Introduction

Alabama provides seniors with various services under Medicaid or other state programs to help with long-term care, including assisted living and in-home care services.

For Medicaid-eligible seniors, The Alabama Department of Senior Services (ADSS), in partnership with the Alabama Medicaid Agency and the Alabama Department of Rehabilitation Services (ADRS), provides assisted living,in-home care, and other consumer-directed services for individuals currently enrolled in three Alabama home and community-based waivers. The following are the 1915(c) Home and Community-Based Waiver Services (HCBS) to be self-directed:

  • Elderly and Disabled Waiver (E&D Waiver)— Personal Care, Homemaker, Unskilled Respite, and Companion
  • State of Alabama Independent Living Waiver (SAIL Waiver)—Personal Care and Personal Assistance
  • Alabama Community Transition Waiver (ACT Waiver)—Personal Care, Homemaker, Unskilled Respite and Companion

Medicaid Waiver Programs for Assisted Living and In-Home Care

Applicants to Alabama’s HCBS Medicaid waivers must meet financial, medical, and program criteria to access waiver services. The applicant also must be at risk of nursing institutionalization (nursing facility, hospital, ICF/MR). A client who receives services through a waiver program also is eligible for all basic Medicaid-covered services. Each waiver program has an enrollment limit. There may be a waiting period for any particular waiver. Applicants may apply for more than one waiver but may only receive services through one waiver at a time. Anyone who is denied Medicaid eligibility has the right to appeal.

Alabama Home and Community-Based Waiver for the Elderly & Disabled(E&D Waiver)

The purpose of the E&D waiver is to provide services that would allow elderly and/or disabled individuals to live in the community who would otherwise require a nursing facility level of care. The Elderly and Disabled Waiver provides services to individuals who might otherwise be placed in nursing homes. It is operated jointly by the Alabama Department of Senior Services and the Alabama Department of Public Health. The enrollment limit for 2017 is 9,205. Applications for the E&D waiver go through Alabama’s Area Agencies on Aging.

Services

Services provided under the E&D waiver include Case Management, Homemaker Services, Personal Care, Adult Day Health, Respite Care (Skilled and Unskilled), Adult Companion Services, and Home Delivered Meals.

Eligibility

Applicants must meet financial, medical, and program criteria to access waiver services.

  1. Health: Applicants to the E&D waiver must meet the state’s Nursing Facility Level of Care.
  2. Financial: Financial criteria for the E&D waiver include those already eligible for Medicaid as current SSI recipients. If an applicant is not already Medicaid-eligible, the applicant’s income and assets must be below certain limits. For 2022, The applicant’s income must be less than $2,523 (300%, or three times the Supplemental Security Income allowance) per month and countable resources less than $2,000 for a single person or $4,000 for a couple. If an applicant’s income is too high, then a Miller Trust (also known as a Qualified Income Trust) can allow them to access the benefits by funnelling their income into the trust for the purpose of paying for care. An individual cannot make more income than the total cost of care. The maintenance needs allowance is equal to the individual’s total income as determined under the post-eligibility process, which includes income that is placed in a Miller Trust.

Practical Considerations

There is no individual cost limit when determining an applicant’s eligibility for the E&D waiver. When applying, you must determine which Area Agency on Aging you reside in or intend to receive services in and apply in that specific area. This means that waiting lists and prioritization of eligible participants occur on the regional level and will be hard to determine prior to deciding to apply. Alabama is a special income limit state for the determination of Medicaid eligibility and allows a Miller Trust (or Qualified Income Trust) to divert income so that it is disregarded for purposes of determining whether the applicant’s income is under the limit.

State of Alabama Independent Living Waiver (SAIL Waiver)

The SAIL waiver provides services to disabled adults with specific medical diagnoses who meet the nursing facility level of care criteria. The specific medical diagnoses that qualify for purposes of the SAIL waiver include, but are not limited to, Quadriplegia, Traumatic Brain Injury, Amyotrophic Lateral Sclerosis, Multiple Sclerosis, Spinal Muscular Atrophy, Muscular Dystrophy, Severe Cerebral Palsy, Stroke, and other substantial neurological impairments, severely debilitating diseases, or rare genetic diseases (such as Lesch-Nyhan disease). It is operated by the Alabama Department of Rehabilitation Services. For 2022, the enrollment limit was only 660 individuals.

Services

Services provided by the SAIL waiver include Case Management, Personal Care, Personal Assistance Service, Environmental Accessibility Adaptations, Personal Emergency Response System (Initial Setup), Personal Emergency Response System (Monthly Fee), Medical Supplies, Minor Assistive Technology, Assistive Technology, Evaluation for Assistive Technology, Assistive Technology Repairs, and transitional services for those needing it.

Eligibility

In addition to the specific medical diagnosis requirement for the SAIL waiver, applicants must meet certain health and financial criteria for eligibility for the program.

  1. Health: Applicants to the SAIL waiver must meet the state’s Nursing Facility Level of Care.
  2. Financial: Financial criteria for the E&D waiver include those already eligible for Medicaid as current SSI recipients. If an applicant is not already Medicaid-eligible, the applicant’s income and assets must be below certain limits. For 2017, The applicant’s income must be less than $2,205 (300%, or three times the Supplemental Security Income allowance) per month and countable resources less than $2,000 for a single person or $3,000 for a couple. If an applicant’s income is too high, then a Miller Trust (also known as a Qualified Income Trust) can allow them to access the benefits by funnelling their income into the trust for the purpose of paying for care. An individual cannot make more income than the total cost of care.

Practical Considerations

The program is available to only 660 participants a year and requires specific medical diagnoses. While it does serve the elderly Medicaid-eligible population, the specific criteria make it a niche program.

Alabama Community Transition Waiver (ACT Waiver)

The ACT waiver provides resources to seniors who are already in a nursing home but wish to transfer back into their own homes or a community setting, such as an assisted living facility. The program only assists a few hundred people per year and is

Services

The ACT waiver includes case management, transitional assistance, personal care, homemaker, adult day health, home-delivered meals, skilled/unskilled respite, skilled nursing, adult companion, home modifications, assistive technology, personal emergency response systems, medical equipment, supplies and appliances.

Eligibility

  1. Health: Applicants to the ACT waiver must meet the state’s Nursing Facility Level of Care. , with medical approval.
  2. Financial: Financial criteria for the E&D waiver include those already eligible for Medicaid as current SSI recipients. If an applicant is not already Medicaid-eligible, the applicant’s income and assets must be below certain limits. For 2017, The applicant’s income must be less than $2,205 (300%, or three times the Supplemental Security Income allowance) per month and countable resources less than $2,000 for a single person or $3,000 for a couple. If an applicant’s income is too high, then a Miller Trust (also known as a Qualified Income Trust), can allow them to access the benefits by funnelling their income into the trust for the purpose of paying for care. An individual cannot make more income than the total cost of care.

Practical Considerations

The very small population is targeted, with an annual number of slots available of only 675. Further, the applicant must be currently residing in a nursing home and wish to transition to their home or a community living setting. This means that it could be a good add-on option for someone deciding whether they want to use Medicaid for long-term care in a nursing home but are open to the idea of receiving care at home instead.

Conclusion

The only viable option for long-term assistance for assisted living or in-home care is enrolling and becoming eligible for the E&D Waiver program. It has significantly more available slots each year and has health criteria that are not as specific as the SAIL or ACT waivers.

Access all state Medicaid Waiver pages.