Alabama Medicaid Long Term Care Programs, Benefits & Eligibility Requirements

Summary
Medicaid’s rules, benefits and even its name can all vary by state. This article focuses on Alabama Medicaid Long Term Care for seniors, which is run by the Alabama Medicaid Agency and will help pay for care in a nursing home, a recipient’s home and other settings through one of three programs – Nursing Home Medicaid, HCBS Waivers or ABD Medicaid. These programs are different from regular Medicaid, which is for financially limited people of all ages.

Last Updated: Dec 29, 2023

Alabama Medicaid Long Term Care Programs Nursing Home Care Care at Home via HCBS Waivers Care at Home via ABD Medicaid Eligibility Criteria Nursing Homes HCBS Waivers ABD Medicaid How Medicaid Treats the Home Applying Choosing a Nursing Home

Alabama Medicaid Long Term Care Programs

Nursing Home / Institutional Medicaid

Alabama Nursing Home Medicaid will cover the cost of long-term care in a nursing home for financially limited Alabama residents who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:

Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
Skilled nursing care
Physician’s visits
Prescription medication
Medication management
Mental health counseling
Social activities

Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.

Alabama Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover nursing home costs. They are allowed to keep a “personal needs allowance” (PNA) of $30/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are dual eligible, and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.

Alabama Nursing Home Medicaid is an entitlement, which means all eligible applicants are guaranteed by law to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.

A Nursing Home Alternative – Alabama Nursing Home Medicaid beneficiaries who want to leave their nursing home and return to living “in the community” can receive financial and functional help with that transition through Medicaid’s Money Follows the Person program. This help can include paying for moving expenses, as well as long-term care services and supports in the new residence. Program beneficiaries must be moving from a Medicaid-approved facility and into their own home, the home of a relative or a small group home with a maximum of four unrelated residents. Alabama’s Money Follows the Person program is called Gateway to Community Living.

Home and Community Based Services (HCBS) Waivers

Home and Community Based Services (HCBS) Waivers will pay for long-term care services and supports that help Alabama Medicaid recipients who require a Nursing Facility Level of Care remain living in the community instead of living in a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long-term care services for Alabama residents who live in their home, the home of a loved one, an adult foster care home or an assisted living residence. While Alabama’s HCBS Waivers will cover some long-term care services and supports in those settings, it will not cover room and board costs such as mortgage payments, rent, utility bills and food expenses.

The HCBS Waivers relevant to Alabama seniors are the Elderly & Disabled Waiver and the Alabama Community Transition Waiver.

Elderly & Disabled (E&D) Waiver
Alabama’s Elderly & Disabled (E&D) Waiver covers long-term care services and supports that help Alabama seniors (age 65 and over) who require a Nursing Facility Level of Care remain living in the community instead. E&D Waiver recipients can live in their own home, the home of a family member or an adult foster care home. However, the state may deny E&D Waiver applicants who live in adult foster care for several reasons including overall cost vs. nursing home, unsuitable conditions or an uncooperative participant.

E&D Waiver benefits include adult day care, case management, meal delivery, housekeeping services and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). These benefits can be provided by licensed caregivers, and program participants have the option to self-direct some of their E&D benefits through the Personal Choice Program. This allows E&D Waiver recipients to hire and pay family members as caregivers, including spouses.

Unlike Nursing Home Medicaid, Alabama’s E&D Waiver is not an entitlement. Instead, there are a limited number of enrollment spots (roughly 9,400 per year as of 2022), and once those spots are full additional applicants are placed on a waitlist.

Alabama Community Transition (ACT) Waiver
The Alabama Community Transition (ACT) Waiver provides long-term care services and supports to Alabama nursing home residents who require a Nursing Facility Level of Care and are living in a Medicaid-approved nursing home, but wish to return to living in the community. The ACT Waiver will assist in the transition from a nursing home to one’s own home or the home of a family member, but not into an adult foster care home or an assisted living residence.

Depending on the beneficiary’s needs and circumstances, the ACT Waiver can help cover moving expenses and provide long-term care services and supports in the beneficiary’s new residence. ACT Waiver benefits can include adult day care, assistive technology, meal delivery, home modifications, housekeeping services, Personal Emergency Response Systems and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting).

ACT Waiver benefits can be provided by licensed caregivers, and program participants have the option to self-direct some of their benefits through the Personal Choice Program. This allows ACT Waiver recipients to hire and pay family members as caregivers, including spouses.

The ACT Waiver has a limited number of enrollment spots (675 per year as of 2022). Once those spots are full, additional applicants will be placed on a waitlist.

Aged, Blind, and Disabled Medicaid

Alabama’s Aged, Blind, and Disabled (ABD) Medicaid provides basic healthcare coverage and long-term care goods and services to Alabama residents who are aged (65 and older), blind or disabled and live in the community. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for financially needy people of all ages. ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive the benefits without any wait.

