Alabama Personal Choices Program: How a Family Caregiver Gets Paid
The Alabama Personal Choices program lets families be paid to care for a parent, spouse or other relative at home when that person is on an Alabama Medicaid home-care waiver.
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Brevy Care Team
6 min read · Published October 16, 2026 · Last verified October 17, 2026
The Alabama Personal Choices program lets families be paid to care for a parent, spouse or other relative at home when that person is on an Alabama Medicaid home-care waiver. Personal Choices gives the person a budget to hire, train and supervise their own caregiver, and Alabama's approved Medicaid State Plan lets them hire a relative who has a duty under state law to care for them, which can include a spouse.Alabama Department of Senior Services. (2023). Alabama Personal Choices Participant Handbook (Rev. April 2023) — ADSS / alabamaageline.gov. alabamaageline.gov. Retrieved Jun 24, 2026, from https://alabamaageline.gov/wp-content/uploads/2023/04/PC-Handbook-2023.pdf,Centers for Medicare & Medicaid Services. (1915). Alabama SPA AL-15-0004 — CMS approval letter and approved Supplement 2 to Attachment 3.1-A pages (1915(j) Personal Choices statewide; approved 12-08-15, eff. 10/01/15) — medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://medicaid.gov/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/AL/AL-15-0004.pdf
The Elderly and Disabled Waiver application says other relatives are paid "As permitted through the 1915j SPA," Alabama's section 1915(j) State Plan Amendment (SPA). The Alabama Department of Senior Services handbook covers having "hired a relative or friend to be your personal assistant," using a sister as its example.Centers for Medicare & Medicaid Services. (1915). Alabama SPA AL-15-0004 — CMS approval letter and approved Supplement 2 to Attachment 3.1-A pages (1915(j) Personal Choices statewide; approved 12-08-15, eff. 10/01/15) — medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://medicaid.gov/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/AL/AL-15-0004.pdf,Alabama Department of Senior Services. (2023). Alabama Personal Choices Participant Handbook (Rev. April 2023) — ADSS / alabamaageline.gov. alabamaageline.gov. Retrieved Sep 2, 2026, from https://alabamaageline.gov/wp-content/uploads/2023/04/PC-Handbook-2023.pdf
Agency-delivered care follows different Elderly and Disabled Waiver rules (Ala. Admin. Code r. 560-X-36-.04), and they don't say whether the bar on paying family for respite and companion services also applies when those services are self-directed.Centers for Medicare & Medicaid Services. (1915). Alabama SPA AL-15-0004 — CMS approval letter and approved Supplement 2 to Attachment 3.1-A pages (1915(j) Personal Choices statewide; approved 12-08-15, eff. 10/01/15) — medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://medicaid.gov/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/AL/AL-15-0004.pdf
What the Paid Worker Must Meet
Under the Elderly and Disabled Waiver's family caregiver rules, a self-directed personal care worker must be at least 18, have two verified references and pass the background checks required by law. On other waivers, ask that waiver's office below.Centers for Medicare & Medicaid Services. (1915). Alabama SPA AL-15-0004 — CMS approval letter and approved Supplement 2 to Attachment 3.1-A pages (1915(j) Personal Choices statewide; approved 12-08-15, eff. 10/01/15) — medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://medicaid.gov/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/AL/AL-15-0004.pdf
An Alabama Personal Choices participant may choose a representative to help with decisions and employer duties, and must have one if they're a minor or have a court-appointed guardian. The 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.Alabama Department of Senior Services. (2023). Alabama Personal Choices Participant Handbook (Rev. April 2023) — ADSS / alabamaageline.gov. alabamaageline.gov. Retrieved Jun 24, 2026, from https://alabamaageline.gov/wp-content/uploads/2023/04/PC-Handbook-2023.pdf
How the Personal Choices Budget Works
The Personal Choices budget is the plan of care's authorized hours or units times the service's cost in the waiver the Centers for Medicare & Medicaid Services (CMS) approved. In the Elderly and Disabled Waiver, personal care isn't an entitlement: hours follow the care plan, and the waiver states no fixed weekly cap for a family caregiver.Alabama Department of Senior Services. (2023). Alabama Personal Choices Participant Handbook (Rev. April 2023) — ADSS / alabamaageline.gov. alabamaageline.gov. Retrieved Jun 24, 2026, from https://alabamaageline.gov/wp-content/uploads/2023/04/PC-Handbook-2023.pdf,Centers for Medicare & Medicaid Services. (1915). Alabama SPA AL-15-0004 — CMS approval letter and approved Supplement 2 to Attachment 3.1-A pages (1915(j) Personal Choices statewide; approved 12-08-15, eff. 10/01/15) — medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://medicaid.gov/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/AL/AL-15-0004.pdf
