Alabama Medicaid helps pay for care at home, not only in a nursing home, mainly through its Home and Community-Based Waiver for the Elderly and Disabled (E&D Waiver).Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov — Alabama Waiver Factsheet (1915(c) waivers, incl. Elderly and Disabled 0068.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AL
Alabama Medicaid HCBS waivers are the state's way of covering home- and community-based services (HCBS) for people who would otherwise need nursing-facility care. The E&D Waiver serves adults 65 and older and people with physical or other disabilities who meet a nursing-facility level of care, and it pays for help such as personal care, homemaker services, and adult day health so a person can keep living at home.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov — Alabama Waiver Factsheet (1915(c) waivers, incl. Elderly and Disabled 0068.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AL
In This Guide
- What Alabama Medicaid HCBS Waivers Are
- The Programs, One at a Time
- Who Qualifies for an Alabama HCBS Waiver
- What These Waivers Cover
- How Enrollment Works
- How to Apply for Alabama Medicaid HCBS Waivers
What Alabama Medicaid HCBS Waivers Are
Home- and community-based services, almost always shortened to HCBS, are the long-term care supports that Medicaid pays for outside an institution: in your own home, a family member's home, or another community setting rather than a nursing facility. States deliver them under a federal authority called a Section 1915(c) waiver, which lets a state "waive" certain Medicaid rules so it can fund home care for people who would otherwise qualify for institutional care.
Alabama uses that authority to run several 1915(c) waivers, operated by the Alabama Department of Senior Services (ADSS) under the state's single Medicaid agency.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov — Alabama Waiver Factsheet (1915(c) waivers, incl. Elderly and Disabled 0068.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AL The common thread across every one of them is the "but for" idea behind HCBS: the person's needs would otherwise require care in a nursing facility, and the waiver funds services at home instead.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov — Alabama Waiver Factsheet (1915(c) waivers, incl. Elderly and Disabled 0068.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AL
The Programs, One at a Time
Alabama does not run a single HCBS program. It runs a small set of waivers plus a self-direction option, each aimed at a different group. Here is how they line up.
| Program | Who it serves | What it does |
|---|---|---|
| E&D Waiver | Adults 65+ and people with physical or other disabilities at risk of nursing-facility placement | The main home-care waiver: personal care, homemaker, respite, adult day health, and more |
| Independent-living waiver for younger adults (SAIL) | Adults with physical disabilities ages 18 to 63 who meet a nursing-facility level of care | Independent-living supports for younger adults with physical disabilities |
| Community-transition waiver (ACT) | People currently living in a nursing facility who want to return to the community | Helps a person transition from a facility back to a home or community setting |
| Personal Choices | Older adults and people with disabilities | Self-directed option: use an allotted budget to arrange your own personal care |
The Home and Community-Based Waiver for the Elderly and Disabled (E&D Waiver) is the one most families come looking for. It serves people ages 65 or older and individuals with physical or other disabilities who are at risk for nursing-facility placement, and a case manager builds a person-centered plan of care around each participant's needs.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov — Alabama Waiver Factsheet (1915(c) waivers, incl. Elderly and Disabled 0068.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AL
Alabama's independent-living waiver for adults with physical disabilities ages 18 to 63 (the SAIL waiver) covers people who meet a nursing-facility level of care, filling the gap for younger adults who need home supports.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov — Alabama Waiver Factsheet (1915(c) waivers, incl. Elderly and Disabled 0068.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AL A community-transition waiver (the ACT waiver) works in the other direction: it helps someone who is already living in a nursing facility move back to a home or community setting.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov — Alabama Waiver Factsheet (1915(c) waivers, incl. Elderly and Disabled 0068.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AL
Personal Choices is not a separate waiver but Alabama's self-directed, or consumer-directed, option. It gives older adults and people with disabilities more choice and flexibility by letting them use an allotted budget to arrange their own personal care instead of relying only on an agency schedule.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov — Alabama Waiver Factsheet (1915(c) waivers, incl. Elderly and Disabled 0068.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AL
Who Qualifies for an Alabama HCBS Waiver
Qualifying for a waiver takes two separate tests, one medical and one financial. You have to clear both.
