Alabama Medicaid Application Packet (Long-Term Care / Nursing Home)

ALABAMA MEDICAID APPLICATION PACKET — LONG-TERM CARE (NURSING HOME / HCBS WAIVER)

TABLE OF CONTENTS

1. Applicant Identification
2. Spouse and Household Information
3. Eligibility Framework — Alabama Medicaid Long-Term Care
4. Income Documentation
5. Resource (Asset) Documentation
6. 60-Month Transfer Look-Back Disclosure
7. Primary Residence and Real Property Treatment
8. Spend-Down and Pre-Eligibility Planning Steps
9. Spousal Impoverishment Calculations
10. Required Supporting Documents Checklist
11. Authorization, Signature, and Submission
12. Alabama Practice Notes
13. Sources and References

1. APPLICANT IDENTIFICATION

2. SPOUSE AND HOUSEHOLD INFORMATION

3. ELIGIBILITY FRAMEWORK — ALABAMA MEDICAID LONG-TERM CARE

Alabama is a § 1634 SSI-criteria state. SSI recipients are automatically eligible for Medicaid; non-SSI long-term care applicants must independently satisfy categorical, financial, and medical-necessity criteria administered by the Alabama Medicaid Agency.

Medically Needy: Alabama does NOT operate a medically needy "spend-down" program for long-term care. Applicants over the Special Income Limit qualify only by funding a Qualified Income Trust (Miller Trust) under Ala. Admin. Code r. 560-X-25-.17.

Medical Necessity: Institutional Medicaid requires Pre-Admission Screening (PAS) and a Level of Care determination by Alabama Medicaid certifying nursing-facility level of care.

4. INCOME DOCUMENTATION

If Total Gross Monthly Income > $2,982.00:

☐ Qualified Income Trust (Miller Trust) executed — date: [__/__/____]

☐ Trustee: [________________________________]

☐ Trust account opened at: [BANK / ROUTING / ACCOUNT]

5. RESOURCE (ASSET) DOCUMENTATION

6. 60-MONTH TRANSFER LOOK-BACK DISCLOSURE

Disclose every transfer of assets (gifts, sales below fair market value, additions of joint owners, payments to family caregivers without a written caregiver agreement, contributions to irrevocable trusts) made on or after [DATE 60 MONTHS BEFORE APPLICATION].

Penalty Period Calculation (per Ala. Admin. Code r. 560-X-25-.09):

Total Uncompensated Transfers ÷ Alabama Penalty Divisor = Months of Ineligibility

$[________] ÷ $7,800.00 = [________] months of ineligibility, beginning the date the applicant is otherwise eligible and would be receiving institutional care but for the penalty.

Hardship Waiver: ☐ Requesting hardship waiver under Ala. Admin. Code r. 560-X-25-.09(7) (applicant unable to obtain medical care without Medicaid and unable to recover transferred assets).

7. PRIMARY RESIDENCE AND REAL PROPERTY TREATMENT

The applicant's primary residence is an excluded resource during institutionalization if any of the following applies:

☐ Applicant intends to return home (signed Intent to Return statement attached);

☐ Community spouse, minor child, or disabled child resides in the home;

☐ Sibling with equity interest who has resided in the home ≥ 1 year occupies the home; or

☐ Adult caregiver child who provided care for ≥ 2 years immediately before institutionalization, enabling the applicant to remain at home, occupies the home (Ala. Admin. Code r. 560-X-25-.09(4)).

Equity Cap: Federal law caps protected home equity at $730,000 for 2026 (42 U.S.C. § 1396p(f)). Equity above the cap renders the residence a countable resource unless the spouse, minor, or disabled child exception applies.

Estate Recovery: Alabama pursues estate recovery against the probate estate of deceased Medicaid recipients age 55+ for long-term care services (Ala. Code § 22-6-152). The homestead is subject to recovery unless protected by spouse, minor, or disabled child survivorship.

8. SPEND-DOWN AND PRE-ELIGIBILITY PLANNING STEPS

The following pre-eligibility actions must be evaluated by counsel BEFORE filing:

☐ Pay outstanding medical, dental, and prescription bills;

☐ Pre-pay an irrevocable burial contract (no cap on burial space items; merchandise/services subject to reasonable funeral cost);

☐ Purchase a single excluded vehicle if needed;

☐ Make necessary home repairs / accessibility modifications (excluded residence);

☐ Replace exempt personal effects (clothing, eyeglasses, hearing aids, durable medical equipment);

☐ Pay off mortgage or non-dischargeable debt on excluded residence;

☐ Convert countable assets into a Medicaid-Compliant Single-Premium Immediate Annuity (SPIA) naming the State of Alabama as primary remainder beneficiary (Ala. Admin. Code r. 560-X-25-.09(5));

☐ Execute a written, market-rate Personal Care Agreement with any family caregiver to convert otherwise-disqualifying gifts into compensated services;

☐ Fund a Qualified Income Trust (Miller Trust) if income exceeds Special Income Limit;

☐ Spousal refusal or fair-hearing strategy evaluated where appropriate;

☐ Verify that none of the foregoing constitutes a disqualifying transfer.

