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Alabama’s Community Waiver Program: Home and community-based services for Alabamians with intellectual disabilities

CMS approved the Alabama Medicaid Agency’s application for a 1115 Demonstration on October 21, 2021.

The 1115 Demonstration, in combination with a 1915(c) Home and Community-Based Services (“HCSB”) Waiver and a 1915(i) Medicaid State Plan HCBS Program, will facilitate the creation of a new Community Waiver Program (the “Program”). The Program will enable Alabama to provide additional services to certain individuals with intellectual disabilities (“IDs”) in Home and Community-based locations instead of institutions.

Additionally, the Program will enable the state to provide services to additional Alabamians by obtaining a waiver of several requirements normally imposed upon 1915(c) HCSB Waivers and 1915(i) Medicaid State Plan HCBS Programs—such as by allowing the Program to limit “the geographic area where the Community Waiver Program will initially operate to best ensure the ability of providers and the State Operating Agency (ADMH/DDD) to manage the successful roll-out and operation of the program with fidelity to program goals.”

Alabamians who require an institutional level of care will participate in the Program through the 1915(c) HCBS Waiver. The 1915(c) HCBS Waiver has four distinct enrollment groups—each with its own set of services and expenditure caps. These expenditure caps vary between $12,000 to $100,000 annually.

Alabamians older than 21 who do not require an institutional level of care will participate in the Program through the 1915(i) Medicaid State Plan HCBS Program which has a single enrollment group with an expenditure cap of $22,000.

By expanding access to non-institutional care, the Alabama Medicaid Agency hopes that fewer individuals enrolled in the 1915(i) Medicaid State Plan HCBS Program will require institutional care in the future.

The benefits packages for each enrollment group, along with additional information about the Community Waiver, can be found here.

If you would like to discuss how the Program can impact your business, please contact Jesse Neil at (615) 850-8910.


Jesse Neil
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Manning Russell
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