Alabama Elderly and Disabled Waiver Family Caregiver: Who Can Be Paid?

Alabama's Medicaid Elderly and Disabled Waiver can pay a family member, including a qualified spouse, as a caregiver when the person self-directs care through Personal Choices. The Elderly and Disabled Waiver pays for in-home help for people who'd otherwise need a nursing home, but Alabama pays no family member for the waiver's agency-delivered personal care, respite or companion services. Start with your local Area Agency on Aging.1,2,3

In This Guide

• What the Elderly and Disabled Waiver Pays For and Who Qualifies
• Who Can Be Paid as a Family Caregiver on the Alabama Elderly and Disabled Waiver
• How Many Hours Can a Family Caregiver Be Paid, and at What Rate?
• How a Family Caregiver Starts Getting Paid Through the Alabama Elderly and Disabled Waiver
• Frequently Asked Questions

What the Elderly and Disabled Waiver Pays For and Who Qualifies

If you're already handling the bathing, meals and late-night checks, here's what the Elderly and Disabled Waiver can take on. Alabama Medicaid lists services including personal care, homemaker help, skilled and unskilled respite, adult day health, companion services, home-delivered meals, skilled nursing, home modifications and emergency response systems. The Alabama Department of Senior Services (ADSS) provides the case management.1

An Alabama Elderly and Disabled Waiver applicant must meet financial, medical and program criteria and be at risk of entering a nursing facility, hospital or intermediate care facility. In 2026 the Alabama Elderly and Disabled Waiver's income limit is $2,982 a month, which is 300% of the $994 federal Supplemental Security Income (SSI) rate, and its resource limit is $2,000. See Alabama Medicaid income and asset limits.1,4

The Alabama Elderly and Disabled Waiver's enrollment limit is 15,000, Alabama Medicaid warns there may be a waiting period, and a person can apply for more than one waiver but get services through only one at a time. Alabama Medicaid can also recover costs from the estate of a recipient 55 or older, including home and community-based services; see Alabama Medicaid estate recovery.1,6

Who Can Be Paid as a Family Caregiver on the Alabama Elderly and Disabled Waiver

It depends on who delivers the care. Agency care follows Alabama Medicaid's rule for the waiver (Ala. Admin. Code r. 560-X-36-.04), while Personal Choices runs under Alabama's section 1915(j) self-direction option, which covers the waiver's personal care, homemaker, unskilled respite and companion services.2

The Alabama Elderly and Disabled Waiver application says a legally responsible individual, a term that includes a spouse, can't provide traditional waiver personal care but may through Personal Choices if they meet its requirements. Spouses should also read getting paid to care for a spouse in Alabama. For other relatives the waiver application says "As permitted through the 1915j SPA" (State Plan Amendment), and the ADSS handbook gives tips for when you've "hired a relative or friend." Alabama's rule names no family bar for agency homemaker services, but no source says a relative can be paid for them.2,7

A Personal Choices personal care worker in Alabama must be at least 18, have two verified references and pass the background checks required by law. The person's Personal Choices representative can't be paid or hired as the worker, so a paid family caregiver needs someone else in that role. Alabama's sources don't say whether a legal guardian or power of attorney can be the paid worker, or whether the agency family bar on respite and companion care also applies when they're self-directed.2,7

How Many Hours Can a Family Caregiver Be Paid, and at What Rate?

If you're weighing whether paid hours could replace hours at your job, start here: personal care on the Alabama Elderly and Disabled Waiver isn't an entitlement. Hours follow the needs written into the person's plan of care, and Alabama's waiver documents state no fixed weekly cap for a paid family caregiver, so your paid hours are whatever that plan authorizes. Alabama Elderly and Disabled Waiver respite can't exceed 720 hours or 30 days per waiver year (October 1 through September 30) and can't provide continuous care while the main caregiver works or attends school, so respite won't cover your own job shifts. Alabama's Elderly and Disabled Waiver companion services are only for people living alone, at no more than four hours a day.2

In Alabama's Personal Choices, your pay comes out of the person's budget: the plan of care's authorized hours or units times the service's cost in the waiver approved by the Centers for Medicare & Medicaid Services (CMS), and 85% of it is available for services after administration. The person is the employer, and a contracted Financial Management Services Agency handles timesheets, payments and taxes.7

Alabama home health and personal care aides earned a median $13.39 an hour in May 2025, according to the U.S. Bureau of Labor Statistics (BLS). That's an estimate based on home care aide wages, not a Personal Choices pay rate, so weigh it against the pay you'd give up at work.5

How a Family Caregiver Starts Getting Paid Through the Alabama Elderly and Disabled Waiver

Learn More

Find personalized help getting paid as an Elderly and Disabled Waiver caregiver in Alabama at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.