Alabama Personal Choices Program

Page Reviewed / Updated - Feb. 2014

What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through "Medicaid Waivers" which are also called Home and Community Based Services (HCBS Waivers) or Waiver Funded Services.

Program Description

Based on the Cash and Counseling model, this program offers qualified, Alabama seniors and disabled individuals the option to select and manage their own care providers. This program is open is Medicaid participants that are currently receiving services under the SAIL Program Waiver or the Elderly and Disabled Waiver.

The Personal Choices program works by re-allocating the money designated for services provided under the Medicaid waivers to the individuals themselves and allows them to direct their own care services. To be clear, cash payments are made to an intermediary financial management agency and then to the care providers of the participants choosing. Participating individuals no longer receive care from Medicaid.

This type of program, in which the consumer directs their own care, is referred to by many names, including participant direction, self-directed care and cash and counseling. These programs are growing in popularity in part because certain family members can be hired a personal care providers, with the requirement that they are over 18 years of age and pass a basic screening test.

 This program is currently available only in 7 counties of Western Alabama: Bibb, Fayette, Greene, Hale, Lamar, Pickens and Tuscaloosa and 2 counties in Southern Alabama: Baldwin and Mobile.


Eligibility Guidelines

To qualify for the Personal Choices program, individuals must enroll (or be enrolled) in Medicaid and be receiving care under the Sail-Homebound Program Waiver or the Elderly and Disabled Waiver.  In addition to these waivers' functional requirements (nursing home level care), they have financial requirements.

Income Limits - These change each year. For 2014, individual income cannot exceed $2,163 / month. However, if only one spouse of a married couple is applying, their joint income can be shifted to provide a livable budget for the non-applicant as well as help the applicant to qualify.

Asset Limits - These typically do not change as frequently as the income limit. For the last few years, the limit for a single applicant has been $2,000. However, non-applying spouses can retain up to $117,240 in assets and this does not include the value of their home provided it is lived in by the owner(s).

Past Asset Transfer Considerations - This is an important factor. The state will review an applicant's financial transfers as far back as 60 months preceding their application to verify they did not give away assets simply to qualify for Medicaid.

Being over the limits in Alabama does not necessary mean one can afford their care nor does it preclude one from qualifying. There are Medicaid planning experts that help families qualify by converting their countable assets into exempt assets and establishing trusts into which excessive income can be allocated. Find assistance in qualifying for Medicaid.


Benefits and Services

The program pays cash to a Financial Management Service Agency in place of providing services. The Service Agency in turn makes payments to care providers as determined by an agreed upon plan between the participant and their Personal Choice Program Counselor. Plans can include the following types of care.

  • Home Health Care
  • Personal Care
  • Respite Care
  • Homemaker Services
  • Companion / Accompaniment Services



How to Apply / Learn More

To apply for the program, contact the West Alabama Regional Area Agency on Aging or South Alabama Area Agency on Aging.  More information about the program is available on the Alabama Personal Choices webpage.