Alabama Elderly and Disabled (E&D) Waiver

The Elderly and Disabled (E&D) Waiver is Alabama’s main Medicaid program for long-term care at home. It serves older adults and people with disabilities who are at risk of moving into a nursing home, and pays for help in the home so they can stay where they are. It sits alongside our Alabama Long-Term Care Medicaid guide, which covers the nursing home rules.

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

At a glance

Item	Details
Type of program	Medicaid home and community-based services (HCBS) waiver
Who runs it	Alabama Medicaid Agency, with the Alabama Department of Senior Services (ADSS) as operating agency through local Area Agencies on Aging
Age	Older adults and adults with disabilities
Care need	Needs a nursing facility level of care
Alabama 2026 income rule (long-term care)	$2,982 a month (300% of the SSI rate)
Alabama 2026 asset limit (single applicant)	$2,000
Waiting list	Yes. Alabama Medicaid says waiver enrollment is limited

The E&D Waiver in brief

To sum up, Alabama Medicaid Agency, with the Alabama Department of Senior Services (ADSS) as operating agency through local Area Agencies on Aging oversees the E&D Waiver. Its target group is older adults and adults with disabilities; on care need, the rule is: Needs a nursing facility level of care. Waiting list status in 2026: Yes. Alabama Medicaid says waiver enrollment is limited. More detail on each point follows, and the Alabama state guide covers the shared financial rules. Other Alabama programs, and general guides on care at home, are linked at the end of this page for comparison with the E&D Waiver.

What the program is

The E&D Waiver is run by the Alabama Medicaid Agency, which sets the rules and decides financial eligibility. Day-to-day, the Alabama Department of Senior Services (ADSS) operates the waiver through the local Area Agencies on Aging, which also serve as Aging and Disability Resource Centers. A case manager from the local agency visits the person, helps write a plan of care and arranges services from approved providers. People on the E&D Waiver are also part of Alabama’s Integrated Care Network, a case management program that helps coordinate long-term care with medical care.

Under federal law, Alabama can run home and community-based waivers like the E&D Waiver, which bend some ordinary Medicaid rules so care can happen outside a facility. Expect a cap on enrollment, a written plan of care, and a coordinator who lines up providers. Participants keep their regular Alabama Medicaid coverage for medical care; the waiver adds long-term care services to it. See our overview of HCBS waivers.

Who qualifies in 2026

To get the E&D Waiver, a person generally has to meet each of these:

Is an older adult, or an adult with a disability, who is at risk of nursing facility placement
Needs a nursing facility level of care under Alabama Medicaid’s admission criteria
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
Can be served safely at home with the services in the plan of care

The money test. The person must qualify for full Medicaid under Alabama’s rules for long-term care. The income and asset figures in the table above are Alabama’s 2026 Long-Term Care Medicaid figures from our state guide. Exempt items generally include the home within the equity cap, a car, household goods and a modest burial fund. Married couples get extra protection in Alabama: the spouse at home keeps a share of assets and may get some of the applicant’s income. See Spousal impoverishment rules.

How the care assessment works. The care test looks at how much help a person needs with everyday activities such as bathing, dressing, eating, using the toilet, moving around and taking medicines, and at memory problems and supervision needs. A nurse or social worker working with Alabama Medicaid usually does it in person, wherever the person is living. Have a relative present to describe the hard days, and keep a medication and diagnosis list handy. See Nursing home level of care and Activities of daily living.

What services it can pay for

The plan of care decides which services are used. The E&D Waiver can cover:

Case management
Personal care (help with bathing, dressing, eating and toileting)
Homemaker help with housework, laundry and meal preparation
Respite care, to give a family caregiver a break
Adult day health
Companion services
Home-delivered frozen meals

Not every participant gets every service; the plan reflects assessed need and the help family already gives. If needs change, ask for a new assessment.

Directing your own care and paying family

Alabama’s self-directed option, Personal Choices, is open to people enrolled in the Elderly and Disabled Waiver, the ACT Waiver and some other waivers. The participant gets an individual budget and a personal support plan, and hires and manages their own workers. A financial management services agency acts as bank and accountant, and a counselor helps with planning and recruiting. Participants can name a representative, such as a relative or trusted friend, to help run things.

How to apply

There are two tracks, a financial one and a care one, and both must say yes. The usual path for the E&D Waiver is:

Contact your local Area Agency on Aging / Aging and Disability Resource Center and say you want to apply for the Elderly and Disabled Waiver.
The local agency screens the person and, if slots are full, explains the waiting period.
Apply for Medicaid with Alabama Medicaid’s Elderly and Disabled application (online) or the paper Form 204/205. This is the same application used for nursing home Medicaid.
A nurse or case manager assesses care needs to decide whether the person meets the nursing facility level of care.
Once both the money and care tests are met and a slot is available, the case manager writes a plan of care and services start.

For the paperwork, use our documents checklist before applying for the E&D Waiver; Applying for a waiver explains the general process.

Waiting lists

Alabama Medicaid says enrollment in its waivers is limited, so a person who qualifies may need to wait for a slot. The list is handled by the local Area Agency on Aging. Keep the agency informed if the person’s condition gets worse.

More on how lists work: Waiver waiting lists.

How it relates to nursing home Medicaid

The E&D Waiver is designed as an alternative to a nursing home. To qualify, a person must meet the same nursing facility level of care that a nursing home resident must meet, and the financial test uses the same 2026 income rule ($2,982 a month, 300% of the SSI rate) and asset limit. If care at home is no longer safe, the person can move to a nursing home without starting over on financial eligibility in most cases, though the case is updated to nursing home Medicaid.

What is the same as nursing home Medicaid. As in nearly every state, Alabama’s financial rules for home and community programs follow its nursing home rules closely. The five-year look-back for gifts generally applies, so a gift or transfer for less than fair value can cause a period when Medicaid will not pay for long-term care services. Alabama Medicaid can also use estate recovery to seek repayment for long-term care services received after 55. Under the E&D Waiver, income above an allowance may go toward the cost of care each month.

Income in a nursing home. In 2026, Alabama lets a nursing home resident keep $30 a month for personal needs; the rest of their income mostly pays toward care. The state guide explains the nursing home side.

Tips for families

Do not wait for a crisis. Lists and assessments for the E&D Waiver take time, and the start date is usually when you first request help.
Keep a paper trail: copies of forms and notices, plus the names and dates of every call to Alabama Medicaid.
Watch the deadlines on notices. A denial or cut can be appealed through a fair hearing, and a timely request can keep services going meanwhile.
Tell Alabama Medicaid about changes in money, address or household as they happen.
Mark renewal dates. Eligibility and the care plan are usually reviewed annually; see Renewals.
Get help with complex the E&D Waiver cases, such as a spouse at home or past gifts. A certified Medicaid planner or a legal aid office can review how Alabama’s rules fit a family’s situation.

Common questions

Can a family member be paid under the E&D Waiver? Yes, through Personal Choices. Alabama Medicaid offers Personal Choices to people enrolled in the E&D Waiver. Participants use a set budget to hire their own helpers, and a financial management services agency handles payroll and taxes. A counselor helps write a personal support plan.

Does the E&D Waiver pay for assisted living? No. Alabama Medicaid generally does not pay for assisted living.

What if income is above $2,982 a month? Alabama nursing home applicants with higher income can use a Qualified Income Trust (Form 262 packet).

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