Page Reviewed / Updated – March 6, 2024

Waiver Description

Alabama’s Elderly and Disabled (E&D) Waiver program, a Home and Community-Based Services (HCBS) Medicaid Waiver, gives seniors who are frail, high-needs, and would qualify to be admitted to a 24-hour skilled nursing facility a way to afford care assistance outside of this setting. This waiver offers seniors 65 years of age and over, as well as disabled Alabama 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 care hours provided at home can never match the level of a residential medical center, seniors can receive added help from friends and family caregivers to make sure 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. In some situations, an adult child, or even one’s spouse, can be hired to provide care. 

The E&D waiver is administered by the Alabama Department of Senior Services (ADSS) and the Alabama Medicaid Agency (AMA).

Eligibility Guidelines

General Requirements

In order to qualify for the Elderly and Disabled Medicaid Wavier, one must be a resident of Alabama, be disabled or elderly (65 years old+), and require a level of assistance consistent with nursing home care. Seniors typically must demonstrate that they need partial or total assistance with some of their activities of daily living. Examples include getting food into their mouth, the ability to move from a bed to a wheelchair, and correctly administering their medications. Other examples that indicate that a nursing home level of care is required are the regular use of oxygen, behavioral issues associated with Alzheimer’s disease and related dementias, such as frequent wandering, and extensive bedsores.  

Financial Requirements

Income Limits

Applicants also must qualify financially. In 2024, an applicant must have a gross monthly income of less than $2,829. (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 $2,829 a month in income. For married applicants with non-applicant spouses, only the applicant’s income is counted. Said another way, the income of a wife or husband who is not applying for Medicaid is not counted toward Medicaid’s income limit for the applicant spouse.

Furthermore, applicant spouses are able to transfer a portion of their income to their non-applicant spouse to ensure they have sufficient funds from which to live. This spousal impoverishment provision is called the Minimum Monthly Maintenance Needs Allowance (MMMNA). From July 2023 – June 2024, applicant spouses may be able to transfer up to $2,465 in monthly income to their non-applicant spouse. (This figure will increase in July of 2024). This is intended to get the non-applicant spouse’s monthly income up to this level. If he / she has income equal to or greater than the MMMNA (currently $2,465), the applicant spouse is not able to transfer any of his / her income to the non-applicant spouse.

Those who are over the income limit may still qualify by setting up a special income trust account. It is also called a Miller Trust or a Qualified Income Trust (QIT). In simple terms, applicants are able to direct some of their income only toward medical or care costs.

Asset Limits

In addition to the income criteria, the countable asset (resource) limit is $2,000 if the applicant is single or has a spouse who is not also applying for Medicaid. If married, and both spouses are applying for the E&D waiver, the asset limit is $4,000. (Each spouse is able to keep up to $2,000 in assets.) 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 (not counted toward the asset limit), such as personal items, a vehicle, and one’s home, given the applicant lives in it and his / her home equity interest (the value of the home minus any remaining mortgage) is valued under $713,000 (in 2024). The home is also exempt, regardless of applicant circumstances, if a spouse lives in the home.

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 and other assets from spend down. This is called the Community Spouse Resource Allowance (CSRA).

Currently, the non-applicant spouse can keep 50% of the couple’s assets, up to $154,140 (as of 2024). If the couple’s assets are under $30,828, the non applicant spouse can keep all of the assets, up to this amount. This is in addition to the $2,000 the applicant spouse is able to keep.

Please Note: The term “spend down” refers to spending down one’s excess assets to meet the E&D’s asset limit. 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.

Over the Financial Limits?

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 their assets and income in line with the requirements. These individuals are knowledgeable about Medicaid law nuances in each state and can help to restructure an individual’s or family’s excess income into Miller income trusts and maximize exempt (non-countable) assets.  Find assistance to prepare for Medicaid.

Benefits and Services

The E&D Waiver’s objective is to assist persons living outside of nursing homes and to help their loved one’s provide care for them. Accordingly, the benefits are selected to help the individual, their family, and caregivers achieve this goal. Under this waiver, candidates are eligible to receive the following types of care and support.

  • Adult Day Health (Adult Day Care) – Education, health screening, therapeutic and recreational activities, transportation, etc.
  • Case Management
  • Non-Medical Companion Services – In addition to providing companionship and supervision, limited assistance with personal care and homemaker tasks may be provided. 
  • Home Delivered Meals – Frozen meals, shelf-stable meals, and breakfast meals.
  • Homemaker Services – Meal preparation, house cleaning, laundry, grocery shopping, picking up prescription drugs, etc.
  • Personal Care – Aid with Activities of Daily Living (ADLs), such as dressing oneself, bathing, toileting, eating, etc. Along with personal care, Aid with Instrumental Activities of Daily Living (IADLs), such as preparing meals, laundry, and housekeeping may be included. 
  • Skilled and Unskilled Respite Care – Provided in the eligible individual’s home.

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How to Apply / Learn More

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 eligibility requirements of the E&D waiver, they still might not be able to receive services. There are a limited number of participant slots available, so in some areas, there may be waiting lists for services. To learn more, see 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.