How Medicaid Can Help Pay for Long-Term Care in Alabama

Q: How many people does Alabama's Elderly and Disabled Waiver serve?

The program is approved for a maximum of 15,000 beneficiaries annually — a real, fixed enrollment cap, not just a general statement about limited slots.

Q: Can I hire my spouse as my caregiver in Alabama?

Not always — Alabama's Personal Choices self-direction program allows hiring family caregivers, but explicitly excludes spouses in some cases. Confirm your specific situation directly rather than assuming spousal hiring is available.

Q: What is Alabama's Qualifying Income Trust?

Alabama's specific name for what's nationally called a Miller Trust or Qualified Income Trust — required if your income exceeds $2,982/month, redirecting the excess so you can still qualify for long-term care Medicaid.

Published August 28, 2026 How we keep this accurate

This page is Alabama-specific. Medicaid long-term care rules vary significantly by state. See our national Medicaid Waivers Explained guide if you're elsewhere.

A real, specific enrollment cap

Alabama's Elderly and Disabled (E&D) Waiver — the state's primary HCBS program for seniors and disabled adults who need nursing-facility-level care but prefer to remain at home — is approved for a maximum of 15,000 beneficiaries annually. This is a genuine, fixed number, not a general statement about "limited slots." Waitlists can be significant, and applying as early as possible matters given this hard ceiling.

A real restriction on family caregiving

Alabama's Personal Choices self-direction program allows hiring family caregivers — but explicitly excludes spouses in some cases. This is different from several other states, where spousal hiring is a genuine option. If having your spouse serve as your paid caregiver is part of your planning, confirm directly whether it applies to your specific situation rather than assuming it works the same way it might in a neighboring state.

The 2026 financial numbers

	E&D Waiver / Nursing Home Medicaid
2026 income limit	$2,982/month (single)
2026 asset limit	$2,000 (single), $3,000 (couple, both applying)
Community Spouse Resource Allowance	Up to $162,660
Annual enrollment cap (E&D Waiver)	15,000 beneficiaries

Source: Alabama Medicaid Agency, Alabama Department of Senior Services; figures effective 2026.

What the waiver actually covers

Alabama Medicaid doesn't directly pay for room and board in assisted living facilities. However, the E&D Waiver can cover services received in an assisted living setting — personal care, homemaker assistance, adult day health care, and assistive technology — even though the room-and-board cost itself isn't covered. This distinction matters if you're weighing assisted living as an option.

If your income is over the limit

Alabama calls its version of a Qualified Income Trust a Qualifying Income Trust — required if your income exceeds $2,982/month. The trust must be properly drafted, funded monthly, and administered according to state rules; errors can result in ineligibility, so this isn't something to assemble without professional help.

How to actually start

Apply through the dedicated E&D application portal at eanddapplication.medicaid.alabama.gov, or contact your local Area Agency on Aging at 1-800-243-5463 — given the 15,000-person cap, apply as early as realistically possible.

If considering a spouse as a paid caregiver, confirm directly whether Personal Choices applies to your situation before assuming it does.

Common Questions

How many people does Alabama's Elderly and Disabled Waiver serve?

A maximum of 15,000 beneficiaries annually — a real, fixed enrollment cap.

Can I hire my spouse as my caregiver in Alabama?

Not always — Personal Choices excludes spouses in some cases, unlike several other states.

What is Alabama's Qualifying Income Trust?

Alabama's name for a Miller Trust/Qualified Income Trust, required for income above $2,982/month.