TA Waiver Overview
The TA Waiver is Alabama’s smallest Medicaid waiver, offering only 80 slots statewide. It is administered by the Alabama Medicaid Agency and the Alabama Department of Senior Services (ADSS).
Who It Serves:
The TA Waiver is designed for adults age 21 and older who meet nursing facility level of care (NF LOC) MM. and:
- Have a tracheostomy, and/or
- Rely on mechanical ventilation to breathe
Cost Cap:
- The cost cap for this waiver is based on the average annual cost of nursing home care for ventilator-dependent individuals, which is significantly higher than for those who are not ventilator-dependent.
- This allows the waiver to fund more intensive services tailored to the needs of individuals requiring advanced medical support.
For assistance on better understanding Medicaid Waivers in Alabama, please reach out to Disability Advocacy Solutions.
Eligibility for the TA Waiver
Financial Eligibility
All 7 waivers have the same financial eligibility rules.
Medicaid waiver programs, including the TA Waiver, have more flexible financial rules than standard Medicaid. Here’s what you, the person with a disability, need to know:
- If you receive SSI benefits, you automatically qualify 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 his/her name on the first day of each month, or one could lose your Medicaid eligibility.
If one has questions about managing money and resources to maintain one’s 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 would not 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
The TA Waiver requires that individuals be at risk in a nursing facility in order to be determined for TA Waiver services. Generally, this means that the individual is unable to care for themselves for a sustained period of time and needs the kind of full-time, intensive care and supervision that would ordinarily be provided in a nursing facility. Alabama has very specific requirements for determining who meets the NF LOC criteria. A checklist to help you determine whether you or your loved one meet those criteria is included as Appendix VII of this manual.
In addition to requiring that applicants meet the NF LOC criteria, the TA Waiver also requires that applicants have a complex skilled medical condition and are either A) ventilator- dependent, or B) have a tracheostomy.
For assistance on better understanding Medicaid Waivers in Alabama, please reach out to Disability Advocacy Solutions.
TA Waiver Application Guide
Before You Begin
Gather the following documents:
- Medicaid card (if applicable), Social Security Number (SSN), and birth certificate.
- Immigration documentation if the applicant is an immigrant.
- Medical documentation supporting disabilities and need for NF LOC (e.g., physician progress notes, medical letters).
- Optional: Complete the 204/205 form (blank forms available in Appendix II) to prepare ahead.
Starting the Application
- Contact the Area Agency on Aging (AAA) YY. for your county to begin the application. Some may require appointments or intake messages — be sure to follow up if you don’t hear back in a few days.
- During communication with the AAA, focus on explaining why the applicant meets nursing facility level of care, especially if already residing in a nursing facility.
- If the AAA suggests the applicant may not qualify, request a written denial. Often, this will prompt further processing.
- Some AAAs will request recent medical records (last 6-12 months) from physicians. Stay in contact with them and follow up regularly.
Assessment Process
- A Case Manager completes a Referral Form, collecting personal info, diagnoses, benefit status, daily living abilities, resources, and current home services.
- The HCBS-1 form is completed during the initial home visit to assess NF LOC.
- A review team of a social worker, nurse, and physician will evaluate the HCBS-1 form along with medical records and history of ventilator dependence or tracheostomy.
After the Application
- Admission prioritization depends on the individual’s assessed level of need.
- Keep track of one’s application status and follow up regularly with a Case Manager or AAA contact.
- One may apply for multiple waivers and stay on multiple waitlists simultaneously but may only receive services from one waiver at a time.
- Federal law guarantees a decision on one’s waiver eligibility within 90 days of application submission. One will be notified if you are eligible or if your application is denied, along with your rights for appeal.
For assistance on better understanding Medicaid Waivers in Alabama, please reach out to Disability Advocacy Solutions.
TA Waiver Services
Services that can be self-directed through the Personal Choices program are highlighted in bold.
· Private Duty Nursing
· Medical Supplies
· Assistive Technology
· Pest Control
· Targeted Case Management
· Personal Care/Attendant Services
For assistance on better understanding Medicaid Waivers in Alabama, please reach out to Disability Advocacy Solutions.
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