I/DD Waivers in Alabama

All states: Medicaid disability services map

Alabama I/DD services at a glance

Last verified against state sources: 2026-10-23.

Who runs I/DD services in Alabama?

The Alabama Department of Mental Health (ADMH), Division of Developmental Disabilities (DDD) runs Alabama's I/DD waivers day to day. It does this under an agreement with the Alabama Medicaid Agency, the state Medicaid agency, which supervises the waivers and approves rates. Families start with the ADMH Developmental Disabilities Call Center, and local support coordination agencies help them through the process.

• Alabama Medicaid Agency: holds the federal waivers, supervises ADMH's work and reviews and approves the rates ADMH sets.
• ADMH Division of Developmental Disabilities: operates the three waivers, certifies providers, sets rates and runs ADIDIS, the system providers use to bill. It works through regional offices, which decide eligibility and manage the waiting list.
• Front door: the DD Call Center at 1-800-361-4491 takes the first application.
• Case management: Alabama calls it support coordination. In the ID and LAH waivers it is delivered by local 310 Boards (local agencies created under a state law known as Act 310) and ADMH regional offices. In the Community Waiver Program counties, ADMH staff provide it in Regions 1, 3, 4 and 5, and conflict-free 310 Boards provide it in Region 2.

What Medicaid waivers and programs serve people with I/DD in Alabama?

Alabama has three 1915(c) waivers for people with intellectual disabilities. A 1915(c) waiver is a federal Medicaid option that lets a state pay for home and community services instead of institutional care. The Intellectual Disabilities (ID) Waiver is the comprehensive waiver, the Living at Home (LAH) Waiver is a capped support waiver, and the Community Waiver Program (CWP) serves 11 pilot counties. ID and LAH were renewed effective October 1, 2025.

• Intellectual Disabilities (ID) Waiver (1915(c), control number AL.0001): serves children and adults with an intellectual disability who would otherwise need the level of care of an intermediate care facility (ICF/IID). It covers up to 4,659 people in each waiver year. Services include residential habilitation in certified homes of six or fewer, supported living, day habilitation, prevocational services, supported employment, personal care, respite, adult companion, crisis intervention, positive behavior support, remote supports, skilled nursing, therapies, housing stabilization, assistive technology and home changes.
• Living at Home (LAH) Waiver (1915(c), control number AL.0391): serves children and adults age 3 and older with an intellectual disability who meet ICF/IID level of care and do not need a paid residential setting. Each person's services are capped at $58,000 a year, not counting crisis intervention. The 2025 renewal raised the cap from $50,000 so that rate increases do not push people over it. It offers day and employment services, personal care, respite, adult companion, community integration and community experience, supported living, behavior and crisis services, remote supports, nursing and therapies, but not residential habilitation. A person whose needs go over the cap can be moved to another ADMH waiver.
• Community Waiver Program (CWP) (1915(c), control number AL.1746, with a related 1115 demonstration): started November 1, 2021 in five pilot areas covering Madison, Morgan, Limestone, Tuscaloosa, Walker, Mobile, Baldwin, Montgomery, Elmore, Houston and Jefferson counties. It serves people age 3 and older with an intellectual disability in enrollment groups by age and living situation, each with its own yearly cost cap, starting at $12,000 for Group 1. Services include community-based residential services, Adult Family Home, supported living, community integration and employment path services, supported employment, co-worker supports, personal assistance, respite (called Breaks and Opportunities), independent living skills training, family and peer supports, remote supports, nursing and therapies. In CWP counties, new applicants can only enter CWP.

An 1115 demonstration is a broader federal approval that lets a state test a new approach; Alabama's runs alongside CWP and covers an extra enrollment group (Group 5, adults 22 and older with at least one substantial functional limitation). ICF/IID level of care is the institutional benchmark for all three waivers, and ADMH does not operate any state-funded ICF/IID, according to the ID waiver's July 2024 amendment.

Does Alabama pay for I/DD services through managed care?

No. Alabama pays I/DD waiver providers fee-for-service, meaning the state pays each claim directly rather than through a health plan. ADMH sets the rates, Medicaid approves them, and providers bill through ADMH's own system.

• Billing: providers enter claims in ADIDIS, ADMH's billing system hosted by WellSky. ADIDIS checks each claim against the person's prior authorization before sending it to Medicaid's claims system for payment, according to the ID waiver renewal.
• Coordination: support coordinators from 310 Boards and ADMH regional offices plan and coordinate services, not health plans.

