Page Reviewed / Updated - Dec. 2018
Alabama’s Elderly and Disabled (E & D) Medicaid Waiver program gives seniors who are frail, high-needs, and would qualify to be admitted to a 24-hour skilled nursing facility a way to afford to live outside of a nursing home. This waiver offers those who are 65 years of age and over, as well as disabled residents, financial assistance for ongoing personal care services at home or in the home of a friend or family member. Although the level of care and number of hours of care provided at home can never match the level of a residential medical center, seniors can receive additional help from friends and family caregivers to make sure that they are safe living at home. At the time of their application, seniors can be living at home, in the community, or within a skilled nursing home.
Under this waiver, individuals decide whether to have the state manage their care services or to self-direct their care services via a program called Personal Choices. Self-direction may also be referred to as consumer direction, participant direction, or the Cash and Counseling model. So long as the organization or the individual is a qualified waiver provider, an individual may choose that caregiver, including friends and relatives. However, there is one exception, spouses are not able to provide care.
The E & D waiver is administered by the Alabama Department of Senior Services and the Alabama Department of Public Health.
In order to qualify for the Elderly and Disabled Medicaid Wavier, one must be a resident of Alabama, be disabled or elderly, and require a level of assistance consistent with nursing home care. Seniors typically must demonstrate that they require partial or total assistance with some of their activities of daily living. Examples include safely getting washed up, the ability to move from a bed to a wheelchair, and correctly administering their medications.
Applicants must also qualify financially. In 2019, this means that an applicant must have gross monthly income less than $2,313. (This figure is equivalent to 300% of the SSI Federal Benefit Rate). If both spouses are applying for the E & D waiver, each spouse is considered as a single applicant. This means that each spouse can have up to $2,313 / month in income. Those who are over the income limit may still qualify by setting up a special income trust account, also called a Miller Trust or a Qualified Income Trust (QIT). In simple terms, applicants are able to direct some of their income exclusively towards medical or care costs. Married applicants with non-applicant spouses only count income in their name. Said another way, the income of a wife or husband who is not applying for Medicaid is not counted.
In addition to the income criteria, the countable asset (resource) limit is $2,000 if the applicant is single. If married, and both spouses are applying for the E & D waiver, the asset limit is $4,000. (Each spouse is able to retain up to $2,000 in assets).However, unlike with income, when only one spouse of a married couple is applying for Medicaid, assets are considered jointly owned. (Click here to learn more about how Medicaid views joint assets). That said, some assets are considered exempt, such as personal items, a vehicle, and one’s home, given the applicant or the applicant’s spouse lives in it and it is valued under $585,000 (in 2019). In addition, there are financial protections for an applicant’s spouse, given the spouse is not also applying for the Medicaid waiver. With this protection, the non-applicant spouse, also called the community spouse, is permitted to protect some of the couple’s savings from spend down. Currently, the maximum amount the non-applicant spouse is able to retain is $126,420.
Please note: The term “spend down” refers to spending down one’s excess assets to meet the E & D’s asset limit. Note:When “spending down”, it is very important that one does not gift assets or sell them for less than they are worth. This is because Medicaid has a look back period, which is 5-years in Alabama. During this time frame, all past asset transfers are reviewed and if one has given assets away or sold them for under fair market value, it is a violation of the look back period. The penalty for violating this rule is a period of Medicaid ineligibility.
For some families, while their income and assets exceed the eligibility limits, they still cannot afford the cost of care. There is the option of working with a professional Medicaid planner to bring assets and income in line with the requirements. These individuals are knowledgeable about Medicaid law nuances in each state and can help to re-structure an individual's or family's excess income into Miller income trusts and maximize exempted assets. Find assistance to prepare for Medicaid.
The E&D Waiver's objective is to assist persons to live outside of nursing homes and to assist their loved one's in helping to care for them. Accordingly the benefits are selected to help the individual, their family and caregivers achieve this objective. Under this waiver, candidates are eligible to receive the following types of care and support.
The Elderly & Disabled Medicaid waiver is available statewide throughout Alabama. However, it is not an entitlement, like Medicaid's nursing home benefits. This means that even if one meets all of the requirements of the E & D waiver, they still might not be able to receive services. There are a limited number of slots available (9,355 in 2019), so in some areas there may be waiting lists for services. To learn more, download the rules and regulations here.
One can apply online for Medicaid in Alabama or by contacting their local Area Agency on Aging. To apply specifically for this waiver, persons who are already enrolled in Medicaid can call 1-800-AGE-LINE or 1-800-243-5463.