The Alabama Community Transition (ACT) Medicaid Waiver provides services for persons who are currently residing in a nursing home but wish to relocate to their own home or the home of a friend or relative. ACT also serves those who are currently receiving services via an Alabama Medicaid Waiver, such as the Elderly and Disabled Medicaid Waiver or the State of Alabama Independent Living Medicaid Waiver, but whose needs are not being met. Furthermore, without services provided by ACT, the individual almost inevitably would require nursing home care.
The ACT Waiver does not have an age restriction. Therefore, it is relevant for frail seniors, disabled individuals, and those with long-term illnesses. The primary medical requirement is that one requires the level of care provided in a nursing home. There is no list of specific illnesses that qualify or eliminate an applicant. Therefore, it is likely that a person with early- to mid-stage Alzheimer’s Disease or Parkinson’s Disease will meet the medical requirement.
Services and benefits available via ACT are intended to promote a participant’s independence in their home or the home of a loved one. To be clear, program participants cannot live in assisted living residences or adult foster care homes. Available services might include homemaker and personal care assistance, adult day health, assistive technology, home modifications, and more. There is also an option for program participants to direct their own care services, often called consumer direction or self-direction, through Alabama’s Personal Choices program. In some cases, an adult child, or even a spouse, can be hired to provide care.
The Alabama Community Transition Medicaid Waiver is a statewide program that is administered by the Alabama Department of Senior Services (ADSS).
What is a Medicaid Waiver?
Medicaid Waivers, also known as Home and Community Based Services (HCBS) Waivers and Waiver Funded Services, allow qualifying program participants to receive services outside of a nursing home. Medicaid’s standard benefit is to pay for nursing home residential care. However, when available, Medicaid Waivers help to provide more options for individuals. The cost of the care outside of a nursing home needs to be less than the cost of care in a nursing home.
Applicants must be residents of Alabama who require a nursing facility level of care. They must currently reside in a nursing home or another institutional setting, such as a hospital. One exception to the nursing home resident rule, as mentioned above, is made for individuals who are receiving services via an Alabama HCBS Medicaid Waiver and are at risk of being placed in a nursing facility if they do not receive ACT services.
The income limit is set at 300% of the current SSI Federal Benefit Rate (FBR). As of 2023, this figure is equivalent to $2,742 / month ($32,904 / year) for an individual. For married applicants whose spouse is not also applying for Medicaid, there are protections in place to prevent their non-applicant spouse from becoming impoverished. While the applicant spouse’s income limit is still $2,742 / month, the non-applicant spouse’s income does not count toward eligibility purposes. This means a non-applicant spouse (often called a community spouse) is able to retain all of his / her income.
In addition, there is a minimum monthly maintenance needs allowance (MMMNA) in place for community spouses who have little to no monthly income of their own. The MMMNA permits applicant spouses to transfer as much as $2,288.75 (effective July 2023 – June 2024) in monthly income to their non-applicant spouse. The idea is to bring the non-applicant spouse’s total monthly income to this level.
There is also an asset limit, which is $2,000 for a single applicant. However, several higher value assets are considered exempt or, said a different way, they are not counted toward Medicaid’s asset limits. These include one’s primary home — as long as the program participant is living in the home or intends to return to the home and his / her equity interest is not valued over $688,000 (as of 2023) — one vehicle, and some sentimental items, such as one’s engagement and wedding rings.
To further help the applicant’s spouse, he / she is allowed a community spouse resource allowance (CSRA), which enables the non-applicant spouse to retain a higher amount of the couple’s joint assets. In 2023, non-applicant spouses are able to keep up to $148,620 in countable assets.
Over the Financial Limits?
There are options for applicants who are over the income / asset limit(s). As Medicaid eligibility can be very complicated, it is highly recommended that individuals who are over the limit(s) consult a Professional Medicaid Planner. They are trained to assist applicants who find themselves in this very situation and are well versed in reallocating income and assets so that they do not count toward the limit(s). For instance, extra income can be deposited into a Miller Trust, also referred to as a Qualified Income Trust, and an Irrevocable Funeral Trust can be used to lower one’s countable assets.
Did you know?
Medicaid has a look back period in which all past asset transfers are reviewed to ensure they were not gifted or sold for less than they are worth in an attempt to meet Medicaid’s asset limit. In Alabama, the look back period is 60 months preceding the date of one’s Medicaid application. Violating the look back period results in a penalty in the form of Medicaid ineligibility.
Benefits and Services
In addition to case management and transitional services (limited to $3,500), a variety of supportive benefits and services are available via ACT. As mentioned above, consumer direction of some services, such as personal care assistance, homemaker assistance, companionship care, and unskilled respite care, is an option.
- Adult Day Health / Adult Day Care (includes transportation to and from the adult day facility)
- Homemaker Services (assistance with light housecleaning, meal preparation and cleanup, laundry, grocery shopping, etc.)
- Personal Care Services (assistance with bathing, dressing/undressing, personal hygiene, mobility, etc.)
- Respite Care (skilled & unskilled – to provide one’s primary caregiver a break from their caregiving duties)
- Companionship Services (supervision and limited personal care / homemaker services)
- Assistive Technology ($15,000 lifetime limit)
- Meal Delivery (frozen and shelf-stable)
- Skilled Nursing
- Home Modifications ($5,000 lifetime limit)
- Personal Emergency Response Systems (installation & monthly fees)
- Medical Supplies ($1,800 / year limit)
- Pest Control Service
How to Apply / Learn More
To learn more about the Alabama Community Transition Medicaid Waiver, click here. One can also contact the Alabama Department of Senior Services at 1-800-243-5463 (1-800-AGE-LINE) for additional information or to apply.