Is there a waiting list for I/DD services in Alabama?

Yes. People found eligible go on one statewide waiting list, ranked by how critical their need is, with time on the list as the tie breaker. The latest count the state itself publishes is more than 1,600 people, from ADMH's waitlist data of January 2020. We did not find a newer count on a state source.

• How the list is ranked: priority follows criteria in Alabama Administrative Code 580-5-30-.14. The 2025 ID waiver renewal renamed it the state-wide waiting list.
• Latest counts: Alabama Medicaid's August 2026 CWP extension application cites more than 1,600 people on the ID waiting list from the January 2020 data. The CMS-approved CWP interim evaluation says that as of 2021, more than 1,600 people were waiting compared with about 5,700 receiving services.
• CWP and the list: the extension application says CWP had enrolled 443 people from the waiting list. It also reports that net enrollments rose from a historical average of 204 a year to 301 and 293 in CWP's second and third years.

For a current count or a person's place on the list, ask the ADMH DD Division at admh-ddd.questions@mh.alabama.gov or 334-242-3704.

How do people apply for I/DD services in Alabama, and how are budgets set?

Families start by calling the ADMH Developmental Disabilities Call Center at 1-800-361-4491. A local support coordination agency gathers the paperwork, and the regional office decides eligibility and places the person on the waiting list. Alabama uses the ICAP (Inventory for Client and Agency Planning) to measure adaptive needs, and the ICAP score also sets day habilitation levels and some rates.

• Steps: per ADMH's waiver application process, the call center completes an initial application within two business days and sends it to the local support coordination agency. That agency contacts the family within five business days, gathers documents and sends the packet to the regional community services office for the person's county.
• Eligibility: a diagnosis of intellectual disability (an IQ of 72 or below on a standardized test, with onset before age 22), significant limits in adaptive functioning, ICF/IID level of care, and Medicaid eligibility (or meeting Medicaid's financial rules) when a slot is offered. A Regional Office Waiting List Coordinator, who is a Qualified Intellectual Disabilities Professional (QIDP), makes the decision.
• Assessment: trained support coordinators complete the ICAP. The ABS (Adaptive Behavior Scale) is added when behavior problems drive a borderline score. The ICAP is redone within 90 days before each yearly redetermination.
• Budgets and caps: LAH is capped at $58,000 a year per person, and each CWP enrollment group has its own yearly cap. We did not find a published individual budget method for the ID waiver.

What day and residential services can I/DD providers offer in Alabama?

In the ID and LAH waivers, providers can offer day habilitation, prevocational services and supported employment, all certified or approved by ADMH. Residential options include residential habilitation (ID waiver only), supported living in all three waivers, and two CWP residential services. CWP has no day habilitation and uses community skill building and employment path services instead.

Day and employment services

• Day Habilitation (ID and LAH): scheduled activities outside the home that build social skills, independence and community participation, including retirement activities. It is billed in 15-minute units at four levels set by the ICAP score, with a transport add-on when the home is more than 10 miles from the program. It is limited to 5 hours a day and 247 billable days a year. Staff ratios are 1:15, 1:12, 1:8 and 1:1 for facility-based Levels 1 to 4, and 1:4, 1:3, 1:2 and 1:1 in the community, with community groups of no more than 4. Programs are certified by ADMH under Alabama Administrative Code chapters 580-3-23, 580-3-25, 580-3-26 and 580-5-30, and surveyed before contract approval and then every one or two years.
• Prevocational Services (ID and LAH): time-limited services that build general work skills toward a competitive job. Billed hourly, capped at 5 hours a day and 2,470 hours over the waiver period. Community-based prevocational services use a 1:3 ratio. We did not find a published ratio for facility-based prevocational services.
• Supported Employment (ID, LAH and CWP): a one-time assessment and discovery, small group employment such as enclaves and mobile crews, and individual job development and job coaching in jobs paid at least minimum wage. Billed in 15-minute units, with small group billed by group size (1:2 to 3 and 1:4).
• CWP day options: Community Integration Connections and Skills Training and Integrated Employment Path Services, alongside supported employment and co-worker supports. We did not find a published ratio, billing unit or certification rule for these.

