What is Alabama's ACT Waiver?
The Alabama Community Transition (ACT) Waiver serves people with disabilities or long-term illnesses who currently live in a nursing facility and want to move to a home or community setting, with Medicaid-funded services to support them after the move.
ADSS operates the waiver and works with Medicaid transition coordinators and ACT case managers. ADSS says most transitions happen within 180 days of the application date. Services after the move are based on the person's medical needs, similar to the help available under the E&D Waiver.
Who is a good candidate for the ACT Waiver?
A good candidate is a Medicaid-eligible nursing home resident whose care needs can be met at home with scheduled help, who has or can get safe housing, and who wants to leave; families, the resident, the facility social worker or the ombudsman can raise it.
Housing is usually the hard part. A transition coordinator can help with the move, but a parent whose home was sold during the Medicaid spend-down needs an apartment or a family home that can accommodate a walker or wheelchair. Plan the physical space early.
How does ACT differ from the E&D Waiver?
ACT is for people already living in a nursing facility who want to move out, while the E&D Waiver is for people at home who are at risk of entering one; both are operated by ADSS and both require nursing facility level of care.
After a successful transition, ongoing services and case management continue under the waiver. Alabama also coordinates long-term services for E&D and ACT participants through the Integrated Care Network, run by Alabama Select Network under a 1915(b) waiver.
Who handles ACT case management around Birmingham?
M4A lists ACT case management among its services for Shelby, St. Clair, Blount, Walker and Chilton counties; in Jefferson and Bibb counties, 1-800-AGE-LINE connects families with the right transition contact.
Ask the nursing home's social worker to put the request in writing and copy the ombudsman, who can help keep the process moving if it stalls.
At a glance
| The ACT Waiver | The ACT Waiver is not | |
|---|---|---|
| Who | For current nursing facility residents | For people still living at home (that is E&D) |
| Goal | A safe move to a home or community setting | A way to pay assisted living fees |
| Timing | Most moves within 180 days of applying (ADSS) | An immediate discharge |
| Run by | ADSS with Medicaid transition coordinators | The nursing home itself |
Sources: CareScout 2025 Cost of Care Survey (Alabama release, March 2, 2026); Alabama Medicaid Agency 2026 income limits; Ala. Admin. Code chapter 560-X-25; Alabama Department of Senior Services; VA pension rate tables. See our editorial standards.
