Ala. Admin. Code r. 560-X-57-.02
Eligibility
Effective Dec 14, 2020Emergency rule effective April 1, 1992. Permanent rule effective June 12, 1992. Amended: Filed January 5, 1994; effective February 10, 1994. Amended: September 6, 1996; effective October 12, 1996. Amended: Filed June 11, 2003; effective July 16, 2003. Amended: March 14, 2007; effective April 18, 2007. Amended: Filed August 11, 2008; effective September 15, 2008. Amended: Published October 30, 2020; effective December 14, 2020.Alabama Medicaid Agency
- (1) Financial eligibility is limited to those individuals receiving SSI, individuals receiving State Supplementation, SSI related protected groups deemed to be eligible for SSI/Medicaid, and Special Home and Community-Based waiver disabled individuals whose income is not greater than 300% of the SSI Federal Benefit Rate.
- (2) Medical eligibility is determined based on current admission criteria for nursing facility level of care as described in Rule No. 560-X-10-.10.
- (3) No waiver services will be provided to recipients in a hospital or nursing facility. However, case management activities are available to assist recipients interested in transitioning from an institution into a community setting. Case management activities to facilitate the transition are limited to a maximum of 180 days prior to discharge into the community.
- (4) The Alabama Medicaid Agency or its operating agency, Alabama Department of Rehabilitation Services, acting on Medicaid's behalf may deny home and community-based services if it is determined that an individual's health and safety is at risk in the community; if the cost of serving an individual on the waiver exceeds the cost of caring for that individual in a nursing facility; if the individual does not cooperate with a provider in the provision of services; or if an individual does not meet the goals and objectives of being on the waiver program.
- (5) The Alabama Medicaid Agency is restricted by the waiver to serving the estimated annual unduplicated number of beneficiaries approved by the Centers for Medicare and Medicaid Services.
- (6) The eligibility age criteria is 18 years and above, with physical disabilities not associated with the process of aging and with onset prior to age 63.
Author: Antionette Hardy, Administrator, LTC Healthcare Reform Unit
Statutory Authority: 42 C.F.R. §441, Subpart G and the Home and Community-Based SAIL Waiver.
History: Emergency rule effective April 1, 1992. Permanent rule effective June 12, 1992. Amended: Filed January 5, 1994; effective February 10, 1994. Amended: September 6, 1996; effective October 12, 1996. Amended: Filed June 11, 2003; effective July 16, 2003. Amended: March 14, 2007; effective April 18, 2007. Amended: Filed August 11, 2008; effective September 15, 2008. Amended: Published October 30, 2020; effective December 14, 2020.