9. SPOUSAL IMPOVERISHMENT CALCULATIONS

10. REQUIRED SUPPORTING DOCUMENTS CHECKLIST

☐ Birth certificate or other proof of age (applicant and spouse);

☐ Social Security card (applicant and spouse);

☐ Medicare card and any Medicare Advantage / Part D evidence;

☐ Proof of citizenship or qualifying alien status;

☐ Marriage certificate / divorce decrees / death certificates of prior spouses;

☐ Most recent 60 months of bank, brokerage, IRA, and credit-union statements (ALL accounts, ALL months — incomplete look-back records are the leading cause of denial);

☐ Deeds, tax assessments, mortgage statements for all real property;

☐ Vehicle titles and registrations;

☐ Life insurance policies (face value, cash value letters);

☐ Burial contracts / cemetery deeds;

☐ Trust instruments (revocable and irrevocable) and complete trust accountings for the look-back period;

☐ Powers of attorney and any guardianship/conservatorship orders;

☐ VA award letters / pension award letters;

☐ Three months of current pay stubs (if working);

☐ Three months of current health insurance premium statements;

☐ PAS / Level of Care determination;

☐ Facility admission agreement (if institutionalized);

☐ Qualified Income Trust instrument and bank account verification (if applicable);

☐ Personal Care Agreement (if applicable);

☐ Annuity contract and DRA-compliance attestation (if applicable).

11. AUTHORIZATION, SIGNATURE, AND SUBMISSION

I declare under penalty of perjury under the laws of the State of Alabama that the foregoing application and disclosures are true and correct to the best of my knowledge. I authorize the Alabama Medicaid Agency to verify any information provided herein, including obtaining records from financial institutions under 42 U.S.C. § 1396w. I understand that knowingly false statements may result in denial, recoupment, civil penalties, and criminal prosecution under Ala. Code § 22-1-11 and 42 U.S.C. § 1320a-7b.

Date: [__/__/____]

[________________________________]

[APPLICANT NAME] (or Authorized Representative)

Capacity: ☐ Applicant ☐ Spouse ☐ Durable POA ☐ Guardian/Conservator ☐ DHR-designated

[________________________________]

[ATTORNEY NAME], Alabama State Bar No. [####]

Counsel for Applicant

[FIRM NAME / ADDRESS / PHONE / EMAIL]

Submission: File the completed application with the local Alabama Medicaid District Office serving the applicant's county of residence, by mail, fax, or upload to the Medicaid Online Services Portal at https://medicaid.alabama.gov/. Telephone applications may be initiated at 1-800-362-1504.

12. ALABAMA PRACTICE NOTES

• § 1634 state. Alabama uses SSA-administered SSI eligibility criteria — there is no separate state SSI supplement and no § 209(b) more-restrictive determination. SSI recipients are automatically Medicaid-eligible.
• No medically needy program for long-term care. Income above the 300% SSI cap requires a Qualified Income Trust; there is no "share of cost" pathway for institutional Medicaid in Alabama.
• Look-back uniformity. The 60-month look-back applies equally to outright gifts and irrevocable trust funding. Transfers between spouses are exempt under 42 U.S.C. § 1396p(c)(2)(B)(i).
• DRA-compliant annuities. Alabama applies the Deficit Reduction Act's annuity rules: actuarially sound, equal monthly payments, no balloon, irrevocable, non-assignable, with the State named primary remainder beneficiary up to Medicaid expenditures.
• Caregiver Child Exemption. Transfer of the homestead to an adult child caregiver who lived in the home and provided care for ≥ 2 years immediately preceding institutionalization is exempt from the transfer penalty (Ala. Admin. Code r. 560-X-25-.09(4)).
• Estate recovery. Alabama recovers from the probate estate only — assets passing by survivorship, beneficiary designation, or living trust generally avoid recovery, subject to any future expansion of the recovery definition.
• Fair Hearing. Adverse decisions may be appealed within 60 days of notice (Ala. Admin. Code r. 560-X-3-.01 et seq.).
• Annual updates. Income, asset, CSRA, MMMNA, and divisor figures change at least annually. Re-verify before each filing.

13. SOURCES AND REFERENCES

• Alabama Medicaid Agency — https://medicaid.alabama.gov/
• Alabama Medicaid 2026 Income Limits (PDF) — https://medicaid.alabama.gov/documents/3.0_Apply/3.2_Qualifying_Medicaid/3.2_Medicaid_Income_Limits_2026_3-11-26.pdf
• Ala. Admin. Code Chapter 560-X-25 (Eligibility) — https://admincode.legislature.state.al.us/
• Ala. Admin. Code r. 560-X-25-.09 (Transfer of Assets) — https://medicaid.alabama.gov/documents/9.0_Resources/9.2_Administrative_Code/9.2.1_Proposed_Agency_Rules/9.2.1_APA_18_560-X-25-.09%20_Transfer_Assets_Affecting_Eligibility.pdf
• 42 U.S.C. § 1396p (Liens, transfers, recovery) — https://www.govinfo.gov/
• 42 U.S.C. § 1396r-5 (Spousal impoverishment) — https://www.govinfo.gov/
• Ala. Code § 22-6-150 et seq. (Medicaid estate recovery) — https://alisondb.legislature.state.al.us/
• Alabama Medicaid Long-Term Care Inquiry Line: 1-800-362-1504

Disclaimer: This packet does not constitute legal advice. Medicaid eligibility is fact-specific and rules change frequently; an Alabama-licensed elder law attorney must review the entire application, all financial verification, and any planning strategy before filing. Do not rely on the figures in this template without re-verifying them against the current Alabama Medicaid Agency Income Limits chart and Administrative Code provisions.