State of Alabama Independent Living (SAIL) Medicaid Waiver

Waiver Description

The State of Alabama Independent Living (SAIL) Medicaid waiver, previously called the Homebound Waiver, is designed to help disabled individuals remain living in their homes (or the homes of loved ones) instead of moving into skilled nursing facilities. Elderly residents of Alabama are eligible for this HCBS (home and community based services) Medicaid waiver should they meet the financial and medical requirements. Neurological conditions, such as Parkinson’s disease, stroke, and Alzheimer’s disease meet the medical diagnosis requirements.

To help an individual move out of nursing home care and back into the community, the waiver provides case management and may also pay for assistive technology, personal care services, and changes to the participant’s place of residence, such as making the home wheelchair accessible, in order to increase a disabled individual’s ability to live independently.

A Medicaid-certified home health agency must operate the personal care services unless there is no such service available in the individual’s geographic area. In this situation, the participant may select friends, neighbors, and some family members to be compensated for the personal care services they provide. However, children, spouses, and parents are barred from being paid as caregivers. Furthermore, there is an option for program participants to self-direct their own care via the Personal Choices Program. In some situations, adult children or spouses may be hired and paid as caregivers via Personal Choices.

The SAIL waiver is administered by the Alabama Medicaid Agency and is operated by the Alabama Department of Rehabilitation Services (ADRS). To avoid confusion, note that the SAIL Medicaid waiver is one of three sub-programs of a larger program, also called SAIL. The other 2 sub-programs are Homebound Services and Independent Living Support Services. 

Another Alabama Medicaid program that might be of interest is the Elderly and Disabled Waiver.

Eligibility Guidelines

General Requirements

To be eligible for the SAIL Medicaid waiver, an applicant must be a resident of Alabama, at least 18 years old, and have a physical disability that requires nursing home level care. This disability must have an onset before the age of 63.

While qualified applicants must require nursing home level care under this waiver, the individual lives at home or must be willing to move from a skilled nursing facility back to their home or that of a friend or family member. It is in this location where they will receive personal care and home health services. They cannot live in assisted living residences or adult foster care homes and be eligible for this waiver program.

Applicants must also be financially eligible. This means they must demonstrate that their monthly income and current assets are below certain levels.

Financial Requirements

Income Limits

In 2024, individual applicants are limited to a monthly income of no more than $2,829, and for married couples in which both spouses are applying for benefits, the monthly income limit is $5,658. (Each spouse is considered as an individual applicant. Therefore, each spouse is allowed up to $2,829 / month in income.) This figure is equivalent to 300% of the SSI Federal Benefit Rate.

However, if the applicant is married and his/her spouse is not also applying for Medicaid, the applicant spouse can allocate some of his/her monthly income to the non-applicant spouse (also called the community spouse) as a living stipend. This is known as the minimum monthly maintenance needs allowance (MMMNA). Currently, up to $2,465 / month can be transferred from the applicant spouse to the non-applicant spouse. This figure will update July 2024. If the non-applicant spouse already has monthly income equal to, or above, this figure, a transfer of income is not permitted from the applicant spouse.

Individuals over the income limits for Alabama Medicaid can also set up a Qualified Income Trust (QIT). Often called Miller Trusts, applicants can become eligible for Medicaid once they demonstrate that the trust is properly set up and being administered correctly.

Asset Limits

In 2024, the asset limit for a single applicant is $2,000, and the asset limit for a married couple in which both spouses are applying for benefits is $4,000. (Each spouse is considered as an individual applicant. Therefore, each spouse is allowed up to $2,000 in assets.)

In the situation where only one spouse of a married couple is applying for the SAIL waiver, the non-applicant spouse can keep 50% of the couple’s assets, up to $154,140 (as of 2024). If the couple’s assets are under $30,828, the non applicant spouse can keep all of the assets, up to this amount. This is known as the community spouse resource allowance (CSRA).

Please note: The asset limit can be somewhat misleading in that many resources are, or can be, considered exempt (not counted toward the asset limit). For example, the full value of one’s home is exempt, provided the applicant lives there, or plans to return to the home, and his/her equity interest is valued under $713,000. The home is also exempt, regardless of any other circumstances, if a non-applicant spouse lives in the home. A car, burial plots,  burial funds or prepaid contract up to $5,000, household items, and even some personal effects are also exempt.

Over the Financial Limits?

Those over the asset limit need to exercise caution when “spending down” resources in order to meet Medicaid’s asset limit. Medicaid has a look back period (60-months in Alabama) in which Medicaid considers all past assets transferred within the specified timeframe. If an applicant is found to have given away assets or sold them for less than they are worth, the applicant will be penalized with a period of Medicaid ineligibility.

However, exceeding the limits by relatively minor amounts may not rule out qualifying for Medicaid. Planning professionals who specialize in Alabama Medicaid eligibility can help families to reach the state standards by shifting assets and using specially designed trusts. Learn more about how a Medicaid planner may assist you.

Benefits and Services

As implied by the words “Independent Living” in the waiver name, the services provided under this waiver are selected to help participants achieve that objective.

• Assistive Technology Needs Evaluations
• Assistive Technology and Devices – Hearing aids, vehicle modifications, etc.
• Assistive Technology Repairs – Replacing parts/batteries of assistive technology previously bought for the individual by Medicaid
• Transitional Assistive Technology – May include wheelchairs, hospital beds, and Hoyer lifts.
• Case Management Services
• Environmental Accessibility Adaptations / Home Modifications – Ramp installation, adding grab bars, and widening doorways
• Medical Supplies
• Personal Care Services – Assistance with activities of daily living, such as bathing, eating, and dressing, aid in preparing meals, basic housecleaning, etc.
• Personal Emergency Response System – Installation and monthly charge
• Personal Assistance Service – Transportation to / from place of employment, monitoring of medication, shopping for essentials, etc. with the purpose of maintaining employment
• Pest Control Services 
• Unskilled Respite Care
• Service Coordination
• Referral Services

How to Apply / Learn More

One should contact the Alabama Medicaid office at 1-800-362-1504 to learn more about this waiver program and begin the application process. One can also learn more about the SAIL waiver here. While open to residents statewide, participation may be limited due to enrollment caps on the program. (At the time of this writing, participant wavier slots were capped at 800.)  Also, the senior’s local Area Agency on Aging may be an additional information resource to learn whether this program is right for you or your loved one.