✅Step 1: 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 need to know:
- If you receive SSI benefits, you automatically qualify financially for a Medicaid waiver.
- You can also qualify if your income is up to 300% of the Federal Benefit Rate (FBR). In the calendar year 2025, the FBR is $967 per month, meaning you can have an income of up to $2,901 per month and still be financially eligible for a Medicaid waiver.
If you need more help understanding this, follow these links:
While income limits are more generous, there is a resource limit. This means you 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 you could lose your Medicaid and waiver eligibility.
If you have questions about managing your money and resources to maintain your waiver eligibility, it is 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. PLEASE NOTE: The counselor helping you with the waiver application may require the parents to include their income, may tell parents wrong information when they state that the parent income will count, and may even attempt to talk parents out of the application process based on them being wrongly informed. Parents need to understand that PARENT INCOME DOES NOT COUNT, and parents need to strongly advocate for their child’s rights to this program without consideration of parent income!
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.
REMINDER: ABLE Accounts and Special Needs Trusts can be used to shelter assets from being counted against disabled individuals. These are important tools that families should explore.
For assistance on better understanding Medicaid Waivers in Alabama, please reach out to Disability Advocacy Solutions.
✅ Step 2: Medical and program eligibility
If you or your child are financially eligible, you should now determine if you or your child meet medical criteria for one or more waivers.
Remember, you can apply for all waivers you are eligible for, but you can only be on one waiver at a time.
Determine which level of care you or your child requires:
A. Intermediate Care Facility for Individuals with Intellectual Disability Level of Care (ICF/IID LOC)
B. Nursing Facility Level of Care (NF LOC)
A. Waivers for People with Intellectual Disabilities
To qualify, the person must require Intermediate Care Facility (ICF) for Individuals with Intellectual Disability (IID) Level of Care (LOC) eligibility criteria.
The person must meet all 3 of the following:
☐ IQ score of 72 or below (both before and after age 18) for the ID waiver or below 70 for the CWP waiver
☐ Formal diagnosis of Intellectual Disability (ID)
☐ Substantial limitations in at least 3 of these areas:
—-Self-Care
—-Living independently
—-Understanding or using language
—-Learning
—-Self-direction (making decisions)
—-Mobility
If the person meets the criteria, they are eligible for one of the 3 waivers administered by Alabama Department of Mental Health (ADMH).
✅ Step 3 for People with Intellectual Disabilities:
📞 Contact ADMH: 800-361-4491
📍 Case Management by: Local 310 Board
For assistance on better understanding Medicaid Waivers in Alabama, please reach out to Disability Advocacy Solutions.
B. Waivers for People Who Need Nursing Facility (NF) Level of Care (LOC)
To qualify, the person must meet at least 2 of the following criteria:
☐ Needs daily medications (keep in mind that this may or may not be interpreted by the operating agency to be sufficient enough to count)
☐ Needs daily rehab help (walking, bowel/bladder training, etc.)
☐ Needs airway suctioning
☐ Has a feeding tube or stoma
☐ Needs tube feeding or IV nutrition (TPN)
☐ Has pressure sores or serious skin issues
☐ Has an unstable medical condition (this may be interpreted by the operating agency as requiring doctor appointments no less than every 3 months, however that is not what their contract with Centers for Medicare and Medicaid states)
☐ Uses oxygen
☐ Needs regular dressing changes
☐ Is comatose
☐ Needs help with 1+ daily living activities (ADLs) (eating, bathing, dressing, etc.)
For a more detailed list of Nursing Facility Level of Care eligibility criteria, follow this link: NF LOC.
If the person meets the NF LOC criteria, they are eligible for one, or more, of 4 waivers administered by Alabama Department of Senior Services and Alabama Department of Rehabilitation Services.
✅ Step 3 for People Requiring Nursing Facility Level of Care:
ii. Choose the Right Waiver
Elderly and Disabled Waiver
Requirements: NF Level of Care
Department: ADSS
📞 Contact ADSS at: 1-800-AGE-LINE; 1-800-243-5463
📍 Case Management by: Area Agency on Aging (AAA, pronounced “triple A”) in your area – Click here for the AAA Contacts webpage
ACT Waiver
Requirements: NF Level of Care + transitioning from a nursing home
Department: ADSS
📞 Contact ADSS at: 1-800-AGE-LINE; 1-800-243-5463
📍 Case Management by: Area Agency on Aging (AAA, pronounced “triple A”) in your area – Click here for the AAA Contacts webpage
TA Waiver
Requirements: NF Level of Care
Department: ADSS
📞 Contact ADSS at: 1-800-AGE-LINE; 1-800-243-5463
📍 Case Management by: Area Agency on Agency (AAA, pronounced “triple A”) in your area – Click here for the AAA Contacts webpage
SAIL Waiver
Requirements: NF Level of Care + age 18 and over + diagnosed before age 63 with specific types of diagnoses.
Click here for more information on criteria for the SAIL Waiver.
📞 Contact ADRS: (334)293-7500
For assistance on better understanding Medicaid Waivers in Alabama, please reach out to Disability Advocacy Solutions.
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