The medical, or functional, test is a nursing-facility level of care. In plain terms, a person must need the kind of daily help that would otherwise justify care in a nursing home, which is what makes the waiver an alternative to that placement.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov — Alabama Waiver Factsheet (1915(c) waivers, incl. Elderly and Disabled 0068.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AL For the E&D Waiver, that applies to people ages 65 and older and to people with physical or other disabilities who are at risk of nursing-facility placement.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov — Alabama Waiver Factsheet (1915(c) waivers, incl. Elderly and Disabled 0068.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AL
The financial test is the second gate. To receive waiver services, a person must already have Medicaid coverage or meet Alabama's financial eligibility criteria.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov — Alabama Waiver Factsheet (1915(c) waivers, incl. Elderly and Disabled 0068.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AL For 2026, the E&D Waiver income limit for a single applicant is $2,982 a month, and the countable-resource limit is $2,000. These are the same institutional-Medicaid financial standards Alabama uses for nursing-home coverage, so a person who would qualify financially for a nursing home generally meets the waiver's money test too.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov — Alabama Waiver Factsheet (1915(c) waivers, incl. Elderly and Disabled 0068.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AL
What These Waivers Cover
The E&D Waiver is built around keeping someone safely at home, so its covered services are the practical, day-to-day supports that make that possible. Under a plan of care developed by a case manager, a participant may receive:Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov — Alabama Waiver Factsheet (1915(c) waivers, incl. Elderly and Disabled 0068.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AL
- Personal care (help with bathing, dressing, and other daily activities)
- Homemaker services
- Respite, both skilled and unskilled, to give family caregivers a break
- Adult day health
- An adult companion service
- Home-delivered meals
- Home modifications
- Medical supplies
- Personal emergency response systems
- Skilled nursing
Not every waiver offers every service, and a case manager authorizes only what your plan of care supports. The point of the array is flexibility: the mix is meant to be assembled around one person's actual situation rather than handed out as a fixed package.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov — Alabama Waiver Factsheet (1915(c) waivers, incl. Elderly and Disabled 0068.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AL
How Enrollment Works
Enrollment runs through a case manager and a person-centered plan of care. Once someone is found eligible on both the medical and financial tests, a case manager assesses their needs and builds a plan that spells out which services they will receive and how often.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov — Alabama Waiver Factsheet (1915(c) waivers, incl. Elderly and Disabled 0068.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AL The plan is meant to be reviewed and adjusted as needs change, so it is not a one-time form but the document that governs the care.
Because a waiver requires both Medicaid eligibility and a nursing-facility level of care, the earliest step is usually a call to your local aging office, which can walk you through the screening and the application. That contact point is the same for every one of Alabama's waivers.
How to Apply for Alabama Medicaid HCBS Waivers
You can start an application, or simply ask questions about waiver services, through your local Area Agency on Aging (AAA) or Aging and Disability Resource Center (ADRC), reached at 1-800-AGE-LINE (1-800-243-5463).Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov — Alabama Waiver Factsheet (1915(c) waivers, incl. Elderly and Disabled 0068.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AL The waivers themselves are operated by the Alabama Department of Senior Services, and financial Medicaid eligibility is determined by the Alabama Medicaid Agency, so an application often touches both.
Once you file a Medicaid application, federal rules cap how long the state can take to decide it. Under federal Medicaid regulations, an eligibility determination may not exceed 45 calendar days for most applicants, or 90 calendar days for applicants who apply on the basis of disability, except in unusual circumstances such as a delay the applicant causes.U.S. Government Publishing Office. (2024). 42 CFR 435.912 Timely determination and redetermination of eligibility (2024 ed.) — govinfo.gov. govinfo.gov. Retrieved Jun 25, 2026, from https://www.govinfo.gov/content/pkg/CFR-2024-title42-vol4/pdf/CFR-2024-title42-vol4-sec435-912.pdf Knowing that timeline helps you gauge when to follow up if you haven't heard back.
Frequently Asked Questions
Can I hire and direct my own caregivers?
In many cases, yes. Alabama offers a self-directed option called Personal Choices, which lets older adults and people with disabilities use an allotted budget to arrange their own personal care rather than relying only on an agency's schedule.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov — Alabama Waiver Factsheet (1915(c) waivers, incl. Elderly and Disabled 0068.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AL It is designed to give participants more choice and flexibility over the type of care they receive. Ask your case manager whether Personal Choices fits your situation.
Do these waivers pay for a nursing home?
No. Home- and community-based services (HCBS) waivers exist to fund care in your own home or community for people who would otherwise need nursing-facility care, which is a different part of Alabama Medicaid.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov — Alabama Waiver Factsheet (1915(c) waivers, incl. Elderly and Disabled 0068.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AL If a nursing home is the right setting, see our guide to Alabama Medicaid and nursing home care; the E&D Waiver is the alternative that keeps care at home.
Will my income and savings count against me?
Alabama applies a financial test to waiver applicants. For 2026, the Elderly and Disabled (E&D) Waiver income limit for a single applicant is $2,982 a month and the countable-resource limit is $2,000, the same standards used for nursing-home Medicaid.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov — Alabama Waiver Factsheet (1915(c) waivers, incl. Elderly and Disabled 0068.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AL For how income and assets are counted, and which assets don't count, see our Alabama Medicaid income and asset limits guide.
How do I actually start the process?
Call your local Area Agency on Aging (AAA) or Aging and Disability Resource Center (ADRC) at 1-800-AGE-LINE (1-800-243-5463).Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov — Alabama Waiver Factsheet (1915(c) waivers, incl. Elderly and Disabled 0068.R08.00). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AL They can explain waiver services, help with screening, and point you to the financial Medicaid application. Our how to apply for Alabama Medicaid guide walks through the full application step by step.
Learn More
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.