Self-Direction and FMS in Alabama

All states: self-direction map

Alabama self-direction at a glance

Last verified against state sources: 2026-10-13.

Which Medicaid programs in Alabama offer self-direction?

Alabama offers Medicaid self-direction in two families of programs. The first is Personal Choices, the self-directed option inside four waivers for older adults and adults with physical disabilities. The second is Self-Directed Services inside the three waivers run by the Alabama Department of Mental Health (ADMH) for people with intellectual disabilities. In both, the participant or a representative hires and manages the workers and manages a budget.

• Personal Choices in the Elderly and Disabled (E&D), Alabama Community Transition (ACT) and Technology Assisted (TA) waivers: serves older adults and adults with physical disabilities who are enrolled in one of those waivers. It is run by the Alabama Department of Senior Services (ADSS) under the Alabama Medicaid Agency. The participant has both employer authority and budget authority. Services that can be self-directed are personal care or personal assistance, homemaker, unskilled respite and companion.
• Personal Choices in the State of Alabama Independent Living (SAIL) Waiver: serves adults 18 and older with specific physical disabilities who meet a nursing facility level of care. It is run by the Alabama Department of Rehabilitation Services (ADRS) under the Alabama Medicaid Agency. It follows the Personal Choices design, but we did not find a SAIL handbook that spells out employer and budget authority, so ask ADRS to confirm the details.
• Self-Directed Services in the Intellectual Disabilities (ID) Waiver and the Living at Home (LAH) Waiver: serves people with intellectual disabilities. It is run by the ADMH Division of Developmental Disabilities under the Alabama Medicaid Agency. The participant has both employer authority and budget authority. Self-directed services in the handbook include personal care, personal care transportation, adult companion, respite, skilled nursing, and individual-directed goods and services.
• Self-Directed Services in the Community Waiver Program (CWP): serves children and adults with intellectual disabilities in the CWP enrollment groups, in a limited set of counties. It is run by the ADMH Division of Developmental Disabilities under the Alabama Medicaid Agency. The participant has both employer authority and budget authority. Self-directed services include Personal Assistance-Home, Personal Assistance-Community, Skilled Nursing, Community Transportation, Breaks and Opportunities (respite), and Individual-Directed Goods and Services.

Employer authority means the participant recruits, hires, schedules and supervises the workers. Budget authority means the participant also manages a set amount of money. In Personal Choices, the 2023 participant handbook sets the budget as the authorized weekly hours times 4.43 times the waiver rate, less a 15 percent fee for counseling and the FMSA. At least 75 percent of the authorized hours must go to employee services. In the ADMH waivers, the Employer of Record sets pay within state wage ranges, and savings from paying below the maximum rate go into a savings account held by the FMSA, capped at $10,000. A Self-Directed Liaison in each ADMH regional office helps with enrollment and budgeting, as described on ADMH's Self-Directed Services page.

Who handles financial management services (FMS) in Alabama?

Alabama uses a fiscal/employer agent model in every self-directed program. The state calls the organization a Financial Management Services Agency (FMSA). The FMSA runs payroll and taxes, while the participant or an unpaid representative stays the legal employer, called the Employer of Record. Acumen Fiscal Agent is the one contracted FMSA for Personal Choices, so those participants do not pick among vendors.

A fiscal/employer agent handles the paperwork side of being an employer. It enrolls the workers, processes their time, pays them and files the employer taxes on the employer's behalf. In the ADMH waivers the Employer of Record signs IRS Form 2678 to appoint the FMSA as agent.

• Legal employer: the participant, or an unpaid representative, is the Employer of Record in Personal Choices and in the ADMH waivers. In Personal Choices a representative is required when the participant is a minor or has a court-appointed guardian.
• Personal Choices (ADSS and SAIL): Acumen Fiscal Agent. An ADSS notice says Acumen pays for services performed on or after December 23, 2023, and the prior vendor paid for services through December 22, 2023. Using the FMSA is mandatory. Acumen's Alabama page lists the SAIL program separately from ADSS Personal Choices.
• ADMH waivers (ID, LAH and CWP): Acumen's Alabama page lists ADMH as one of its three Alabama programs. The ADMH participant handbooks describe a choice between two FMSAs. We did not find a current state list that names the FMSAs under contract with ADMH today, so we cannot confirm whether a second FMSA still serves participants. Ask ADMH at ADMH-DDD.Questions@mh.alabama.gov.
• Changing FMSA in the ADMH waivers: an ADMH transfer process sheet says an Employer of Record can transfer only at the start of a quarter and only once a year, with paperwork due at least 60 days ahead.

Pay rules in the ADMH handbooks tell Employers of Record to pay at least $7.25 an hour, including to paid family, and time and a half for hours over 40 a week unless the worker lives with the participant.

Who can be a paid caregiver under self-direction in Alabama?

Participants can hire family and friends in every Alabama self-directed program, with limits. The person who acts as the unpaid representative or Employer of Record can never also be the paid worker. The ADMH waivers add more limits: legal guardians are barred from most paid services, and the ID and LAH waivers also bar the participant's spouse, parent or child.

