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Institutional Medicaid

The Alabama Medicaid Agency offers institutional care coverage for qualified individuals. Medicaid for Institutional Care is for people in nursing homes, hospitals and ICF-IID facilities. People who meet nursing home level of care may opt to apply for one of the Agency’s Home and Community Based waivers to receive care in the community.

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Click here for more information on HCBS waivers.

• Applicants must be medically approved by Medicare or Medicaid for the nursing facility to be paid
• Applicants must also be a resident of an approved medical institution for at least 30 continuous days to be eligible (Except for SSI recipients)
• Applicants must have monthly income below a certain limit, set each year in January.  The 2018 limit is $2,250 per month for an individual
• Applicants must have resources below a certain limit
• Applicants must be a US citizen and live in Alabama

• The resource limit for Nursing Home Medicaid is $2,000 as of the first day of the month
• Special rules apply when a spouse remains in the home
• Examples of resources include cash, cash surrender value of life insurance (when face value of all policies is more than $5,000; checking and savings, loans, mineral and timber rights, mortgages, mutual funds, promissory notes, real estate, stocks and bonds, certificates of deposit and annunities
• Some resources do not count toward the $2,000 monthly resource limit. These include household goods and personal effects, burial funds or prepaid contract up to $5,000; burial space items (casket, vault, plot, marker, opening and closing of grave); one car if used by the household member
• Property is not counted if a spouse, other dependent relative or joint owner is living on the property, if a bona fide effort is being made to sell the property, if there is intent to return home from the medical institution, if the property, valued at less than $6,000, is income producing or if the property interest is a life estate. A lien may be required.
• All property information such as deeds, wills, etc. will need to be submitted to the Medicaid District Office for review.

• Used when an applicant has excess income (not resources)
• Allows Medicaid to disregard excess income for the purpose of determining eligibility
• Strict rules apply to the establishment of an acceptable QIT

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  Form 262 – Qualifying Income Trust Packet – Used for a Medicaid applicant who is entering a nursing home and has excess income

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  Overview of Medicaid Programs for Elderly and Disabled

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  Applications and Forms

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  Tips for Applying for Institutional (Nursing Home) Medicaid – Updated 2/6/18

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  Fillable Application – Type information onto on-line form, print and mail. Print a copy for your records since the information on the form will not be saved once it is closed. Application cannot be faxed.

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  Addresses to Mail Applications

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  Reporting Changes – Nursing Home/Institutionalized Recipients – 3/27/17    

• Policies may help Alabama residents protect their assets if they ever have to apply for nursing home assistance from Medicaid
• Allows Medicaid to disregard, or exclude, the benefits paid under an approved policy when determining an applicant’s financial eligibility for long-term care.
• Policies must include inflation protection to keep up with the rising cost of long-term care services and meet IRS and other requirements.
• Qualifying policies must be certified by the Alabama Department of Insurance.

• The Expedite Online Nursing Home Application System is available to nursing home providers who wish to submit application forms and related documents online.

Medicaid Plan First (Family Planning Only)

Through a special agreement (waiver) with the federal government, women ages 19 through 55 may also qualify for family planning services through the

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Plan First

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Program. Men age 21 or older may qualify for vasectomies only. For women, this includes a yearly family planning exam, birth control such as pills or shots, tubes tied, lab work to test for pregnancy or sexually-transmitted disease and help in planning when to have a baby.  Call 1-888-737-2083 toll-free for more information.

How to Qualify:

• Be a U.S. citizen and live in Alabama
• Be a woman between the ages of 19 and 55, or be a man who is at least 21 (vasectomies only)
• Have income that is below the Medicaid limit
• Not have had surgery to to prevent pregnancy (tubes tied)
• Provide proof of identity such as a drivers’ license

Find Out More!

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  Brochure – Plan First

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  Plan First Program Fact Sheet

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  Qualifying for Medicaid

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  How to apply for Plan First

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  Click to Contact the Plan First program

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  Apply Online!

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  Income Limits for 2018

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  Frequently Asked Questions about Applying and Qualifying for Medicaid

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  What documents are needed to prove citizenship status?

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  How is Household Income Calculated? Household income is calculated based on the Modified Adjusted Gross Income (MAGI) methodology. Household income is the sum of the MAGI-based income of every individual included in the individual’s household. The total income of a household will equal the MAGI of all individuals in the household size regardless of whether or not they file taxes.

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  How is Family Size Determined?  Family size is the number of persons counted as members of an individual’s household. The family size of the household is determined by counting those who are included on the family federal income tax form. The number of individuals expected to be claimed on the federal income tax return determines family size.

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Home and Community-Based Waiver Services

Home and Community-Based Waiver Services are available to eligible Medicaid recipients who are at risk of needing care in a nursing home, hospital or other institution. Clients must meet financial, medical and program requirements and must be willing to receive services in their homes or communities.  Waiver program enrollment is limited and a waiting period may be necessary.

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In-Home Care Providers:  – All in-home care providers are required to use Medicaid’s Electronic Visit Verification and Monitoring System that has been implemented. Click here for training information!

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  Summary of Programs – Updated 2/13/18

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  Chart – Alabama HCBS Waiver Services – Updated 2/20/18

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  Alabama Community Transition (ACT) Waiver

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  Long Term Care Waiver Quality Assurance Manual

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  Elderly and Disabled Waiver

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  Living at Home Waiver

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  Intellectual Disabilities Waiver

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  State of Alabama Independent Living (SAIL) Waiver

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  Technology Assisted Waiver for Adults

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  Alabama Statewide Transition Plan – CMS Home and Community-Based Services regulations

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  Medicaid Waiver Survey (REOMB)

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  Alabama’s Olmstead Plan: Gateway to Community Living

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  Checklist for Waivers (HCBS) – Information on denials, reasons for recoupments, where to find information in the Medicaid Provider Billing Manual, free tools and contacts for providers to use in preventing fraud and abuse – 9/17

 

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Disclaimer: The community resource directory information is deemed accurate and up-to-date, however, you should always call the provider to confirm this information and make an appointment. Be sure to confirm payment information with the provider, if payment is required. God-Bless-You

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