Residential services

• Residential Habilitation (ID): care, supervision and skills training in a home the provider rents, leases or owns, with enforceable leases, billed per day. ADMH certifies each site and program. No new home is certified for more than six people, and clustered settings are not certified.
• Supported Living Services (ID, LAH and CWP): help keeping a home of one's own, or one shared with chosen housemates, that is not owned or controlled by a waiver provider. Billed monthly in the ID waiver. New providers send a written proposal to the Division to qualify.
• Adult Family Home (CWP Group 4): up to three people live with a trained host family that is not their own family, as an alternative to residential habilitation. We did not find who licenses these homes.
• Community-Based Residential Services (CWP Group 4): CWP's provider-operated residential service for the highest-need group. We did not find its licensing rules.

How are I/DD provider rates set and how do agencies enroll in Alabama?

ADMH sets I/DD waiver rates and the Alabama Medicaid Agency reviews and approves them. Rates are the same statewide and do not vary by provider. Agencies must be certified by ADMH before they can serve waiver participants.

• Rate method: ADMH builds rate models from Alabama wage data and assumptions for wages, benefits, productivity, staffing ratios, mileage, facility and administrative costs, with public comment. Day habilitation rates are tiered by ICAP level and setting. ADMH plans to collect provider cost reports at least every five years, timed with waiver renewals.
• Latest rate change: the ID waiver amendment effective July 1, 2024 raised rates for waiver years 4 and 5 based on the rates paid during the public health emergency. The 2025 renewal's cost estimates include a further increase in waiver year 4 based on a rate study, but no date or amounts are published. ADMH's posted fee schedule could not be opened when we checked, so we do not list current rate amounts.
• Enrollment: per ADMH's DD provider certification page, providers serving people with I/DD must be certified. ADMH's Provider Network Manager processes new provider applications for the ID and LAH waivers and holds a new provider orientation each quarter.
• EVV: ADMH's EVV page covers the ID and LAH waivers. Traditional personal care has used electronic visit verification (EVV) since October 2017, and self-directed services were phased in from November 2020. Workers clock in by phone app or by phone line (IVR). The page does not name the EVV system, and we did not confirm whether it covers CWP services. Ask ADMH which system to use.

What is changing next for I/DD services in Alabama?

In August 2026, Alabama Medicaid asked the federal Centers for Medicare and Medicaid Services (CMS) to extend the Community Waiver Program 1115 demonstration through September 2031. As of October 23, 2026, we did not find a published approval, so this is a request, not a final decision. The state says the extension is meant to keep CWP running while it weighs future options for all three of its intellectual disability waivers after a statewide listening tour.

• End of CWP Group 5: the same extension application proposes to end enrollment Group 5 and move all CWP spending under the 1915(c) waiver. This depends on CMS approval.
• Proposed CWP amendment: a public notice dated August 13, 2026 describes an amendment that would revise Waiver Year 5 enrollment, increase reserve capacity and cut the number of contracted self-direction financial management agencies from two to one. No effective date is given.
• Rate study increase: the ID waiver renewal projects a rate increase based on a rate study, with no published date or amounts.

Recent changes already in effect: the ID and LAH renewals took effect October 1, 2025, and a CWP amendment effective February 1, 2026 lets relatives, legally liable relatives and legal guardians be paid for self-directed personal assistance and community transportation.

Alabama I/DD sources

• Alabama Department of Mental Health: Division of Developmental Disabilities
• Alabama Department of Mental Health: Waiver application process
• Alabama Medicaid: Intellectual Disabilities (ID) Waiver
• Alabama Medicaid: Living at Home Waiver
• Alabama Medicaid: Community Waiver Program
• Alabama Medicaid: ID Waiver renewal (effective October 1, 2025)
• Alabama Medicaid: CWP amendment (effective February 1, 2026)
• Alabama Medicaid: CWP 1115 extension application (August 2026)
• Alabama Department of Mental Health: DD provider certification
• Alabama Department of Mental Health: Electronic visit verification

Related reading

• Developmental Disabilities vs. Mental Health: Key Differences
• Essential Acronyms in Disability Services: A Quick Reference Guide
• Disability Services DayHab has a dilemma - how to solve it
• Disability Services and Independent Living Guide
• I/DD services in every state (map)
• Alabama EVV requirements

Page history

• October 23, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for I/DD provider agencies, including EVV, service documentation, goal tracking and billing. If you would like to talk through your program, contact Ankota or read more about Ankota's I/DD software.