Alabama pays for in-home care with three programs: the Alabama Community Transition (ACT) waiver, the Elderly and Disabled waiver and the Personal Choice waiver. These programs are similar, as all of them pay caregivers to provide personal support in seniors’ homes, but they vary in the specific services they cover and who is eligible.

The Alabama Community Transition (ACT) waiver

Alabama’s ACT waiver supports seniors enrolled in Medicaid who are currently receiving care in a long-term care nursing home. The program helps seniors transition out of long-term care and back into their own homes or independent living. Its paid caregiver support and transition assistance includes moving and utility hookup assistance. This program does not have an age restriction, but adults under age 65 must have a disability verified by a doctor. Applicants for ACT waivers must be current Medicaid enrollees with a need for in-home care, as verified by a home visit during the intake process.

The Elderly and Disabled Waiver (EDW)

Alabama’s EDW provides services that are similar to the ACT waiver, including payments for in-home caregiver support, but for seniors who are not currently receiving nursing home care. This waiver is intended to help seniors receive care in their own homes rather than long-term nursing care. To sign up for the Elderly and Disabled Waiver, a senior must be a resident of Alabama who receives Medicaid and has a medical or age-related disability that would qualify them for admission to a nursing home.

A home visit during the enrollment process verifies that the applicant has a safe place to live where all of their needs can be met with caregiver support and establishes an allotment of caregiver hours the state will authorize. Caregivers may be a personal acquaintance of the beneficiary or an employee of a state-authorized in-home care agency.

The Personal Choice (PC) Waiver

Alabama’s PC waiver is a beneficiary-directed support for in-home care that is open to seniors who qualify for either of the state’s other two waiver programs. Under a PC waiver, seniors take control of the hiring, management and retention of their caregivers by authorizing hours worked to be paid out of their monthly allowances. This allowance can also be used to pay for monthly necessities, such as respite care, personal items and some home modifications to improve safety and accessibility. Examples of modifications include safety bars in bathrooms and widening of doorways around the house.