State of Alabama Independent Living (SAIL) Waiver Overview

The SAIL Waiver is administered by the Alabama Department of Rehabilitation Services (ADRS) and has 800 participant slots. 

Eligibility for the SAIL Waiver

Financial Eligibility

All 7 waivers have the same financial eligibility rules.

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

• If one receives SSI benefits, one automatically qualifies financially for a Medicaid waiver.
• One 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.

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 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 SAIL Waiver. If he qualifies for the waiver, he can also receive all basic Medicaid services

SAIL Waiver: Medical and Program Eligibility

To qualify for the SAIL Waiver, an individual must:

1. Be 18 years or over;
2. Be at risk of institutionalization:
   • Must meet Nursing Facility Level of Care (NF LOC) MM. 
   • This means they require sustained, full-time care and supervision similar to that provided in a nursing facility
   • A detailed NF LOC checklist is included in Appendix VII of the manual
3. Have a qualifying medical diagnosis
   Eligible diagnoses include (but are not limited to):
   • Quadriplegia
   • Traumatic Brain Injury (TBI)
   • Amyotrophic Lateral Sclerosis (ALS)
   • Multiple Sclerosis (MS)
   • Spinal Muscular Atrophy
   • Muscular Dystrophy (MD)
   • Severe Cerebral Palsy
   • History of stroke
   • Other substantial neurological impairments
   • Severely debilitating or rare genetic diseases
4. Age at Diagnosis:
   • The qualifying diagnosis must have been received before the age of 63
   • If the diagnosis occurs after age 63, the individual is not eligible for the SAIL Waiver—even if the diagnosis is otherwise qualifying

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

SAIL Waiver Application Guide

Before You Begin:

Gather the following:

• Medicaid card, Social Security Number, and birth certificate
• Immigration documentation (if applicable)
• Medical records supporting the need for Nursing Facility Level of Care (NF LOC)
  (e.g., physician letters, progress notes)
• Optional: Complete the 204/205 form early (see Appendix II in the manual)

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How to Apply:

1. Start the Application:
   • Call the SAIL Waiver hotline or your local ADRS District Office
   • Contact information for the SAIL Waiver can be found at this link. KK. 
2. Referral Form Completion:
   • An ADRS Case Manager will fill out a SAIL Referral Form with you
3. LOC Assessment:
   • If a waiver slot is available, the Case Manager will also complete an HCBS-1 form to evaluate Nursing Facility Level of Care (NF LOC)
4. Final LOC Determination:
   • An ADRS Nurse Reviewer will review the HCBS-1 form and additional documentation (e.g., hospital records, physician notes)
5. If No Slot Is Available:
   • The applicant is placed on a referral waitlist, prioritized by the date the referral form was submitted

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After You Apply – SAIL Waiver

Eligibility Determination Timeline

• Medicaid law requires a decision within 90 days (3 months) of submitting your application.
• You must either:
  • Be found eligible and offered services, or
  • Receive a denial letter with information about your appeal rights

What to Do While You Wait

• Keep in regular contact with your ADRS District Office
• Track how much time has passed since your application was submitted
• Don’t hesitate to follow up frequently to ensure the process stays on track

Common Tip

• Although the SAIL Waiver usually has open slots, delays can still happen—be persistent and proactive.

Additional Guidance

• You can apply for multiple waivers at once
  (e.g., ACT, TA, E&D, SAIL)
• You may stay on multiple waitlists, but:
  • You can’t receive services from more than one waiver at a time

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

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SAIL Waiver Services

Services that can be self-directed are in bold.

·   Case Management

·   Environmental Accessibility Adaptations

·   Personal Emergency Response System (Initial Setup) and Personal Emergency Response 

System (Monthly Fee)

·    Medical Supplies

·   Minor Assistive Technology

·   Assistive Technology

·   Evaluation for Assistive Technology

·   Assistive Technology Repairs

·   Pest Control

·   Personal Care

·   Personal Assistance Service

·   Unskilled Respite Care

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

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