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Home care programs · Alabama

Alabama home care programs

Alabama pays for care at home through 7 programs. Consumer-directed care is available through Personal Choices. Family members can be paid caregivers in 2 of them.

Verified Oct 9, 2026Sources: official state and federal agencies

Every state
Programs
7
Consumer-directed
Yes
Family can be paid
Yes
Structured family caregiving
No
On this page
Programs

Every way Alabama pays for care at home

Alabama pays for care at home through 7 programs. Consumer-directed care is available through Personal Choices. Family members can be paid caregivers in 2 of them.

ProgramTypeCan family be paidHow it differs
Home health services (Alabama Medicaid) (HHA)State Plan home health (42 CFR 440.70)Home healthNoSkilled home health: nursing, therapy and aide visits under a plan of care from a licensed home health agency; run as a Medicaid State Plan benefit, paid fee-for-service.
Personal Choices1915(j) State Plan self-directed personal assistanceConsumer-directedYesConsumer-directed care: the participant hires and directs their own aide, with payroll handled for them; run as a 1915(j) self-directed state plan option, paid fee-for-service.
ACT Waiver and Technology Assisted Waiver1915(c) waivers AL.0878 and AL.0407Waiver in-homeNot statedWaiver in-home services: supports at home for people who meet a nursing-home or similar level of care; run as a 1915(c) home and community-based services waiver, paid fee-for-service.
Elderly and Disabled Waiver1915(c) waiver AL.0068Waiver in-homeNot statedWaiver in-home services: supports at home for people who meet a nursing-home or similar level of care; run as a 1915(c) home and community-based services waiver, paid fee-for-service.
Intellectual disability waivers (LAH)1915(c) waivers AL.0001, AL.0391, AL.1746Waiver in-homeYesWaiver in-home services: supports at home for people who meet a nursing-home or similar level of care; run as a 1915(c) home and community-based services waiver, paid fee-for-service.
State of Alabama Independent Living Waiver (SAIL)1915(c) waiver AL.0241Waiver in-homeNot statedWaiver in-home services: supports at home for people who meet a nursing-home or similar level of care; run as a 1915(c) home and community-based services waiver, paid fee-for-service.
Program of All-Inclusive Care for the Elderly (PACE)State Plan PACE (42 CFR Part 460)PACENoPACE: one organization covers medical care, a day center and home care for people 55 and over; run as the PACE benefit, delivered through managed-care plans.
Guide

Home health vs home care vs consumer-directed care in Alabama

What each kind of program is, who employs the caregiver and when a family member can be paid.

Home health: the medical benefit

In Alabama, skilled home health is Home health services (Alabama Medicaid) (HHA). It is a medical benefit: a doctor or other practitioner orders nursing, therapy or home health aide visits under a written plan of care, and the visits stop when the skilled need ends.

Only a licensed home health agency enrolled with Alabama Medicaid can bill it, and the agency's own nurses, therapists and aides make the visits. Family members are not paid under this benefit.

Home care: non-medical personal care through an agency

Help with bathing, dressing, eating and household tasks is "home care" or personal care. In Alabama it is paid through the programs below rather than a separate agency personal care benefit.

Consumer-directed care: the person hires their own aide

Alabama's consumer-directed option is Personal Choices. The person receiving care, or a representative, recruits, hires, trains, schedules and supervises the aide, and can let go of one. A fiscal intermediary runs payroll, taxes and background checks, so the person never handles wages directly.

This is the route most families use to be paid: Personal Choices allows a relative to be hired as the paid aide. Which relatives qualify (adult children, parents of adults, spouses, legal guardians) and how a live-in caregiver is treated are set program by program.

Structured family caregiving: a paid live-in family caregiver

Alabama has no structured family caregiving program. A family caregiver is paid instead through consumer-directed care (Personal Choices), by the hour, as the participant's chosen aide.