1. ABD Long Term Care Benefits
Alabama ABD Medicaid will cover long-term care benefits for seniors who show a medical need for those benefits, which can include in-home personal care, adult day care, home modifications and Personal Emergency Response Systems (PERS). ABD Medicaid recipients qualify for these benefits one at a time. This is different from Nursing Home Medicaid, which makes all of its services immediately available for anyone who qualifies. Instead, ABD Medicaid recipients will be evaluated by the state to determine what kind of long-term care benefits they need and will receive.

2. Living Independence for the Elderly (LIFE)
Alabama residents who are age 55 or older and have ABD Medicaid can cover their medical, social service and long-term care needs with one comprehensive plan and delivery system using the Living Independence for the Elderly (LIFE) program. LIFE program participants are required to need a Nursing Facility Level of Care, but they must live in the community. Alabama LIFE will coordinate the care and benefits of Medicaid and Medicare for “dual eligible” seniors. LIFE also administers vision and dental care, and LIFE day centers provide meals, social activities, exercise programs and regular health checkups and services to program participants. The Alabama LIFE program, Mercy LIFE of Alabama, is located in Daphne. LIFE is also known as Program of All-Inclusive Care for the Elderly (PACE) in other states, and the term PACE is sometimes used in connection with Alabama’s LIFE program. To learn more about LIFE/PACE, click here.

Eligibility Criteria For Alabama Medicaid Long Term Care Programs

To be eligible for Alabama Medicaid, a person has to meet certain financial and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.

TOOLBOX: The easiest way to find the most current Alabama Medicaid eligibility criteria for one’s specific situation is to use our Medicaid Eligibility Requirements Finder tool.

Alabama Nursing Home Medicaid Eligibility Criteria

Financial Requirements
Alabama residents have to meet an asset limit and an income limit in order to be financially eligible for nursing home coverage through Alabama Medicaid. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for Alabama Nursing Home Medicaid for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, Alabama Nursing Home Medicaid recipients are required to give most of their income to the state to help cover the cost of care. They are only allowed to keep $30/month of their income as a “personal needs allowance,” plus enough to make Medicare premium payments if they are dual eligible, and they can make any allowable spousal income allowance payments to financially needy, non-applicant spouses.

For married applicants with both spouses applying, the 2024 asset limit for Alabama Nursing Home Medicaid is $2,000 per spouse, and the income limit is $2,829/month per spouse. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

Plan Ahead: There are alternative pathways to eligibility for Alabama Nursing Home Medicaid applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Alabama has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for Nursing Home Medicaid in Alabama is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that can only be provided in a nursing home. To determine if the Nursing Facility Level of Care requirement is for Medicaid purposes, the state uses the Alabama Home and Community Based Program Assessment (HCBS-1) form. This assessment takes into consideration the applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and taking medications), as well as cognitive ability.

Alabama Medicaid Home and Community Based Services (HCBS) Waivers Eligibility Criteria

Financial Requirements

Alabama residents have to meet an asset limit and an income limit in order to be financially eligible for Home and Community Based Services (HCBS) Waivers. For a single applicant in 2024, the asset limit for HCBS Waivers in Alabama is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for HCBS Waivers in Alabama for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants with both spouses applying, the 2024 asset limit for HCBS Waivers in Alabama is $2,000 per spouse, and the income limit is $2,829/month per spouse. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

Plan Ahead: There are alternative pathways to eligibility for Alabama HCBS Waivers applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Alabama has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for Home and Community Based Service (HCBS) Waivers through Alabama Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that can only be provided in a nursing home. To determine if the Nursing Facility Level of Care requirement is for HCBS Waivers, the state uses the Alabama Home and Community Based Program Assessment (HCBS-1) form. This assessment takes into consideration the applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and taking medications), as well as cognitive ability.

Alabama Aged, Blind, and Disabled Medicaid Eligibility Criteria

Financial Requirements
Alabama residents have to meet an asset limit and an income limit in order to be financially eligible for Aged, Blind, and Disabled (ABD) Medicaid. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for a single applicant is $963/month. Almost all income is counted (IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc.) other than COVID-19 stimulus checks and Holocaust restitution payments.

For married applicants, the 2024 asset limit for Alabama ABD Medicaid is a combined $3,000, and the income limit is a combined $1,435/month. These limits apply to married couples with both spouses applying and married couples with just one spouse applying.

Plan Ahead: There are alternative pathways to eligibility for Alabama ABD Medicaid applicants who are over the asset limit and/or the income limit, such as Medicaid Planning. While Alabama has a Look-Back Period of five years for Nursing Home Medicaid and Home and Community Based Service Waivers applicants to make sure they don’t give away their assets to get under the limit, the Look-Back Period does not apply to ABD Medicaid applicants. However, ABD applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid, or an HCBS Waiver, and those programs will deny or penalize the applicant for giving away assets.

