Aging in place in your state: Alabama

Downtown Gadsden, Alabama; image by 12019 on Pixabay

We’re Marching into early spring with a report on Alabama’s options for assisting  seniors with the kind of home modifications and other adaptations that help them age in place. Though this post completes our initial survey of each state, we’ll continue to cover this topic in the future, taking a look at U.S. territories and keeping you updated on changes to states’ benefit structures over time. 

But for now, let’s examine Alabama, the only state in the nation to lack an officially recognized nickname. Some people call it The Cotton State, and others the Yellowhammer State—this last a nod to its state bird, a type of woodpecker with brilliant golden coloring under its wings and tail—but the state Legislature has never adopted any of them officially.

Alabama legislators have also never adopted full Medicaid expansion, along with 14 other states, which naturally affects the benefits seniors can access as they strive to continue living independently as long as possible. We’ll be looking at that topic as it applies to every state soon. But for now, here are a few ways elderly Alabamans can get help as they seek to age in place.

First and foremost is the Alabama Elderly and Disabled Waiver, part of the state’s Medicaid offerings. Note that this waiver program is not an entitlement program, which means even people who qualify for services may not receive them right away; waiting lists are common in services like this.

Qualifications for Alabama’s E&D waiver are similar to those in other states: residents of Alabama must be disabled and/or age 65 or older and require a nursing home level of care. They also must meet financial requirements: a monthly income of less than 300% of the federal benefit rate, which is about $2,200 as of the beginning of 2024. Qualifying applicants also may retain assets valued at no more than $2,000. However, several assets don’t count towards that total: a home valued at up to about $700,000, personal possessions, a primary vehicle, and a few other assets. Spouses of people applying for waiver benefits also can have a portion of the applicant’s income transferred to them to meet these limits, as well as retaining some savings accounts and other financial assets of up to about $150,000.

Once applicants qualify, they can receive a multitude of services, from case management and skilled nursing to companion services, home-delivered meals, supervisory visits, skilled nursing, assistive technology, durable medical equipment, and home modifications.

According to the Alabama Department of Senior Services, modifications allowed under the waiver must be “physical adaptations to the home which are necessary to ensure the health, welfare, and safety of individuals, or which enable individuals to function with greater independence in the home, and without this service the individual would require institutionalization.” Services that can be covered include, for example, installation of ramps and grab bars, doorway widening, and “supplies which are necessary for the welfare of the individual.” Any adaptations or improvements “not of direct medical or remedial benefit to the waiver recipient” are not allowed, along with adaptations that add to the total square footage or affect the home’s structural integrity or electrical components. 

In addition, services must be documented on a recipient’s plan of care and performed by a license contractor in accordance with state and local building codes and the Americans with Disabilities Act Accessibility Guidelines. There is a lifetime limit of $5,000 per person for home modifications, although expenditures over that limit may be approved by the Alabama Medicaid Agency.

In addition, the Elderly and Disabled Waiver allows people to receive a personal emergency response system, along with installation and monitoring, to help seniors living alone, or who are alone for large parts of the day without a caretaker. “The recipient may wear a portable ‘help’ button which allows flexibility in mobility,” the Alabama Senior Services website reads. The system can be linked to a recipent’s phone or to that of a caregiver, giving families an extra layer of protection when an elderly loved one wants to continue living at home.

The Elderly and Disabled Waiver also has a client-directed option called Personal Choices, which allows a recipient to play a greater role in identifying their own needs and managing their long-term services under the waiver.

In addition, the Alabama Community Transition (ACT) waiver helps people currently living in nursing homes or other institutions move back to a home or other community dwelling. This program, also called Gateway to Community Care, is funded through the Centers for Medicare and Medicaid Services’ Money Follows the Person program and “uses the state’s existing long-term care system as a foundation,” according to the ACT web page. 

Through this program, individuals who qualify for services receive help from a “dedicated transition coordinator,” who helps them make a transition plan. The state then helps with finding appropriate housing and with moving costs, including rental and utility deposits. For people who are able to work, the coordinator will also help find job opportunities. 

A similar program, Hospital to Home, helps people who have been hospitalized and who might be at risk for placement in an institution return, instead, to community living. Though it has no home modification component, seniors able to use this program to return to community living can later apply for services under the Elderly and Disabled Waiver.

Now that we’ve finished looking at offerings from all 50 states, watch this space for a wider look at Medicaid, Medicaid waiver services, and other benefits nationwide, as well as more insights into how to live well while aging.