Page Reviewed / Updated - Jan. 2017
Alabama’s Medicaid program gives seniors a way to afford to live outside of a nursing home for frail and high-needs individuals who would qualify to be admitted to a 24-hour, skilled nursing facility. The Elderly and Disabled Medicaid Waiver offers 65 and over, or 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 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 outside of the nursing home. At the time of their application, seniors can be either at home, in the community, or currently living 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. 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.
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, such as a safely getting washed up or correctly administering their medications.
Applicants must also qualify financially. In 2017, this means that an applicant must have gross monthly income less than $2,205. Individuals over the income limit may set up a special income trust account to direct some of their income exclusively towards medical or care costs. Married applicants only count income in their name, not their wife’s or husband’s income.
In addition to the income criteria, the countable asset limit is $2,000, if the applicant is single. If married, the limit is $3,000. There are financial protections for the applicants’ spouses, where they are permitted to protect some of their savings from spend down. Currently, the maximum allowed to be protected is $120,900.
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 program is available statewide throughout Alabama. However, it is not an entitlement, like Medicaid's nursing home benefits. There are a limited number of slots available (9,205 in 2007), so in some areas there may be waiting lists for services. To learn more, download the rules and regulations here. One can apply online or by contacting their local Area Agency on Aging.