Functional Requirements
The only functional requirement for receiving healthcare coverage through Alabama’s Aged, Blind, and Disabled (ABD) Medicaid is being aged (65 and over), blind or disabled. For ABD Medicaid applicants who require long-term care services and supports, Alabama Medicaid will conduct an assessment of their ability to perform the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and taking medications) to determine what kind of long-term care benefits the applicant needs and the state will cover.

How Alabama Medicaid Treats the Home for Eligibility Purposes

One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:

If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage/debt) is less than $713,000 (as of 2024) then the home is exempt.
If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives.
If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $713,000.

These rules apply to all three types of Medicaid, with one important exception – ABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status.

Alabama Nursing Home Medicaid applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about Medicaid Estate Recovery in Alabama and how you can protect your home from it, click here.

Applying For Alabama Medicaid Long Term Care Programs

The first step in applying for Alabama Medicaid Long Term Care coverage is deciding which of the three Medicaid programs discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.

The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that program. Applying for Alabama Medicaid when not financially eligible will result in the application, and benefits, being denied.

During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Alabama Medicaid applicant. These documents will be needed for the official Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.

After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Alabama residents can call the Alabama Medicaid Agency at 1-800-362-1504 to take the next steps in the application process. They can also download, complete and return this blank application to their local district Medicaid office.

For step-by-step guides to take you through the application process of all three types of Medicaid Long Term Care, click on the program you want: 1) Nursing Home Medicaid 2) HCBS Waivers 3) ABD Medicaid.

Professional Help: Many seniors need support when it comes to Medicaid Long Term Care’s rules, benefits and application process. These are all complicated, constantly changing and vary by state. The best place to get help with Medicaid Long Term Care is through a professional like a Certified Medicaid Planner or an Elder Law Attorney.

Choosing an Alabama Medicaid Nursing Home

After being approved for nursing home coverage through Alabama Medicaid, you or your loved one has to choose which Medicaid-accepting nursing home best meets your needs. Even though Nursing Home Medicaid is an entitlement, not all nursing homes take Medicaid, and those that do may not have available spaces. Finding the right facility can be a chore, especially if you’re looking in a specific location.

There are about 220 nursing homes in Alabama that accept Medicaid, and approximately 25% of them are located in just 3 of the state’s 67 counties – Jefferson County, Mobile County and Madison County. Birmingham has the most nursing homes of any Alabama city with about 20, and there are roughly 30 total in Jefferson County, where Birmingham is located. The city of Mobile has approximately 10 nursing homes, and there are three more in Mobile County plus another six in neighboring Baldwin County. Huntsville, the state’s largest city, has eight nursing facilities and there are 11 total in Madison County and four more in neighboring Morgan County. There are eight nursing homes in the city of Montgomery, and 13 total in Montgomery County. Outside of these areas, the choices narrow. For example, there’s just one nursing home in Auburn and three in all of Lee County, which is the eighth biggest in the state.

TOOLS: Alabama residents can use this Alabama Nursing Home Association facility locator to find Medicaid-approved nursing homes in their area. They can also use Nursing Home Compare. This is a search tool administered by the Centers for Medicare & Medicaid Services (CMS) that has information about more than 15,000 nursing homes across the country.

After finding nursing homes in your area that accept Medicaid, you can start comparing them, if there are multiple options. The Nursing Home Compare search can be filtered by overall rating, health inspections, staffing and quality measures, so that can be a good place to start. The Alabama Nursing Home Association locator also includes specialty care units, such as facilities that handle Alzheimer’s disease and other related dementias, behavioral issues and hospice. Each nursing home and specialty care facility listing includes an address, phone number, fax number and the names of the head administrator and director of nursing. Alabama residents. You can also get information on nursing homes by contacting your local Area Agency on Aging.

Once you’ve done the research, you or someone you trust should visit potential options before making a final decision. Call first to make an appointment for the visit, and arrive prepared with a list of questions. Some things you might ask are: Does the residence provide transportation? Does it organize social activities? How does it facilitate oral and eye care? Who are the staff doctors? What’s the food like? CMS has a thorough “Nursing home checklist” you can use to evaluate a nursing home while visiting.

All told, there are 27,363 nursing home beds in Alabama. And the Alabama Nursing Home Association reported that 86% of residents are satisfied with their care in Alabama nursing homes and would recommend their facility, and 85% of families of residents were satisfied and would recommend their facility. That’s in line with data collected by CMS from 2019-2022 which shows that only 1.1% of Alabama nursing home residents reported depressive symptoms. That’s significantly lower than the national average of 8.1%.

The CMS data also showed that Alabama nursing homes averaged just 10 health deficiencies from 2019-2022, which is well below the national average of 25.7 health deficiencies per nursing home for the same time period. Alabama nursing homes also averaged 9.6 fire safety deficiencies during the same three-year period, which is also below the national average of 13.5.