Medicaid for nursing home and home care in Alabama

Who qualifies

You must live in Alabama, be a U.S. citizen or qualified non-citizen, and be 65 or older, blind or disabled. You must also meet a medical test and money tests.

• Medical need. Medicare or Medicaid must approve that you need nursing home level care.
• 30 days in a row. For nursing home Medicaid, you must be in an approved medical facility for at least 30 days in a row. People who get SSI do not have to meet this rule.

If your income is over the limit

Alabama uses a Qualifying Income Trust (sometimes called a Miller trust). Your extra income goes into the trust each month, and Medicaid does not count it toward the limit. The trust does not help with assets that are over the limit. Strict rules apply to how the trust is set up. Medicaid's packet for this is Form 262. Many families get legal help to set one up.

What counts and what does not

Assets that count

Cash, bank accounts, stocks and bonds, and real estate other than your home all count toward the $2,000 limit.

Assets that do not count

• Household goods and personal items.
• One car used by someone in your household.
• Burial funds or a prepaid burial contract up to $5,000, and burial space items such as a plot.
• Your home, in most cases. Alabama follows a home equity limit that the federal government publishes each year. Ask your district office if your home has very high equity.

Send deeds, wills and other property papers to your Medicaid district office so it can review them.

Gifts and transfers

Medicaid looks back 60 months (five years) from the month you apply. If you gave away money or property, or sold it for less than it was worth, Medicaid can set a period when it will not pay for long-term care. The length is based on the value given away divided by the average monthly cost of a private nursing home in Alabama.

If your spouse stays at home

Special rules protect a husband or wife who still lives at home.

• Savings. Your spouse can keep half of the couple's combined countable savings. That share cannot be less than $32,532 or more than $162,660 in 2026.
• Income. If your spouse's own income is low, part of your income can be set aside for them each month. Some can also go to dependent family members at home. Ask your district office for the current amounts.

What you pay toward your care

If you live in a nursing home, most of your monthly income goes to the nursing home. You keep a small amount for personal needs. Amounts can also be set aside for a spouse or dependents and for health insurance premiums. Medicaid pays the rest of the nursing home's rate.

Some useful nursing home rules from Alabama's Medicaid code:

• Medicaid covers your nursing care, room, meals, special diets, personal care supplies, linens and incontinence supplies.
• Things like a phone, your own clothes, a private room (unless needed for your health) and routine dental care are not part of the basic rate.
• A nursing home cannot make a family member sign as a guarantor of payment as a condition of admission.
• You can manage your own money. If you ask the home in writing to hold it, the home must keep it separate from its own funds, put larger amounts in an account that earns interest, and give a full accounting.

Care at home: the waivers

Waivers let you get help at home instead of moving to a nursing home. You must meet the same income, asset and medical rules. The Alabama Department of Senior Services runs these programs.

• Elderly and Disabled (E&D) Waiver: For older adults and people with disabilities at risk of nursing home placement. A case manager makes a care plan with you. Services can include personal care, homemaker help, respite for family caregivers, adult day health, companion services and home-delivered frozen meals.
• Personal Choices: Lets you direct your own care. You get a budget to pay for the personal care you need.
• Alabama Community Transition (ACT) Waiver: Helps people living in a nursing home move back to a home in the community. Most moves happen within 180 days of applying.
• Technology Assisted Waiver for Adults: For adults 21 and over who use a ventilator or have a tracheostomy.
• Hospital to Home: Helps people with full Medicaid go back home after a hospital stay when they are at risk of moving to a nursing home.

How to apply

1. For care at home, start with your local Area Agency on Aging and Aging and Disability Resource Center. Call 1-800-AGE-LINE (1-800-243-5463).
2. Fill out Form 204/205, the application for Elderly and Disabled programs, including nursing home care and waivers. It is on the Applicant Forms page at medicaid.alabama.gov.
3. Send it in. Email it to [email protected], mail it to Medicaid, PO Box 5624, Montgomery, AL 36103-5624, or take it to your county's Medicaid district office. Nursing homes can also file online for residents through Medicaid's Expedite system.
4. Send proof. This includes income, bank statements and property papers. Medicaid may ask for more.
5. Wait for a letter. A decision may take several weeks. Call the Recipient Call Center at 1-800-362-1504 with questions.

After you apply

• Renewals. Medicaid reviews your case at least once every 12 months.
• Report changes in income, address or marriage with Form 295.
• Appeals. If Medicaid denies or ends your coverage, Medicaid must receive your fair hearing request within 60 days of the date the notice was mailed. Send it to your district office, email [email protected], or call 334-353-5210. If you are losing coverage and ask within 10 days, benefits may continue until the hearing. If waiver services are denied, cut or stopped, use the Department of Senior Services appeal form MW-32.
• Estate recovery. After death, Alabama Medicaid may seek repayment from the estate. Questions: Estate Recovery Unit, 334-242-5727.

Free help

• 1-800-AGE-LINE (1-800-243-5463): Area Agencies on Aging, ADRCs and SHIP counseling.
• Alabama Department of Senior Services: 334-242-5743.
• Alabama Medicaid Recipient Call Center: 1-800-362-1504.

Read more about paying for a nursing home, Medicare and SSI, or see all benefits in Alabama.

Phone numbers: Free help lines for Alabama agencies

Check what you may qualify for