To become a paid caregiver through Alabama Medicaid, the person you care for must first qualify for a Home and Community-Based Services (HCBS) waiver, and then you either get hired by a Medicaid-contracted home health agency or hired directly by the recipient under Alabama’s self-directed Personal Choices program. Family members, including adult children and grandchildren, can be paid under Personal Choices. Everything else — background checks, training, electronic visit verification, and payment — flows from that setup.
Step 1: Get the Person You Care For Approved for a Waiver
No caregiver gets paid until the care recipient is enrolled in a Medicaid waiver. Eligibility has a financial side and a medical side, and both have to line up.
Financially, a single applicant’s monthly income cannot exceed $2,982 in 2026, and countable assets must stay at $2,000 or less on the first day of each month.1Alabama Medicaid. Home and Community Based Waivers – 2026 A primary home and one vehicle are generally excluded from the asset count.
Medically, a physician has to certify that the person needs the level of care a nursing facility would provide. That usually means regular help with daily activities like bathing, dressing, eating, or moving between a bed and a chair. Qualifying for regular Medicaid is not enough on its own; the nursing-facility-level assessment is a separate hurdle.
Most in-home personal care is funded through the Elderly and Disabled (E&D) Waiver, run by the Alabama Department of Senior Services. It pays for personal care, homemaker services, respite, adult day health, companion services, and home-delivered meals for people at risk of nursing facility placement.2Alabama Department of Senior Services. Medicaid Waiver Programs Two other waivers cover narrower populations: the Alabama Community Transition (ACT) Waiver, for people moving out of a nursing facility or whose needs have outgrown another waiver,3Alabama Administrative Code. Alabama Administrative Code 560-X-44-.01 – Authority and Purpose and the Technology Assisted (TA) Waiver for Adults, for people who depend on medical technology.4Alabama Administrative Code. Alabama Administrative Code 560-X-54 – Home and Community-Based Services for Technology Assisted Waiver for Adults
One thing to know up front: waiver enrollment is not an entitlement. Slots are limited, and a waiting period can apply even when someone meets every requirement.5Alabama Medicaid. Home and Community-Based Waiver Services Getting the application in early matters.
Step 2: Choose the Hiring Route
Once the recipient is approved, they decide how care will be delivered. That decision determines how you get hired.
Working Through a Home Health Agency
Under this route, the recipient contracts with a Medicaid-approved home health agency, and the agency employs the caregiver. You apply to a provider agency the way you’d apply to any job. The agency handles hiring, scheduling, supervision, payroll, taxes, workers’ compensation, and training compliance. It’s the more traditional route and puts less administrative weight on you or the recipient.
Getting Hired Directly Through Personal Choices
Personal Choices is Alabama’s self-directed care program. The recipient gets an allotted budget and the authority to hire, train, and manage their own caregivers.6Alabama Department of Senior Services. Personal Choices This is the route that most often allows family members to be paid. A recipient can hire a son, daughter, adult grandchild, niece, nephew, or in some cases a spouse.
A Fiscal Management Service (FMS) handles the employer paperwork so the recipient doesn’t have to. The FMS withholds and files federal, state, local, and unemployment taxes, buys workers’ compensation coverage, processes timesheets, and cuts your paychecks.7Centers for Medicare & Medicaid Services. Self-Directed Services You submit your hours through the FMS, and it pays you after verifying your time against the approved plan of care.
Step 3: Meet the Caregiver Requirements
Before you can start billable work, you have to clear background screening, training, and electronic visit verification. These apply to both routes, though the paperwork trail differs.
Background Screening
All direct service providers have to pass a background check. Providers classified by Alabama Medicaid as “high” categorical risk — those with a prior payment suspension, existing overpayment, or previous exclusion — are notified by letter and have 30 days to submit fingerprints at the Alabama Law Enforcement Agency or a local law enforcement office. Failing to comply means denied enrollment or terminated participation.8Alabama Medicaid. Fingerprint-Based Criminal Background Checks on Providers
You also cannot be on the federal Office of Inspector General’s List of Excluded Individuals and Entities. Anyone on that list is barred from receiving payment from any federally funded health care program, and employers who hire an excluded individual face civil monetary penalties.9Office of Inspector General. Exclusions Program A prior Medicare or Medicaid fraud conviction almost always lands someone on the list.
