What disability support looks like in Alabama

Alabama residents with disabilities can draw on federal programs (Social Security Disability Insurance and Supplemental Security Income), state-run programs that fill gaps those programs leave, and work incentives that let you earn money without losing benefits. The programs do not all talk to each other automatically, so you often have to report changes yourself—a move, a job, a marriage—to each program separately. Understanding which program covers what, and what you have to do to keep each one, matters because the rules overlap but are not the same.

Alabama also runs its own programs for people who do not meet federal disability rules or who need services federal programs do not pay for. These include vocational rehabilitation (which pays for job training), home and community-based services for people with intellectual disabilities, and Medicaid waiver programs that let you live in your own home instead of a facility while still getting paid care. The state Medicaid program is called Medicaid, not something else, but Alabama's version of it has its own rules about what it covers and how much it pays providers.

Key Takeaways

  • Federal disability programs (SSDI and SSI) are the same in Alabama as everywhere else, but Alabama Medicaid covers some services and has some rules that differ from other states.
  • You must report changes—income, living situation, marital status, work—to each program you receive from, because they do not automatically share information.
  • Alabama's vocational rehabilitation program can pay for training, education, and job placement services if you have a disability and want to work.
  • Home and community-based services and Medicaid waivers let you receive paid care in your own home instead of moving to a facility, but waiting lists exist and vary by county.
  • The Alabama Department of Rehabilitation Services and the Department of Human Resources are the state bodies that run most non-federal disability programs.

How federal disability programs work in Alabama

Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) are federal programs, so the rules are the same whether you live in Alabama or anywhere else. You explore through Social Security, not through the state. The Social Security office in your area handles your case, but the decision comes from Social Security's national office in Baltimore. If you are denied, you can appeal, and the appeal process is the same in Alabama as it is in every state.

What changes by state is Medicaid. When you get SSDI or SSI, you become may be able to access for Medicaid in your state. In Alabama, that means you can get Medicaid through the federal program, but Alabama decides what services Medicaid covers and how much it pays doctors and hospitals. Some states cover more mental health services, more therapy, or more medications than Alabama does. You can find out what Alabama Medicaid covers by calling the Alabama Medicaid Agency or visiting its website.

Work incentives—rules that let you earn money without losing your benefits—are federal, so they work the same way in Alabama as elsewhere. You can work and still get SSDI or SSI if your earnings stay below the limit Social Security sets. You can also use programs like Impairment Related Work Expenses (IRWE), Plans to Achieve Self-Support (PASS), and the Student Earned Income Exclusion to earn more without losing benefits. A work incentive planning counselor can help you figure out how much you can earn without triggering a benefit cut. You can find one through your local Social Security office or through a disability organization in Alabama.

Alabama's vocational rehabilitation program

The Alabama Department of Rehabilitation Services (ADRS) runs the state's vocational rehabilitation program. If you have a disability and want to work, ADRS can pay for job training, education, assistive technology, transportation to job interviews, and job coaching. You do not have to be on SSDI or SSI to use ADRS. You do have to have a disability that creates a substantial barrier to work, and you have to want to work.

To start, you contact your local ADRS office and ask for an intake appointment. At that appointment, a counselor will ask about your work history, your disability, what kind of work you want to do, and what barriers you face. If ADRS determines that you can work with the right support, you and the counselor write a plan together. That plan might include community college, a certificate program, on-the-job training, or direct job placement. ADRS pays the provider directly, not you, so you do not have to come up with the money upfront.

ADRS also has a program called Pre-Employment Transition Services (Pre-ETS) for students with disabilities in school. Pre-ETS pays for work experience, job exploration, counseling, and assistive technology while you are still in school, to help you figure out what kind of work you want to do and build skills before you graduate.

Home and community-based services and Medicaid waivers

If you have a disability and need paid help with daily tasks—bathing, dressing, meals, housekeeping—you can get that help through Alabama Medicaid's home and community-based services. Instead of moving to a nursing home or residential facility, you can stay in your own home and have a paid caregiver come to you. The state pays the caregiver's wages, and you direct what help you need and when.

Alabama runs several Medicaid waiver programs, each designed for a different group. The Intellectual Disability waiver serves people with intellectual disabilities. The Physically Disabled and Development Disabilities waiver serves people with physical disabilities or developmental disabilities. The Elderly and Disabled waiver serves people over 65 or people under 65 with disabilities. Each waiver has its own waiting list, and how long you wait depends on where you live and how many people are ahead of you. Some counties have short waits; others have waits of several years.

