Alabama Community Transition (ACT) Waiver

The Alabama Community Transition (ACT) Waiver helps people who are living in a nursing home, or who are at risk of going into one, move to or stay in the community with Medicaid-paid support. It is one of the waivers listed by Alabama Medicaid for people who need long-term care. For the wider picture, see our Alabama Long-Term Care Medicaid guide.

Figures change periodically. Double-check current amounts before relying on them.

At a glance

The ACT Waiver in brief

In short, the ACT Waiver is run by Alabama Medicaid Agency. It serves adults with disabilities or long-term illnesses (age rules are set in the waiver), and the care requirement is: Needs a nursing facility level of care. On waiting lists, the current picture is: Enrollment is limited. Each of these points is covered in more depth below, alongside the general Alabama rules from our state guide. If the ACT Waiver is not the right fit, the related pages at the end point to other Alabama programs and general guides.

What the program is

Alabama Medicaid lists the ACT Waiver among its home and community-based waivers for people moving out of a nursing facility. A transition coordinator or case manager works with the person, the facility and family to plan the move, line up housing and services, and make sure supports are in place on the first day home. Like the Elderly and Disabled Waiver, people on the ACT Waiver are part of Alabama’s Integrated Care Network for care coordination.

Transition programs such as the ACT Waiver move people out of facilities and into homes or small residences, with services arranged before the move. Many draw on the federal Money Follows the Person program for one-time costs and planning.

Who qualifies in 2026

Eligibility for the ACT Waiver comes down to these points. The person:

• Is living in a nursing facility, or is at risk of entering one, and wants to live in the community
• Needs a nursing facility level of care
• Qualifies for full Medicaid under Alabama’s long-term care financial rules (see the money test below)
• Lives in Alabama and is a U.S. citizen or qualified non-citizen
• Has a safe place to live and a plan of care that can meet their needs at a cost the waiver allows

Income and assets. Applicants for the ACT Waiver must meet Alabama’s long-term care Medicaid financial rules. Figures shown above are the 2026 Alabama long-term care limits from our state guide. Alabama Medicaid’s countable assets do not usually include the home (within the equity limit, if the applicant or a spouse lives there or intends to return), one car, personal belongings and a small burial fund. When one spouse applies for the ACT Waiver and the other stays at home, the spouse at home keeps a protected share of the couple’s assets and may receive part of the applicant’s income. See Spousal impoverishment rules.

About the level-of-care assessment. Alabama Medicaid’s assessment covers daily activities, from bathing and dressing to toileting and medications, plus memory and safety. The visit is normally face to face, at home or in a hospital or facility. Families should describe the worst days honestly and bring a list of conditions and medicines. See Nursing home level of care and Activities of daily living.

What services it can pay for

What a participant receives under the ACT Waiver follows the care plan. Possible services include:

• Case management and transition coordination
• Personal care and homemaker services
• Respite
• Adult day health
• Home-delivered meals
• Medical supplies and equipment not otherwise covered
• Home changes needed for safety

No program pays for everything. The ACT Waiver services are based on assessed need, and a family caregiver who is already helping is usually counted when the plan is written. A change in health is a reason to request a reassessment.

Directing your own care and paying family

ACT Waiver participants can choose Personal Choices, Alabama’s self-directed option. Under it, they manage an individual budget, hire their own workers and get help from a counselor and a financial management services agency.

How to apply

Applying usually involves two decisions: one about money (financial eligibility for Medicaid) and one about care needs. In plain terms, the steps are:

1. Tell the nursing home social worker, or the local Area Agency on Aging / ADRC, that the person wants to move home and wants the ACT Waiver.
2. If not already on Medicaid, apply with Alabama Medicaid’s Elderly and Disabled application or Form 204/205.
3. A care assessment confirms the nursing facility level of care and identifies needed services.
4. The transition coordinator builds a plan covering housing, services and any one-time needs.
5. When a slot is available and the plan is approved, the move happens and services begin.

Our documents checklist and Applying for a waiver guide list the paperwork.

Waiting lists

Alabama Medicaid says its waiver enrollment is limited. People who are in a nursing home and want to leave are often given priority in transition programs, but this is not guaranteed.

General advice is in Waiver waiting lists.

How it relates to nursing home Medicaid

The ACT Waiver exists because some people who live in a nursing home could live at home with the right help. A person must meet the same level of care as a nursing home resident, and the same 2026 income rule ($2,982 a month) and asset limit apply. A nursing home resident who already has Medicaid does not usually need a new financial application to move to the waiver, though the case will be updated.

Where the nursing home rules still apply. Most money rules carry over from nursing home Medicaid. Gifts and below-value transfers in the five-year look-back can trigger a penalty period for home care as well as nursing home care. Estate recovery also applies: the state can seek repayment from the estate of a person who received long-term care services after age 55. Some participants pay a monthly share of income toward services.

Personal needs allowance. If the person does move to a nursing home, Alabama’s 2026 personal needs allowance is $30 a month. Most of the rest of their income goes toward the cost of care. Our state guide covers the nursing home rules in detail.

Tips for families

• Begin before it is urgent. Every step of the ACT Waiver takes time, and an early request protects your place.
• Document everything, from forms and letters to who you spoke with at Alabama Medicaid and when.
• Use your appeal rights. Notices that deny or reduce services explain how to request a fair hearing; acting quickly can protect current services.
• Report changes promptly, including income, assets, a move or a new living arrangement.
• Expect yearly reviews of both Medicaid eligibility and the care assessment. See Renewals.
• Protect a spouse at home. Spousal protections must be claimed; a certified Medicaid planner or legal aid office can explain them for your family.

Common questions

Is the ACT Waiver only for people leaving a nursing home? It is mainly for people moving out of a nursing facility.

Will Medicaid pay to set up a new home? Transition programs often help with one-time costs such as basic furnishings or deposits; what is covered varies by program.

Can my mother go back to the nursing home if it does not work? Yes. Moving home does not take away the right to nursing home Medicaid later if it is needed.

Related pages

• Alabama Long-Term Care Medicaid guide
• Alabama Elderly and Disabled Waiver
• Money Follows the Person
• Three kinds of Long-Term Care Medicaid
• PACE programs

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.