Training
Alabama requires pre-work and annual training for direct service providers, including personal care aides, companions, and homemakers. Provider agencies must document and file completion of every training requirement in the applicable Scope of Services.10SARCOA. Medicaid Waiver Direct Service Providers Personal care aides generally complete continuing education each year. Companions and homemakers typically complete initial training, which can include first aid certification. Annual TB testing is required for employees and supervisors.
Under Personal Choices, the recipient or their representative handles your training. The expectations are less formal than an agency’s, but you still need to demonstrate competency in the tasks listed in the plan of care.
Electronic Visit Verification
Every caregiver providing personal care under an Alabama Medicaid waiver has to log visits through an Electronic Visit Verification (EVV) system. This is a federal requirement under the 21st Century Cures Act.11Medicaid.gov. EVV Requirements in the 21st Century Cures Act
Alabama uses a Provider Choice Model, so caregivers and agencies pick their own system as long as it meets state standards and reports to the state EVV aggregator. The system must record the service type, the recipient’s name, the date, the location, your name, and your clock-in and clock-out times.12Alabama Medicaid. Electronic Visit Verification System Most caregivers use a mobile app or a phone-based check-in. If you work for an agency, they’ll tell you which system to use. Under Personal Choices, the FMS or support broker gets you set up.
How You Get Paid and How It’s Taxed
Home care workers are covered by the Fair Labor Standards Act. You must be paid at least the federal minimum wage and receive overtime for hours over 40 in a workweek, whether you work through an agency or under Personal Choices.13U.S. Department of Labor. Paying Minimum Wage and Overtime to Home Care Workers In a self-directed arrangement, the recipient may count as your employer for FLSA purposes if they set your schedule, assign your tasks, and can hire or fire you. The FMS handles the wage calculations, but the underlying obligation stands.
Caregiver pay is generally taxable, with one significant exception. Under IRS Notice 2014-7, Medicaid waiver payments for care provided under a Section 1915(c) HCBS waiver are treated as difficulty-of-care payments and can be excluded from gross income if the caregiver and the recipient live in the same home.14Internal Revenue Service. Certain Medicaid Waiver Payments May Be Excludable From Income All of Alabama’s HCBS waivers operate under Section 1915(c), so all of them qualify.
The exclusion turns on where you actually live. If the recipient’s home is your home — where you eat, sleep, and spend holidays — the entire waiver payment can be excluded from gross income. If you keep a separate residence and just travel to the recipient’s home to work, the payments are fully taxable. Respite care never qualifies for the exclusion, regardless of living arrangement.
If you don’t qualify for the exclusion, normal employment tax rules apply. In 2026, Social Security and Medicare taxes kick in once a household employee earns $3,000 or more in cash wages during the year.15Internal Revenue Service. Household Employer’s Tax Guide Agencies handle withholding for their employees; under Personal Choices, the FMS handles it automatically.
Where to Start
The process starts on the recipient’s side. Call Alabama’s AgeLine at 1-800-243-5463 to reach the local Area Agency on Aging and Aging & Disability Resource Center.2Alabama Department of Senior Services. Medicaid Waiver Programs The AAA runs the initial screening, checks financial and functional eligibility, and starts the waiver application. If the person is already on Medicaid, the next step is the medical assessment confirming nursing-facility-level need.
Once the waiver is approved, the recipient chooses agency-based care or Personal Choices. Pick an agency, and you apply for a job with a Medicaid-contracted provider; the agency handles your credentialing and Medicaid enrollment. Pick Personal Choices, and the recipient hires you directly, then works with the FMS to set up payroll, background screening, and EVV. No services can be delivered and no payments can flow until the plan of care is approved and you’ve met every provider requirement.