Other ways Alabama pays for care at home

Waiver in-home services: ACT Waiver and Technology Assisted Waiver, Elderly and Disabled Waiver, Intellectual disability waivers (LAH), and State of Alabama Independent Living Waiver (SAIL). These pay for in-home supports for people who meet a nursing-home or similar level of care, often with more services than state plan personal care and, in some programs, a waiting list or enrollment cap.

PACE: Program of All-Inclusive Care for the Elderly (PACE). One PACE organization covers medical care, a day center and home care for people 55 and over who need nursing-home level care.

Which one fits

  • Needs nursing, wound care, injections or therapy at home: home health (Home health services (Alabama Medicaid) (HHA)).
  • Wants to choose the aide, including a relative where allowed: Personal Choices.
  • Meets nursing-home level of care and needs more than personal care: ACT Waiver and Technology Assisted Waiver, Elderly and Disabled Waiver, Intellectual disability waivers (LAH), and State of Alabama Independent Living Waiver (SAIL).
In the workspace

Alabama program rules, side by side

Eligibility, the family caregiver rules (spouses, parents, live-in caregivers), employer of record, fiscal intermediary, caregiver training, provider requirements, how to enroll, published pay, EVV and waiting lists: 68 details across 7 programs.

ProgramFamily rulesEmployerEligibilityPay
See Alabama's program rules — start free

Who can be paid, who employs the caregiver, what each program requires of agencies and caregivers, how to become a provider and what it pays, for all 7 programs.

  • Family caregiver rules
  • Provider requirements
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Program by program

Alabama's programs

What each program is and how it differs from the others. Locked details open in the workspace.

Home health services (Alabama Medicaid) (HHA)

Home health

State Plan home health (42 CFR 440.70) · Alabama Medicaid Agency

Skilled home health: nursing, therapy and aide visits under a plan of care from a licensed home health agency; run as a Medicaid State Plan benefit, paid fee-for-service.

Can family be paid?No
How to get set up
Provider track · 6 steps
  1. Form the business
  2. 5 more steps: forms, fees, timelines and links
Family / participant track · 4 steps
  1. Medicaid coverage
  2. 3 more steps: forms, fees, timelines and links
Open the full checklist →
EligibilityServices coveredFamily caregiver rulesEmployer of recordProvider requirementsHow to become a providerEVVWaiting list or capHow it differs, in detailSetup checklistUnlock the details →

Personal Choices

Consumer-directed

1915(j) State Plan self-directed personal assistance · Alabama Medicaid Agency with ADSS

Consumer-directed care: the participant hires and directs their own aide, with payroll handled for them; run as a 1915(j) self-directed state plan option, paid fee-for-service.

Can family be paid?Yes
How to get set up
Provider track · 3 steps
  1. State-contracted FMSA
  2. 2 more steps: forms, fees, timelines and links
Family / participant track · 6 steps
  1. Be in an eligible waiver
  2. 5 more steps: forms, fees, timelines and links
Open the full checklist →
EligibilityServices coveredHours or budgetFamily caregiver rulesEmployer of recordFiscal intermediaryCaregiver requirementsProvider requirementsHow to become a providerEVVWaiting list or capRecent changesHow it differs, in detailSetup checklistUnlock the details →

ACT Waiver and Technology Assisted Waiver

Waiver in-home

1915(c) waivers AL.0878 and AL.0407 · Alabama Medicaid Agency (ADSS operates ACT)

Waiver in-home services: supports at home for people who meet a nursing-home or similar level of care; run as a 1915(c) home and community-based services waiver, paid fee-for-service.

Can family be paid?Not stated
How to get set up
Provider track · 5 steps
  1. Form the business
  2. 4 more steps: forms, fees, timelines and links
Family / participant track · 4 steps
  1. Apply
  2. 3 more steps: forms, fees, timelines and links
Open the full checklist →
EligibilityServices coveredEmployer of recordProvider requirementsWaiting list or capHow it differs, in detailSetup checklistUnlock the details →

Elderly and Disabled Waiver

Waiver in-home

1915(c) waiver AL.0068 · Alabama Medicaid Agency; operated by the Alabama Department of Senior Services (ADSS) and the Integrated Care Network

Waiver in-home services: supports at home for people who meet a nursing-home or similar level of care; run as a 1915(c) home and community-based services waiver, paid fee-for-service.