• Personal Choices: family and friends may be hired. The participant's representative may not be paid for that role and may not be hired to provide services. We did not find an explicit rule on whether a spouse, a legal guardian or the parent of a minor can be a paid worker. Ask ADSS at ALPersonalChoices@ADSS.Alabama.gov or 1-800-243-5463.
• ID and LAH waivers: relatives may be paid for self-directed personal care. Legal guardians and legally responsible individuals may not. The worker also cannot be the Employer of Record or the participant's spouse, parent or child. This comes from the handbook updated in November 2020.
• Community Waiver Program: relatives can be paid for most self-directed services. Legal guardians cannot, except for Community Transportation. A relative who lives with the participant can be paid for Personal Assistance-Home only if the participant is 21 or older, and the units are capped at 50 percent of the usual maximum. This comes from the CWP handbook of September 2022.
• SAIL: we did not find a SAIL handbook with its own paid family rules. Ask ADRS or the participant's case manager.

We did not find a published weekly hour cap for self-directed workers in Alabama. The ADMH handbooks address overtime instead: hours over 40 a week are paid at time and a half unless the worker lives with the participant.

Does EVV apply to self-directed workers in Alabama?

Yes. Electronic visit verification (EVV) applies to self-directed workers in Alabama, and they use the FMSA's EVV system. In Personal Choices, workers clock in and out through Acumen's DCI mobile app, web portal or phone line, and pay requires the participant or Employer of Record to verify the visit. In the ADMH waivers, workers clock in and out with a phone app or a call-in line.

• Personal Choices (ADSS): an ADSS notice says workers must clock in and out electronically and that no paper timesheets are accepted for time after June 1, 2024. Payment requires the client or Employer of Record to verify the visit in the system. Corrections must be made within 60 calendar days to be considered for payment.
• Personal Choices in SAIL: ADRS told self-directing SAIL participants in a memo revised October 3, 2024 that EVV use is required to stay in the waiver, and pointed them to Acumen's EVV training.
• ID and LAH waivers: ADMH's EVV page says self-directed workers clock in and out with a phone app, or with a call-in (IVR) line if the app cannot be used. A worker with no phone can call from the participant's home phone. ADMH phased this in from November 2020.
• Community Waiver Program: the handbook says EVV is required for some CWP services and that the Employer of Record approves EVV time records before they go to the FMSA for payment.
• After an FMSA change: the new FMSA trains the Employer of Record on its own EVV system, and time is reported through that system from the first day of the quarter.

Three points could not be confirmed. We did not find a published EVV exemption for live-in self-directed caregivers in any Alabama program. We did not find an ADMH rule that pay is denied when a shift is not recorded in EVV. ADMH says only that following the EVV training avoids delays in staff payment. We also did not find a state source that names the EVV system ADMH self-directed workers use today. For Personal Choices, ask ADSS. For the ADMH waivers, ask ADMH at ADMH-DDD.Questions@mh.alabama.gov.

What is changing next for self-direction in Alabama?

Alabama Medicaid has proposed a Community Waiver Program amendment that would cut the number of contracted self-direction FMSAs from two to one. Public comment closed on September 15, 2026. No effective date has been published and the notice names no vendor, so this is a proposal and not a final change.

The notice on the ADMH site is dated August 15, 2026. We did not find a statement that the amendment has been approved, which FMSA would remain, or whether the same reduction would apply to the ID and LAH waivers. If it becomes final, participants who use the FMSA that does not remain would need to move, so Employers of Record should watch for notices from ADMH.

A second item concerns paid family in the Community Waiver Program. A CWP amendment noticed in September 2025 proposed letting relatives, including legally liable relatives, and legal guardians be paid for self-directed personal assistance and community transportation, as long as they are qualified and are not the participant's representative or Employer of Record. The comment period ended on October 12, 2025. We could not confirm that these terms were approved, so the handbook limits described above are the rules to follow until ADMH says otherwise.

One change is already in effect. Since October 1, 2026, E&D Personal Choices participants no longer receive up to 10 percent of the monthly budget as a cash allowance. The ADSS policy notice says the same funds are reached through approved Goods and Services requests paid by the program's purchasing process, with no cut to the budget.

Alabama self-direction sources

• Alabama Department of Senior Services: Personal Choices
• ADSS: Personal Choices participant handbook (2023)
• ADSS: Personal Choices financial management services transition notice
• ADSS: Personal Choices electronic timekeeping notice
• Acumen Fiscal Agent: Alabama programs
• Alabama Department of Mental Health: Self-Directed Services Handbook for the ID and LAH waivers (updated November 2020)
• Alabama Department of Mental Health: Community Waiver Program Self-Directed Services Handbook (September 2022)
• Alabama Department of Mental Health: Electronic Visit Verification
• Alabama Department of Mental Health: Community Waiver Program amendment notice (August 2026)

Related reading

• Self-Directed Medicaid Home Care Services in 2026
• Understanding Self-Direction and FMS
• Self-Direction Fiscal Intermediary: A Guide for Participant-Directed Care
• 5 Big Challenges in Self-Directed Care And How FMS Providers Can Solve Them
• Self-direction in every state (map)
• Alabama EVV requirements

Page history

• October 13, 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 FMS organizations and agencies that support self-direction. If you would like to talk through your program, contact Ankota or read more about Ankota's self-direction and FMS software.