Personal Care Services (CFC-PCS): serves Medicaid recipients who meet an institutional level of care and need long-term care at home. It is run by SDS under the 1915(k) Community First Choice authority (7 AAC 127). The recipient has employer authority but not budget authority. This is the program in which a spouse, a parent of a minor child or a guardian can be the paid assistant.
Employer authority means the recipient picks the assistant, trains and schedules that person, supervises the work, signs the timesheets and can end the assistant's employment. Budget authority would mean the recipient also manages a set amount of money. Alaska does not work that way. The hours come from a state service level authorization, and the agency bills from the assistant's timesheets. The state's Personal Care Services page describes the consumer-directed option as the one where the individual manages their own care while the agency gives administrative support.
Not everyone can use the consumer-directed option. A recipient with documented self-neglect, or one found to lack cognitive capacity, is limited to agency-based services unless capacity is shown or a qualified representative takes responsibility.
Alaska also has five 1915(c) waivers, all run by SDS. We did not find participant direction or a financial management service in any of them. The state's waivers page describes services as planned by the participant's team and approved by SDS, and it does not mention self-direction. The waiver applications themselves could not be checked, so ask SDS before assuming either way.
Who handles financial management services (FMS) in Alaska?
Alaska has no stand-alone financial management services contractor in its personal care programs. It uses an agency with choice model. The recipient designates a certified personal care agency that offers a consumer-directed program, and that agency employs the assistant and bills Medicaid. Recipients choose among certified agencies, so there is no single statewide vendor.
Agency with choice means two parties share the employer role. The recipient is the day to day boss, and the agency is the employer on paper. The phrase comes from the background section of a 2025 state EVV request for proposals, which says the consumer selects, hires, fires and supervises the assistant, and that the assistant must be an employee of a certified agency and hold a Medicaid rendering number. Alaska does not use a fiscal employer agent model in these programs.
- What the recipient does: designates the agency and signs a contract with it, then chooses, trains, schedules and supervises the assistant, signs timesheets and can end the assistant's employment. In Community First Choice a representative or designee can take these steps for the recipient.
- What the agency does: collects and verifies the assistant's timesheets, submits claims based on them, keeps records, reviews the recipient's services at least every six months and builds a backup plan with the recipient.
- Payroll and insurance: the state's provider Conditions of Participation require agencies to carry workers' compensation coverage for all employees and to keep funds to pay employee salaries and employee-related taxes on time.
- Vendor by program: the state names no FMS vendor for either program. Any agency certified by SDS for personal care may run a consumer-directed program, and a certified agency may run both an agency-based and a consumer-directed program.
We did not find a published list of the agencies that offer a consumer-directed program. To find one, ask Senior and Disabilities Services at doh.sds.info@alaska.gov or 907-269-3666.
Who can be a paid caregiver under self-direction in Alaska?
The answer depends on the program. In Community First Choice personal care, a spouse, the parent of a minor child or a court-appointed guardian can be the paid assistant if that person is qualified and employed by a certified agency. In State Plan personal care those same people cannot be paid, with one exception for a guardian whom a court has authorized to provide the services.
Important: The two personal care programs have opposite rules for close family. SDS says legally responsible individuals can provide Community First Choice personal care but are not permitted to provide State Plan personal care. Check which program the recipient is in before a spouse or parent is hired.
Alaska uses the term legally responsible individual for a spouse, the parent of a minor child or a court-appointed guardian.
- State Plan personal care: under 7 AAC 125.010, services are not paid when the assistant is the recipient's spouse, the parent of a minor recipient, a person with a legal duty to support the recipient, the recipient's representative or the representative's designee. The exception is a court-appointed guardian whom a court has authorized to provide the services.
- Community First Choice personal care: under 7 AAC 127.015, a legally responsible individual who is qualified and employed by a certified provider may provide the service. A guardian who does so must appoint a designee. A foster parent placed by the state is not treated as a legally responsible individual.
- Hour cap: the regulation caps a legally responsible individual at 40 paid hours in any seven days. In a June 27, 2025 Director's Memo, SDS said it will not enforce that limit for Community First Choice personal care.
- Power of attorney (both programs): a recipient's power of attorney may be the paid assistant only if a second person who is not affiliated with a provider agency is named jointly on the power of attorney, and the power of attorney appoints a designee. This comes from an October 15, 2024 SDS memo.