To get on a waiver, you contact your county Department of Human Resources office and ask about home and community-based services. You will need to show that you have a disability, that you need the level of care the waiver provides, and that you meet the income and resource limits. Once you are approved, you are placed on the waiting list. When a slot opens, you are notified and services begin.

Medicaid in Alabama and what it covers

Alabama Medicaid covers hospital care, doctor visits, prescription medications, mental health services, and therapy. It also covers some services that Medicare does not, like dental care for children and some vision care. If you are on SSDI, you become may be able to access for Medicaid after you have been on SSDI for 24 months. If you are on SSI, you are may be able to access for Medicaid right away in most cases.

Alabama Medicaid does have limits. It covers a certain number of therapy visits per year, a certain number of mental health visits, and a certain list of medications. If your doctor prescribes something not on the list, Medicaid may deny it, though your doctor can ask for an exception. You can call the Alabama Medicaid Agency to find out whether a specific service or medication is covered before you go to your appointment.

If you are on both Medicare and Medicaid (called "dual may be able to access"), Medicare is your primary insurance and Medicaid is secondary. That means Medicare pays first, and Medicaid covers what Medicare does not. In Alabama, you can also get help paying your Medicare premiums and cost-sharing through the Medicare Savings Program, which is run by Medicaid.

Reporting changes and keeping your benefits

When something changes in your life—you get a job, you move, you get married, you have a child, someone moves in with you, your income changes—you have to report it. The programs do not automatically know. If you do not report, you may lose benefits or have to pay money back later.

For SSDI and SSI, you report changes to Social Security. You can do this online through your Social Security account, by phone at 1-800-772-1213, or in person at your local Social Security office. For Medicaid, you report changes to the Alabama Medicaid Agency or your county Department of Human Resources, depending on which program you are in. For ADRS services, you report to your ADRS counselor. For waiver services, you report to your waiver coordinator.

The safest approach is to keep a list of the programs you receive from and call each one when something changes. It takes an hour, but it keeps you from losing benefits or facing a debt later.

How to find local disability services in Alabama

Your county Department of Human Resources office is the entry point for most state disability programs. You can find your local office by searching "Department of Human Resources [your county name] Alabama" or by calling 1-800-362-3334. That office handles Medicaid, waiver programs, and can refer you to other services.

For vocational rehabilitation, contact the Alabama Department of Rehabilitation Services. You can find your local ADRS office on the ADRS website or by calling 1-800-441-7607. For Social Security (SSDI and SSI), find your local Social Security office on the Social Security website or call 1-800-772-1213.

If you are not sure which program might help you, call your county Department of Human Resources and describe what you need. They can tell you which programs you might be able to use and how to start.

Frequently Asked Questions

Can I work and still get SSDI or SSI in Alabama?

Yes. You can earn money and keep your benefits as long as your earnings stay below the limit Social Security sets (currently $1,550 per month for SSDI and $65 per month for SSI, though these amounts change yearly). Work incentives like IRWE and PASS let you earn more without losing benefits. Contact Social Security before you start work so you understand how your earnings will affect your benefits.

How long is the waiting list for home and community-based services in Alabama?

It varies by county and by waiver program. Some counties have waits of a few months; others have waits of several years. Call your county Department of Human Resources to find out the current wait for the waiver you need. You can also ask to be put on the list even if the wait is long, because your place in line is based on when you explore, not when a slot opens.

What if I disagree with a decision Social Security made about my SSDI or SSI?

You can appeal. You have 60 days from the date on the letter to ask for reconsideration. You can do this online through your Social Security account, by mail, or in person at your local Social Security office. If reconsideration is denied, you can request a hearing before an administrative law judge. Many people hire a lawyer or representative for the hearing, and you only pay if you win.

Do I have to use ADRS vocational rehabilitation, or can I just go to college on my own?

You can go to college on your own and pay for it yourself, or use student loans and grants. ADRS is free and can pay for tuition, books, and other costs, but you have to meet their rules about what kind of training they will pay for. If you want ADRS to pay, you work with an ADRS counselor to write a plan. If you want to go on your own, you do not have to involve ADRS.

What happens to my Medicaid if I go to work and earn too much money?

If you are on SSDI and earn too much, you lose your cash benefit but keep Medicaid for a period of time (called "Medicaid continuation"). If you are on SSI and earn too much, you lose both the cash benefit and Medicaid. However, you may be able to use work incentives to keep earning without losing Medicaid. Talk to a work incentive planning counselor before you start work so you understand what will happen.