Alabama Medicaid for seniors and long-term care

Last verified: June 2026

Long-term care eligibility for seniors in Alabama

To qualify for Alabama Medicaid long-term care coverage — whether in a nursing facility or through a home and community-based waiver — applicants must meet both a medical standard and a financial standard.

The income limit for nursing facility and waiver coverage is 300% of the Social Security Federal Benefit Rate (FBR). In 2025, the SSI FBR is $943/month, making the income limit approximately $2,829/month for an individual. Income above this limit does not automatically disqualify an applicant — a Qualified Income Trust (also called a Miller Trust) can be used to bring income under the limit in Alabama.

• Individual resource limit: $2,000 in countable assets
• Income limit: approximately $2,829/month for individuals (300% FBR, 2025)
• Must meet nursing facility level of care, established through a clinical assessment
• Home is generally excluded (with some conditions for unoccupied homes)
• One vehicle is generally excluded
• Community spouse protections apply — see spousal impoverishment rules

Elderly and Disabled (E&D) Waiver: home care instead of a nursing facility

The Elderly and Disabled (E&D) Waiver is Alabama's primary 1915(c) HCBS program for seniors age 65 and older and adults with physical disabilities. Members who qualify can receive home care services at a Medicaid cost the state treats as equivalent to what nursing facility care would cost — giving members the choice to remain at home or in community settings.

• Personal care assistance
• Home health aide visits
• Skilled nursing visits for complex medical needs
• Adult day health care
• Respite care for family caregivers
• Homemaker services
• Case management
• Assistive technology and home modifications

The E&D Waiver has a limited number of slots. There may be waiting periods depending on county and availability. Apply through your county DHR office; the office will refer you for a level-of-care assessment.

Technology Assisted (TA) Waiver

The Technology Assisted (TA) Waiver serves individuals with specific diagnoses — including ventilator dependence, IV nutrition, complex nursing needs — who would otherwise require nursing facility care. As of June 2026, the Alabama Medicaid Agency is seeking public comments on the TA Waiver renewal application. Members currently enrolled in the TA Waiver should check medicaid.alabama.gov for updates on the renewal process.

Qualified Income Trust (Miller Trust) for high-income applicants

If a senior's monthly income exceeds the 300% FBR limit for long-term care Medicaid, a Qualified Income Trust — also called a Miller Trust or QIT — can be used. The QIT is a legal tool that allows income above the limit to be deposited into the trust each month, placing it outside the countable income calculation.

Setting up a Qualified Income Trust requires working with an elder law attorney and a financial institution. The trust must be established and funded correctly each month. Income deposited into the trust is used to pay for nursing care, personal needs, and a spousal share if applicable, with Medicaid paying the remaining nursing facility costs. Contact the Alabama State Bar at alabar.org to find an elder law attorney in your area.

Estate recovery in Alabama

Alabama's Medicaid estate recovery program is administered by the Alabama Medicaid Agency. The state may seek reimbursement from the estate of a Medicaid member who received long-term care services — nursing facility, HCBS waiver, or other institutional care — after age 55. Recovery cannot occur while a surviving spouse, minor child, or disabled child is living in the home. Consult an elder law attorney before transferring assets if a family member may soon apply for long-term care Medicaid.

Medicaid as the primary payer for long-term care

Medicare does not cover custodial nursing home care beyond 100 days following a qualifying hospital stay. Private long-term care insurance covers only those who purchased it. For the majority of Americans who need extended nursing home care, Medicaid ends up as the payer — after they have spent down their own assets to the program's limit.

Nationally, Medicaid pays for roughly two-thirds of all nursing home residents, per CMS data. Alabama's share of that population is administered through Alabama Medicaid Agency. The rules that determine eligibility — income, assets, lookback periods, and exempt property — differ from the MAGI-based rules used for standard Medicaid.

Long-term care Medicaid also includes home and community-based services (HCBS), which allow people to receive care at home or in assisted living rather than a nursing facility. These programs operate through Section 1915(c) waivers and have waiting lists in most states.

Nursing facility coverage

Alabama Medicaid Agency covers skilled nursing facility care for seniors who meet clinical and financial criteria. Clinical eligibility requires a documented need for skilled nursing care — typically assessed through a standardized instrument. Financial eligibility means income and countable assets fall within the program's limits.

Once approved, Medicaid pays the nursing home directly. The resident contributes most of their monthly income toward the cost of care — typically all income minus a personal needs allowance (which varies by state but is often $30–$50 per month). Medicaid covers the gap.

If income exceeds the institutional Medicaid limit, Alabama may use a "Miller Trust" (qualified income trust) arrangement to route excess income through a trust account, making the person financially eligible. Not all states allow this; verify whether Alabama uses this approach with Alabama Medicaid Agency.

Home and community-based services (HCBS)

HCBS waivers let states cover long-term care services outside nursing facilities — in a person's home, adult day program, or assisted living. Section 1915(c) of the Social Security Act authorizes these waivers. Each state designs its own waiver programs, so what's available through Alabama Medicaid Agency differs from what's available in neighboring states.

Common HCBS services include personal care assistance, home health aide visits, adult day health care, respite care for family caregivers, and modifications to make a home accessible. Some states cap the number of waiver slots, creating waiting lists that can run for months or years.

Contact Alabama Medicaid Agency to ask which HCBS waiver programs are currently open for enrollment and whether there is a waiting list.

Asset limits for long-term care Medicaid

Unlike MAGI-based Medicaid, long-term care Medicaid has an asset test. Countable assets — bank accounts, investments, second vehicles, vacation property — must fall below the state's limit. The specific threshold varies by state and is updated periodically; it is not a figure this page can reliably publish.

Exempt assets are not counted. The primary home is exempt while the applicant lives there or intends to return, as well as when a spouse, minor child, or disabled adult child lives there. One vehicle is typically exempt. Personal belongings and a prepaid funeral arrangement are also generally exempt.

Medicaid has a 60-month (5-year) lookback period for asset transfers. Transfers of assets for less than fair market value within those 60 months can result in a penalty period during which Medicaid will not pay for care. Consult Alabama Medicaid Agency or a Medicaid planning attorney before transferring assets.

Spousal protections

When one spouse needs nursing home care, federal law protects the other spouse from complete impoverishment. The community spouse (the one still at home) is entitled to keep a minimum amount of assets — called the Community Spouse Resource Allowance (CSRA) — and a minimum monthly income.

The CSRA allows the community spouse to keep between a federal minimum and maximum, with the exact amount varying by state and updated annually. Alabama's current CSRA is set by Alabama Medicaid Agency and published on their website.

The community spouse's own income is not counted toward the institutionalized spouse's Medicaid eligibility. If the community spouse has insufficient income, a portion of the institutionalized spouse's income may be allocated to them — the minimum monthly maintenance needs allowance (MMMNA).

What long-term care Medicaid typically covers

• Skilled nursing facility care — room, board, nursing services, and most medical care in the facility
• Physical, occupational, and speech therapy provided in a nursing home
• Personal care assistance with daily activities (bathing, dressing, eating) through HCBS waivers
• Home health aide visits for those receiving care at home
• Adult day health care programs
• Respite care to give family caregivers temporary relief
• Durable medical equipment prescribed by a physician
• Transportation to and from medical appointments