Quick answer: For most older adults, Alabama's main Medicaid home care program is the Elderly & Disabled (E&D) Waiver. In 2026, income can't exceed $2,982 a month, countable resources must be $2,000 or less on the first day of the month, and the applicant must need nursing-facility level of care.

At a glance (2026)

Monthly income limit, Elderly & Disabled (E&D) Waiver
$2,982 (300% of the SSI rate)
Countable resource limit, individual
$2,000, measured on the first day of the month
Medical requirement
Nursing-facility level of care
Who runs the E&D Waiver
Alabama Department of Senior Services (ADSS), through local Area Agencies on Aging
Enrollment
Limited slots; a waiting period is possible

How Alabama's Medicaid home care waivers work

Alabama Medicaid pays for care at home through home and community-based services (HCBS) waivers. A waiver lets someone who would otherwise qualify for a nursing home get help where they live. Alabama runs seven of them. Four use a nursing-facility level of care standard:

  • the Elderly and Disabled (E&D) Waiver
  • the Alabama Community Transition (ACT) Waiver
  • the State of Alabama Independent Living (SAIL) Waiver
  • the Technology Assisted (TA) Waiver for Adults

The Intellectual Disabilities (ID), Living at Home (LAH) and Community Waiver Program (CWP) waivers serve people who meet an intermediate-care-facility standard for intellectual disabilities instead.

For most older adults, the E&D Waiver is the main program. In 2026 the applicant's income can't exceed $2,982 a month, and countable resources must be $2,000 or less on the first day of the month. The applicant must also meet nursing-facility level of care. Covered services include:

  • case management
  • homemaker and personal care services
  • skilled and unskilled respite
  • adult day health and companion services
  • home-delivered meals, medical supplies and skilled nursing
  • a personal emergency response system
  • minor home modifications

Personal Choices is Alabama's self-directed option inside the waivers. A participant can hire and manage their own caregivers, sometimes including a family member, instead of using an agency. For E&D participants, Personal Choices starts through the local Area Agency on Aging.

If income is over $2,982: Alabama is an income-cap state. An applicant with more income can still qualify by setting up a Qualified Income Trust (a "Miller trust") and depositing the excess each month.

If a spouse stays at home: spousal impoverishment rules protect part of the couple's assets and income for the at-home spouse. The 2026 federal maximum resource allowance is $162,660.

Example

Ruth, 82, lives alone in Huntsville. She gets $1,900 a month from Social Security and a small pension, and has $1,600 in checking. After a fall, she needs daily help with bathing and dressing. Her income is under $2,982, her countable resources are under $2,000, and her physician documents nursing-facility level of care, so she can apply for the E&D Waiver through her Area Agency on Aging. If a slot isn't open right away, she may be placed on a waiting list. Her family should plan for private-pay help in the meantime.

Illustrative example; names and figures are hypothetical.

Common mistakes

  • Assuming a waiver works like an entitlement. E&D slots are capped, and a waiting period is common.
  • Spending down unevenly: the $2,000 test applies on the first day of each month.
  • Giving money to family to qualify faster. Alabama applies Medicaid's five-year look-back to transfers for nursing-home and waiver services.
  • Depositing income into a Miller trust incorrectly. The trust must meet Medicaid's rules, and the excess must actually be deposited each month.

Questions and answers

Does Alabama Medicaid pay family members to provide care?

In some cases, yes, through the Personal Choices self-directed option, depending on the waiver and the person's plan of care. Ask the Area Agency on Aging what applies to your situation.

Does the E&D Waiver pay for assisted living?

No. The E&D Waiver's listed services are in-home and community services. They don't include room and board in assisted living.

How do I apply?

Contact the Alabama Department of Senior Services at 1-800-243-5463 (or your local Area Agency on Aging) to be screened for an E&D Waiver slot. Financial eligibility is then confirmed with Alabama Medicaid.

What if my income is over the limit?

A Qualified Income Trust can bring countable income under the $2,982 cap. An elder-law attorney or an experienced Medicaid planner should set it up.

Sources

← Back to the full Alabama guide