Disability Advocacy Solutions LLC

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Birmingham, Alabama, USA

Alabama Community Transition (ACT) Waiver

ACT Waiver Overview

The ACT Waiver is administered by the Alabama Department of Senior Services (ADSS) and has approximately 675 open slots available. 

For assistance on better understanding Medicaid Waivers in Alabama, please reach out to Disability Advocacy Solutions. 

Eligibility for the ACT Waiver

  • Applicants must meet Nursing Facility Level of Care (NF LOC) MM. criteria.
  • There is no age requirement.
  • The ACT Waiver primarily serves:
    • Individuals currently residing in nursing facilities or other institutions who want to transition back to the community.
    • Individuals already living in the community and enrolled in another HCBS waiver but whose needs are not fully met by that waiver.

How It Differs From the E&D Waiver

  • Unlike the E&D Waiver, which generally prevents institutionalization, the ACT Waiver focuses on helping people leave institutions to live in the community.
  • The ACT Waiver has a cost cap, known as the Institutional Cost Limit (ICL), meaning the cost of community services cannot exceed what it would cost to serve the individual in an institution like a nursing facility.

Financial Eligibility

All 7 waivers have the same financial eligibility rules.

Medicaid waiver programs, including the ACT Waiver, have more flexible financial rules than standard Medicaid. Here’s what you, the person with a disability, need to know:

  • If onereceives SSI benefits, one automatically qualifies financially for a Medicaid waiver.
  • One can also qualify if one’s income is up to 300% of the Federal Benefit Rate (FBR). In the calendar year 2025, the FBR is $967 per month, meaning one can have an income of up to $2,901 per month and still be financially eligible for a Medicaid waiver.

While income limits are more generous, there is a resource limit. This means one generally can’t have more than $2,000 in resources (like money in bank accounts) in your name on the first day of each month, or one could lose your Medicaid eligibility.

If you have questions about managing your money and resources to maintain your waiver eligibility, it’s a good idea to talk to an attorney, as everyone’s situation is different.

Important Note for Children: When a child under 18 applies for a Medicaid waiver, only the child’s income and resources are counted, not the parents’. Usually, a child will have no income, making them financially eligible. If a child receives SSI, they are also automatically financially eligible.

Example: A young man earning $1,000 per month at a part-time job wouldn’t qualify for standard Alabama Medicaid (which has an income limit of $963 per month in 2024). However, because his income is below the $2,829 per month limit for a waiver, he could be financially eligible for an ACT Waiver. If he qualifies for the waiver, he can also receive all basic Medicaid services

Medical and Program Eligibility for the ACT Waiver

  • Nursing Facility Level of Care (NF LOC) MM.:
    To qualify, individuals must be at risk of institutionalization in a nursing facility. This generally means they are unable to care for themselves for an extended period and require the kind of full-time, intensive care and supervision typically provided in a nursing facility.
    Alabama has detailed criteria for determining NF LOC eligibility, with a checklist available to help assess qualification. MM.
  • Program Eligibility:
    • The ACT Waiver is primarily for individuals currently residing in institutions who want to transition back to community living.
    • It also serves a secondary group: individuals already on another waiver whose current services are insufficient, and who would require institutionalization without access to ACT Waiver services.

For assistance on better understanding Medicaid Waivers in Alabama, please reach out to Disability Advocacy Solutions. 

ACT Waiver Application Guide

Referrals from Nursing Facilities

  • ACT Waiver recipients are typically individuals currently residing in nursing facilities who want to transition back to community living.
  • Nursing facility staff usually make the referral to the Alabama Department of Senior Services (ADSS) to start the application process.
  • An initial Level of Care (LOC) evaluation is done while the applicant is still in the nursing facility.
  • A case manager submits the waiver application to an ADSS Nurse Reviewer, who evaluates and makes the LOC determination.
  • The eligibility process also includes assessment of the applicant’s:
    • Community support systems
    • Functional limitations
    • Diagnosis
    • Risk factors for possible re-institutionalization after community return

Referrals from the Public

  • ADSS delegates application intake and processing to Area Agencies on Aging (AAAs), which vary by county.
  • Intake processes differ among AAAs: some require only a phone call, others may ask for forms to be completed. Contact your local AAA for more information. 

Contact information for the AAAs can be found at this link.

For assistance on better understanding Medicaid Waivers in Alabama, please reach out to Disability Advocacy Solutions. 

Before Starting the Application

  • Collect these documents:
    • Medicaid card (if available)
    • Social Security Number (SSN)
    • Birth certificate
    • Immigration documentation (if applicable)
    • Documentation reflecting disabilities and NF LOC need (e.g., physician notes, medical progress reports)
    • If the applicant is in a nursing home, obtain documentation confirming residency there

Starting the Application

  • Call the AAA for your county to initiate the application. Some AAAs require appointments or intake messages—be sure to leave contact information.
  • If you don’t hear back within a few business days, call again to keep the process moving.

Communicating with the AAA

  • Focus discussions on why the applicant needs nursing facility LOC.
  • If the applicant is in a nursing facility, emphasize this fact.
  • Be cautious of questions designed to discourage the application.
  • If told the applicant would not qualify, ask if this is a formal denial and request a written denial. Usually, this will prompt the AAA to proceed with the application.

After Starting the Application

  • Some AAAs will request medical records from physicians, typically focusing on the last 6–12 months.
  • Stay proactive: follow up frequently with the AAA to track the progress and timing of the eligibility determination.

After the Application

  • Prioritization: Admission to the ACT Waiver is prioritized based on:
    • The date the application was submitted
    • The results of the Level of Care (LOC) evaluation
  • Stay Proactive:
    • Keep in regular contact with the Area Agency on Aging (AAA) during the application and eligibility process.
    • Track how long you have been waiting for a decision and follow up often.
    • If currently in a nursing facility, also regularly check in with facility staff such as social workers.
  • Multiple Waivers:
    • One may apply for multiple waivers if eligible.
    • One can remain on multiple waitlists simultaneously.
    • One  can stay on the waitlist for one waiver while receiving services from another.
    • However, you cannot receive services from more than one waiver at the same time.
  • Legal Timeframe:
    • Federal law requires that Medicaid applicants applying based on a disability receive a decision within 90 days (3 months).
    • Within this timeframe, you should either be notified of eligibility for waiver services or informed of denial with information about your due process rights.

For assistance on better understanding Medicaid Waivers in Alabama, please reach out to Disability Advocacy Solutions. 

ACT Waiver Services

Services that can be self-directed through the Personal Choices program are in bold.

·   Case Management

·   Transitional Assistance

·   Adult Day Health

·   Home Delivered Meals

·   Skilled Respite

·   Skilled Nursing

·   Home Modifications

·   Assistive Technology

·   Personal Emergency Response Systems (PERS) Installation/Monthly Monitoring

 ·   Medical Equipment Supplies and Appliances

·   Personal Assistant Services (PAS)

·   Pest Control

·   Adult Companion Services

·   Unskilled Respite

·   Personal Care

·   Homemaker Services

For assistance on better understanding Medicaid Waivers in Alabama, please reach out to Disability Advocacy Solutions.

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