Alabama Medicaid for Seniors & Long-Term Care

The Elderly and Disabled (E&D) Waiver is Alabama's primary 1915(c) HCBS program for seniors age 65 and older and adults with physical disabilities. Members who qualify can receive home care services at a Medicaid cost the state treats as equivalent to what nursing facility care would cost — giving members the choice to remain at home or in community settings.

The E&D Waiver has a limited number of slots. There may be waiting periods depending on county and availability. Apply through your county DHR office; the office will refer you for a level-of-care assessment.

The Technology Assisted (TA) Waiver serves individuals with specific diagnoses — including ventilator dependence, IV nutrition, complex nursing needs — who would otherwise require nursing facility care. As of June 2026, the Alabama Medicaid Agency is seeking public comments on the TA Waiver renewal application. Members currently enrolled in the TA Waiver should check medicaid.alabama.gov for updates on the renewal process.

If a senior's monthly income exceeds the 300% FBR limit for long-term care Medicaid, a Qualified Income Trust — also called a Miller Trust or QIT — can be used. The QIT is a legal tool that allows income above the limit to be deposited into the trust each month, placing it outside the countable income calculation. Setting up a Qualified Income Trust requires working with an elder law attorney and a financial institution. Income deposited into the trust is used to pay for nursing care, personal needs, and a spousal share if applicable, with Medicaid paying the remaining nursing facility costs.

Alabama Medicaid Agency covers skilled nursing facility care for seniors who meet clinical and financial criteria. Clinical eligibility requires a documented need for skilled nursing care — typically assessed through a standardized instrument. Financial eligibility means income and countable assets fall within the program's limits.

Once approved, Medicaid pays the nursing home directly. The resident contributes most of their monthly income toward the cost of care — all income minus a personal needs allowance of $30/month and any Medicare premiums, plus a monthly maintenance needs allowance for a non-applicant spouse where applicable. Medicaid covers the gap. If income exceeds the institutional Medicaid limit, Alabama may use a "Miller Trust" (qualified income trust) arrangement to route excess income through a trust account, making the person financially eligible.

Countable assets — bank accounts, investments, second vehicles, vacation property — must fall below the state's limit. Exempt assets are not counted: the primary home is exempt while the applicant lives there or intends to return, as well as when a spouse, minor child, or disabled adult child lives there. One vehicle is typically exempt. Personal belongings and a prepaid funeral arrangement are also generally exempt. Medicaid has a 60-month (5-year) lookback period for asset transfers; transfers for less than fair market value within those 60 months can result in a penalty period during which Medicaid will not pay for care.

When one spouse needs nursing home care, federal law protects the other spouse from complete impoverishment. The community spouse is entitled to keep a minimum amount of assets — called the Community Spouse Resource Allowance (CSRA) — and a minimum monthly income (the minimum monthly maintenance needs allowance, or MMMNA). In 2026, Alabama's CSRA allows the community spouse to retain 50% of the couple's countable assets, up to a maximum of $162,660, with a minimum protected amount of $32,532. The MMMNA is $2,705/month (effective 7/1/26–6/30/27).

Alabama's Medicaid estate recovery program is administered by the Alabama Medicaid Agency. The state may seek reimbursement from the estate of a Medicaid member who received long-term care services — nursing facility, HCBS waiver, or other institutional care — after age 55. Recovery cannot occur while a surviving spouse, minor child, or disabled child is living in the home. Consult an elder law attorney before transferring assets if a family member may soon apply for long-term care Medicaid.

HCBS waivers let states cover long-term care services outside nursing facilities — in a person's home, adult day program, or assisted living. Contact the Alabama Medicaid Agency to ask which HCBS waiver programs are currently open for enrollment and whether there is a waiting list.