Can family be paid?Not stated
How to get set up
Provider track · 7 steps
  1. Form the business
  2. 6 more steps: forms, fees, timelines and links
Family / participant track · 6 steps
  1. Apply
  2. 5 more steps: forms, fees, timelines and links
Open the full checklist →
EligibilityServices coveredHours or budgetFamily caregiver rulesEmployer of recordCaregiver requirementsProvider requirementsHow to become a providerEVVWaiting list or capHow it differs, in detailSetup checklistUnlock the details →

Intellectual disability waivers (LAH)

Waiver in-home

1915(c) waivers AL.0001, AL.0391, AL.1746 · Alabama Department of Mental Health, Division of Developmental Disabilities

Waiver in-home services: supports at home for people who meet a nursing-home or similar level of care; run as a 1915(c) home and community-based services waiver, paid fee-for-service.

Can family be paid?Yes
How to get set up
Provider track · 7 steps
  1. Form the business
  2. 6 more steps: forms, fees, timelines and links
Family / participant track · 4 steps
  1. Apply
  2. 3 more steps: forms, fees, timelines and links
Open the full checklist →
EligibilityServices coveredHours or budgetFamily caregiver rulesEmployer of recordProvider requirementsWaiting list or capHow it differs, in detailSetup checklistUnlock the details →

State of Alabama Independent Living Waiver (SAIL)

Waiver in-home

1915(c) waiver AL.0241 · Alabama Department of Rehabilitation Services (ADRS)

Waiver in-home services: supports at home for people who meet a nursing-home or similar level of care; run as a 1915(c) home and community-based services waiver, paid fee-for-service.

Can family be paid?Not stated
How to get set up
Provider track · 5 steps
  1. Form the business
  2. 4 more steps: forms, fees, timelines and links
Family / participant track · 4 steps
  1. Apply
  2. 3 more steps: forms, fees, timelines and links
Open the full checklist →
EligibilityServices coveredEmployer of recordProvider requirementsWaiting list or capHow it differs, in detailSetup checklistUnlock the details →

Program of All-Inclusive Care for the Elderly (PACE)

PACE

State Plan PACE (42 CFR Part 460) · Alabama Medicaid Agency

PACE: one organization covers medical care, a day center and home care for people 55 and over; run as the PACE benefit, delivered through managed-care plans.

Can family be paid?No
How to get set up
Provider track · 6 steps
  1. Form the PACE organization
  2. 5 more steps: forms, fees, timelines and links
Family / participant track · 7 steps
  1. Check the service area
  2. 6 more steps: forms, fees, timelines and links
Open the full checklist →
EligibilityServices coveredFamily caregiver rulesEmployer of recordProvider requirementsHow to become a providerWaiting list or capHow it differs, in detailSetup checklistUnlock the details →
FAQ

Frequently asked questions

Can family members get paid to be caregivers in Alabama?

Yes. Personal Choices and Intellectual disability waivers (LAH) let a family member be the paid caregiver. Which relatives qualify, including spouses and parents of minor children, is set program by program.

Does Alabama have consumer-directed care?

Yes: Personal Choices. The person receiving care hires and directs their own aide, and a fiscal intermediary handles payroll.

Does Alabama have structured family caregiving?

No. Alabama does not run a structured family caregiving program. Family caregivers are paid through consumer-directed care instead.

What is the difference between home health and home care in Alabama?

Home health (Home health services (Alabama Medicaid) (HHA)) is medical: nursing, therapy and aide visits ordered by a practitioner and delivered by a licensed home health agency. Home care is non-medical help with daily activities, based on functional need.

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