AL HCBS Living at Home Waiver for Persons with Intellectual Disabilities

Published on
August 16, 2023
Last updated
February 29, 2024
Written by
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Katie Wilkinson
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Learn about the AL HCBS Living at Home Waiver for Persons with Intellectual Disabilities, a Medicaid program that can help you pay for home and community-based services and potentially compensate your family caregiver.
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Suppose you care for a loved one with an intellectual disability in Alabama. In that case, you may be eligible for a Medicaid waiver program to help you pay for the services and support you need. This article explores what the AL HCBS Living at Home Waiver for Persons with Intellectual Disabilities is, how it works, and how it can benefit you and your family.

Overview of AL HCBS Living at Home Waiver for Persons with Intellectual Disabilities

The AL HCBS Living at Home Waiver for Persons with Intellectual Disabilities (LH Waiver) is a Medicaid waiver that provides home and community-based services (HCBS) to individuals with intellectual disabilities who live in their homes or with their families. The LH Waiver is designed to prevent or delay institutionalization and to promote independence and community integration for individuals with intellectual disabilities. The LH Waiver serves Medicaid-eligible individuals under the waiver who would otherwise need an ICF/IID level of care.


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Eligibility requirements

To qualify for the LH Waiver, you must meet the following criteria:

  • You must be a resident of Alabama and a U.S. citizen or a qualified alien.
  • You must be 18 years of age or older.
  • You must have an intellectual disability, as the Alabama Department of Mental Health (ADMH) defines.
  • You must meet the financial eligibility requirements for Medicaid under the waiver based on your income and resources.
  • You must meet the medical eligibility requirements for the LH Waiver, which are based on your need for ICF/IID level of care.
  • You must have a person-centered plan of care that identifies your goals, preferences, strengths, needs, and services.
  • You must receive benefits in your home or community instead of an institution.

Services and supports

The LH Waiver offers a variety of services and supports that can help you live safely and comfortably in your home or community. Some of the services and supports available under the LH Waiver are:

  • Community Day Habilitation Services: These are services that provide opportunities for socialization, recreation, education, and skill development in community settings.
  • Day Habilitation Services: These services offer structured activities in a non-residential setting to enhance your physical, cognitive, behavioral, and social skills.
  • Prevocational Services: These services prepare you for paid or unpaid employment by developing your work habits, attitudes, and skills.
  • Supported Employment Services: These services help you find and keep a job in an integrated setting with ongoing support from a job coach.
  • Occupational Therapy Services: These services improve your ability to perform daily living activities such as dressing, eating, bathing, and mobility.
  • Speech and Language Therapy Services: These services help you improve your communication skills, such as speaking, listening, reading, writing, and using assistive devices.
  • Physical Therapy Services: These services allow you to improve your physical functioning, such as strength, balance, coordination, and range of motion.
  • Positive Behavior Support Services: These are services that help you reduce challenging behaviors and increase positive behaviors through assessment, intervention, training, and monitoring.
  • Respite Care Services: These temporarily relieve your primary caregiver by caring for you in your home or another setting.
  • Personal Care Services: These are services that assist you with activities of daily living such as bathing, dressing, grooming, toileting, eating, and transferring.
  • Environmental Accessibility Adaptations Services: These services make physical changes to your home or vehicle to improve accessibility and safety.
  • Specialized Medical Supplies Services: These are services that provide items such as diapers, gloves, catheters, ostomy supplies, wound care supplies, and nutritional supplements that are not covered by the Medicaid state plan.
  • Assistive Technology Services: These services provide devices such as wheelchairs, walkers, lifts, ramps, communication devices, and alarms that enhance your independence and quality of life.
  • Skilled Nursing Services: These services provide medical care such as medication administration, wound care, injections, tube feeding, and health monitoring by a registered nurse or a licensed practical nurse.
  • Crisis Intervention Services: These are services that provide immediate response and support to you and your family in case of an emergency or a behavioral crisis.
  • Individual Directed Goods and Services: These services allow you to purchase goods or services that are not otherwise available under the LH Waiver but are necessary to meet your needs and goals.
  • Assistance in Community Integration Services: These services help you access and participate in community activities and resources such as transportation, recreation, education, and civic engagement.
  • Benefits and Career Counseling Services: These provide information and guidance on accessing and maintaining public benefits and employment opportunities.
  • Community Experience Services: These provide opportunities to explore your interests, hobbies, and talents in community settings.
  • Personal Emergency Response System (PERS) Services: These services provide an electronic device that allows you to call for help in an emergency.
  • Supported Employment Emergency Transportation Services: These services offer transportation to and from your supported employment site in case of an emergency or a disruption of your regular transportation.
  • Remote Support Services: These are services that provide monitoring and assistance to you through technology such as cameras, sensors, and alarms when you are alone or unsupervised in your home.
  • Companion Services: These provide companionship and supervision to you in your home or community.
  • Housing Stabilization Services: These services help you obtain and maintain safe and affordable housing in the community.

Who are you caring for?

Compensation for caregivers

One of the benefits of the LH Waiver is that it allows you to self-direct some of the services and supports you receive. This means that you can choose who provides the service, how the service is provided, when the service is provided, and where the service is provided. You can hire, train, supervise, and fire your service providers. Self-direction gives you more control and flexibility over your care.

One of the services you can self-direct under the LH Waiver is Personal Care Services, meaning you can choose to hire a family member, a friend, or a neighbor as your personal care provider. You can also pay them for the care they provide. This is a great way to compensate your unpaid family caregiver for their work.

You must enroll in the Self-Directed Personal Care program (SDPC) to self-direct your Personal Care Services under the LH Waiver. The ADMH administers the SDPC program and provides training, support, and oversight to help you manage your personal care budget and staff. You must also use a fiscal intermediary agency (FIA) to handle your personal care provider's payroll, taxes, and insurance.

The amount of money you can pay your family caregiver depends on several factors, such as the number of hours of care you need, the rate of pay for personal care providers in your area, and the availability of funds in the LH Waiver. The rate of pay may vary depending on your location and the qualifications of your provider. You can contact your case manager or the ADMH to find out how much money you can allocate for your personal care provider.

Learn more about Medicaid self-directed care >>

A note from Givers

If you or your loved one may qualify for this waiver program, we encourage you to fill out this form to determine your eligibility for caregiver compensation. We will help you navigate the application process and connect you with the resources you need. 

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