We did not find a state source on wage or overtime rules specific to consumer-directed personal care assistants. Ask the employing agency or SDS.
Does EVV apply to self-directed workers in Alaska?
Yes. Electronic visit verification (EVV) has applied to consumer-directed personal care in both programs since January 1, 2021. The assistant uses the EVV system of the agency that employs them. An agency may not submit a claim for the service without the EVV data that supports it.
- Whose system: Alaska lets providers choose. An agency can use the state-contracted Therap system at no cost, or an approved third-party system. A consumer-directed assistant uses whichever one the employing agency uses.
- Services covered: the state's EVV page lists both Personal Care Consumer Directed (code T1019 U3) and Personal Care Consumer Directed Community First Choice (code S5125 SE).
- Claims: a provider may not submit a State Plan personal care claim (7 AAC 125.070) or a Community First Choice claim (7 AAC 127.053) without also submitting the supporting EVV data.
- Agency duties: certified personal care providers must tell SDS which EVV vendor they use. They must give one business day of notice for an unplanned vendor change and 30 days of notice for a planned one.
Two points could not be confirmed. We did not find a published EVV exemption for live-in caregivers or for anyone else. The state EVV page lists none. We also did not find a state source that ties the assistant's paycheck to a verified visit. The rule is a condition on the agency's claim. For either question, ask the employing agency or SDS.
What is changing next for self-direction in Alaska?
The state has said it will remove the 40 hour weekly limit on legally responsible individuals paid under Community First Choice. No date is set. Until the regulation is changed the limit stays on the books, although SDS has said it will not enforce it for Community First Choice personal care.
The statement comes from the June 27, 2025 SDS Director's Memo. In the same memo SDS said it would put the regulation changes on legally responsible individuals in Community First Choice personal care into practice on August 1, 2025, after delaying an earlier October 19, 2024 effective date. We did not find a later state notice confirming that this happened, or that the 40 hour limit has since been repealed. Check the current official regulation or ask SDS.
A second item sits outside self-direction but matters to families. The memo says federal Medicaid officials approved legally responsible individuals providing In-Home Supports and Supported Living services in the 1915(c) waivers, and that SDS is allowing this while it writes regulations. A 40 hour weekly limit is expected for those services but was not in effect as of the memo. That is paid family caregiving through a provider agency, not a consumer-directed program, and no dates have been announced.
We did not find any pending change to the agency with choice model itself or to how EVV applies to consumer-directed assistants.
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Who to ask about self-direction in Alaska
Questions about self-direction in Alaska are best put to the state. Start with Alaska Department of Health, Personal Care Services (PCS) Program. Published contact: Senior and Disabilities Services: doh.sds.info@alaska.gov, 907-269-3666.
Alaska self-direction sources
- Alaska Department of Health: Personal Care Services (PCS) Program
- Alaska Department of Health: Community First Choice
- Alaska SDS: PCS and CFC-PCS provider Conditions of Participation (revised September 1, 2022)
- 7 AAC 125.010: State Plan personal care, who may not be a paid assistant
- 7 AAC 125.130: Consumer-directed personal care, agency duties
- 7 AAC 127.015: Community First Choice, legally responsible individuals
- Alaska SDS Director's Memo, June 27, 2025: Community First Choice regulation implementation
- Alaska SDS Director's Memo, October 15, 2024: legally responsible individuals and power of attorney
- Alaska Department of Health: Electronic Visit Verification
Related reading
- Self-Directed Medicaid Home Care Services in 2026
- Understanding Self-Direction and FMS
- Self-Direction Fiscal Intermediary: A Guide for Participant-Directed Care
- 5 Big Challenges in Self-Directed Care And How FMS Providers Can Solve Them
- Self-direction in every state (map)
- Alaska EVV requirements
Other states with a choice of FMS vendors
Colorado, Georgia, Idaho, Kentucky, Louisiana, Maryland, Minnesota, North Carolina, Texas, Utah. See every state on the self-direction map.
Page history
- October 13, 2026: Page rewritten and checked against state sources.
This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.
Ankota provides software for FMS organizations and agencies that support self-direction. If you would like to talk through your program, contact Ankota or read more about Ankota's self-direction and FMS software.
