State of Alabama Independent Living (SAIL) Medicaid Waiver

Page Reviewed / Updated - Dec. 2018

Waiver Description

The State of Alabama Independent Living (SAIL) Medicaid waiver, previously called the Homebound Waiver, is designed to help disabled individuals remain living in their homes or community instead of moving into a skilled nursing facility. Elderly residents of Alabama are eligible should they meet the medical requirement. For instance, neurological conditions, such as Parkinson’s disease, stroke, and Alzheimer’s disease meet the medical diagnosis requirements. To help an individual move out of nursing home care and back into the community, the waiver provides case management and may also pay for assistive technology, personal care services, and changes to the participant’s place of residence, such as making the home wheelchair accessible, in order to increase a disabled individual’s ability to live independently.

A Medicaid-certified home health agency must operate the personal care services unless there is no such service available in the individual’s geographic area. In this situation, the participant may select friends, neighbors, and some family members to be compensated for the personal care services they provide. However, children, spouses, and parents are barred from being paid as caregivers.

The SAIL waiver is administered by the Alabama Medicaid Agency and is operated by the Alabama Department of Rehabilitation Services (ADRS). Also, to avoid confusion, note that there are 3 sub-programs under this waiver: Homebound Services, SAIL Medicaid Waiver, and Independent Living Support.

The SAIL waiver takes part in the Personal Choices Program, which allows individuals to direct their own personal care. Another Alabama Medicaid program that might be of interest is the Elderly and Disabled Waiver.

Eligibility Guidelines

To be eligible for the SAIL Medicaid waiver, individuals must be at least 18 years old and have a physical disability that requires nursing home level care. This disability must not be related to aging and must have an onset before the age of 60.

As mentioned above, qualified applicants must require nursing home level care. However, under this waiver, the individual lives at home or must be willing to move from a skilled nursing facility back to their home or that of a family member to receive personal care and home health services. In addition, applicants have to be financially eligible to receive Medicaid HCBS (waivers). This means that they must demonstrate that their monthly income and current savings are below certain levels.

2019 Alabama Medicaid Waiver Income Limits
Individual applicants are limited to a monthly income of no more than $2,313, and for married couples in which both spouses are applying for benefits, the monthly income limit is $4,626. (Each spouse is considered as an individual applicant. Therefore, each spouse is allowed up to $2,313 / month in income). This figure is equivalent to 300% of the SSI Federal Benefit Rate. However, if the applicant is married and his/her spouse is not applying for Medicaid, the applicant spouse (also called the community spouse) can allocate some of his/her joint income to the non-applicant spouse as a living stipend. This is known as the minimum monthly maintenance needs allowance (MMMNA), and as of 7/1/18, up to $2,058 can be transferred from the applicant spouse to the non-applicant spouse.

Individuals over the income limits for Alabama Medicaid can also set up a Qualified Income Trust(QIT). Often called Miller Trusts, applicants can become eligible for Medicaid once they demonstrate that the trust is properly set up and being administered correctly.

2019 Alabama Medicaid Waiver Asset Limits

The asset limit for a single applicant is $2,000, and the asset limit for a married couple in which both spouses are applying for benefits is $4,000. (Each spouse is considered as an individual applicant. Therefore, each spouse is allowed up to $2,000 in assets). In the situation where only one spouse of a married couple is applying for the SAIL waiver, the non-applicant spouse is permitted up to $126,420 in countable assets. This is known as the community spouse resource allowance (CSRA).Please note: The asset limit can be somewhat misleading in that many resources are, or can be, considered exempt. For example, the full value of one’s home is exempt, provided the applicant or their spouse lives there, or a single applicant plans to return to the home, and it is valued under $585,000. A car, burial plots, burial fund up to $5,000, household items, and even some personal effects are also exempt.

Those over the asset limit need to exercise caution when “spending down” resources in order to meet Medicaid’s asset limit. Medicaid has a look back period (60-months in Alabama) in which Medicaid considers all past assets transferred within the specified timeframe. If an applicant is found to have given away assets or sold them for less than they are worth, the applicant will be penalized with a period of Medicaid ineligibility.

Benefits and Services

As implied by the words "Independent Living" in the Waiver name, the services provided under this waiver are selected to help participants achieve that objective.

• Assistive Technology Needs Evaluations
• Assistive Technology and Devices - Hearing aids, vehicle modifications, etc.
• Transitional Assistive Technology - May include wheelchairs, hospital beds, and Hoyer lifts
• Assistive Technology Repairs - Replacing parts/batteries of assistive technology bought for the individual previously by Medicaid
• Case Management Services
• Environmental Accessibility Adaptations / Home Modifications - Ramp installation, adding grab bars, and widening doorways
• Medical Supplies
• Personal Care Services - Assistance with activities of daily living, such as bathing, eating, and dressing, aid in preparing meals, basic housecleaning, etc.
• Personal Emergency Response System - Installation and monthly charge
• Personal Assistance Service - Transportation, monitoring of medication, shopping, etc.
• Medical Supplies 

How to Apply / Learn More

One should contact the Alabama Medicaid office at 1-800-362-1504 to learn more about this waiver program and begin the application process. One can also learn more about the SAIL waiver here. While open to residents statewide, participation may be limited due to enrollment caps on the program. (At the time of this writing, wavier slots were capped at 660.)  Also, the senior’s local Area Agency on Aging may be an additional information resource to learn whether this program is right for you or your loved one.