Personal Choices takes 15% of the authorized amount for administration, including the required counseling and financial management services, and "the remaining 85% represents the net amount available for direct services and goods." The budget can pay a worker or be saved toward equipment purchases. Unspent monthly Personal Choices money belongs to Medicaid and doesn't roll over, except savings dollars, which must be spent by calendar year-end, so plan each month's hours with the full budget in mind.Alabama Department of Senior Services. (2023). Alabama Personal Choices Participant Handbook (Rev. April 2023) — ADSS / alabamaageline.gov. alabamaageline.gov. Retrieved Jun 24, 2026, from https://alabamaageline.gov/wp-content/uploads/2023/04/PC-Handbook-2023.pdf
Everyone uses the single contracted Financial Management Services Agency (FMSA) for timesheets, pay and tax filing, but the person stays the employer, responsible for wages and employer tax filings, with a Personal Choices Counselor to guide them.Alabama Department of Senior Services. (2023). Alabama Personal Choices Participant Handbook (Rev. April 2023) — ADSS / alabamaageline.gov. alabamaageline.gov. Retrieved Jun 24, 2026, from https://alabamaageline.gov/wp-content/uploads/2023/04/PC-Handbook-2023.pdf
What a Personal Choices Worker Can't Do
No paid Personal Choices worker may perform skilled medical or nursing services, even for Mom; doing so means involuntary termination from the program.Alabama Department of Senior Services. (2023). Alabama Personal Choices Participant Handbook (Rev. April 2023) — ADSS / alabamaageline.gov. alabamaageline.gov. Retrieved Jun 24, 2026, from https://alabamaageline.gov/wp-content/uploads/2023/04/PC-Handbook-2023.pdf
The handbook's skilled list includes preparing or giving medications by any route (a worker may only remind the person to take them), tube feeding, suctioning, wound or dressing care, and changing indwelling tubes or devices. If the person needs continuous skilled care, a qualified family member must be home while the worker is there.Alabama Department of Senior Services. (2023). Alabama Personal Choices Participant Handbook (Rev. April 2023) — ADSS / alabamaageline.gov. alabamaageline.gov. Retrieved Jun 24, 2026, from https://alabamaageline.gov/wp-content/uploads/2023/04/PC-Handbook-2023.pdf
How to Get Started as an Alabama Personal Choices Program Caregiver
1
Step 1
Check the waiver rules
In 2026, Alabama Medicaid's Elderly and Disabled, SAIL, Intellectual Disabilities and TA for Adults waivers have a $2,982 monthly income limit and a $2,000 resource limit, the same as nursing home care, and the person must need hospital, nursing facility or intermediate care facility level of care. See Alabama Medicaid income and asset limits, and, if married, the spousal rules in getting paid to care for a spouse.U.S. Social Security Administration. (2026). SSI Federal Payment Amounts for 2026. ssa.gov. Retrieved Aug 1, 2026, from https://www.ssa.gov/oact/cola/SSI.html
2
Step 2
Call the office for the waiver
in the table above and ask about Personal Choices. If the person isn't on Medicaid yet, start with how to apply for Alabama Medicaid.U.S. Social Security Administration. (2026). SSI Federal Payment Amounts for 2026. ssa.gov. Retrieved Aug 1, 2026, from https://www.ssa.gov/oact/cola/SSI.html
3
Step 3
Get the plan of care
, which sets the authorized hours or units the budget is built from.Alabama Department of Senior Services. (2023). Alabama Personal Choices Participant Handbook (Rev. April 2023) — ADSS / alabamaageline.gov. alabamaageline.gov. Retrieved Jun 24, 2026, from https://alabamaageline.gov/wp-content/uploads/2023/04/PC-Handbook-2023.pdf
4
Step 4
Meet the Personal Choices Counselor
, who enrolls the person and completes the Personal Support Plan and Monthly Spending Plan with them.Alabama Department of Senior Services. (2023). Alabama Personal Choices Participant Handbook (Rev. April 2023) — ADSS / alabamaageline.gov. alabamaageline.gov. Retrieved Jun 24, 2026, from https://alabamaageline.gov/wp-content/uploads/2023/04/PC-Handbook-2023.pdf
CDPAP is New York's Consumer Directed Personal Assistance Program, and New York law bars a spouse from being the paid personal assistant. Alabama uses Personal Choices instead, which can pay a qualified spouse.Office of the Federal Register. (2008). CMS Final Rule — Self-Directed Personal Assistance Services Program State Plan Option (Cash and Counseling), 73 FR 57854 (Oct. 3, 2008). federalregister.gov. Retrieved Sep 2, 2026, from https://www.federalregister.gov/documents/full_text/text/2008/10/03/E8-23102.txt,Alabama Department of Senior Services. (2023). Alabama Personal Choices Participant Handbook (Rev. April 2023) — ADSS / alabamaageline.gov. alabamaageline.gov. Retrieved Jun 24, 2026, from https://alabamaageline.gov/wp-content/uploads/2023/04/PC-Handbook-2023.pdf,Centers for Medicare & Medicaid Services. (1915). Alabama SPA AL-15-0004 — CMS approval letter and approved Supplement 2 to Attachment 3.1-A pages (1915(j) Personal Choices statewide; approved 12-08-15, eff. 10/01/15) — medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://medicaid.gov/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/AL/AL-15-0004.pdf
Find personalized help getting set up as a paid Personal Choices 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.
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