Pursuant to 42 CFR 431.408, the Alabama Medicaid Agency (Medicaid) notifies the public that it intends to submit an Alabama Community Waiver Program (CWP) Section 1115a Demonstration extension application to the Centers for Medicare and Medicaid Services (CMS). A copy of the proposed extension application and Interim Evaluation Report is available at https://medicaid.alabama.gov/content/6.0_LTC_Waivers/6.1_HCBS_Waivers/6.1.9_Community_Waiver_Program.aspx.
Medicaid invites the public to review and submit written comments on the proposed extension application and Interim Evaluation Report beginning August 10, 2026. This thirty-five (35) day public comment period will conclude at 5:00 p.m. CST on September 15, 2026. Written comments can be submitted to the following e-mail address: PublicComment@medicaid.alabama.gov or by mail to: Administrative Secretary, Alabama Medicaid Agency, 501 Dexter Avenue, P.O. Box 5624, Montgomery, Alabama 36103-5624. Comment letters must be postmarked by September 15, 2026 to be accepted.
Upon request, a hard copy of this public notice and documents can be made available for public review at Medicaid's Central Office and each District Office location. Please note that public comments submitted in response to this notice are considered public documents and can be shared on the Medicaid website.
Demonstration Description, Goals, and Objectives
Medicaid, working closely with the Alabama Department of Mental Health and its Division of Developmental Disabilities (ADMH-DDD) is seeking CMS approval to extend the Alabama Community Waiver Program (CWP) Section 1115a Demonstration for an additional five-year period beginning October 1, 2026 through September 3 0, 203 1. The Demonstration operates concurrently with the CWP Section 1915( c) Waiver. The intent of this extension application is to continue CWP operations while the state evaluates future options for the three existing intellectual disability waiver programs (i.e. CWP, Intellectual Disabilities (ID), and Living at Home (LAH)). The request to extend the specified demonstration waiver extension application will not have a negative impact on Medicaid recipients.
The application's purpose will ensure the continuation of providing person-centered, high-quality care in the home and community, while maintaining cost-effectiveness and meeting federal requirements. The application's design will continue to aid in improving access to home and community-based services (HCBS) for individuals with intellectual disabilities while promoting independence, community integration, employment, family preservation, self-direction, and long-term program sustainability.
Goals
The State proposes to continue the existing five (5) demonstration goals as follows:
Goal 1: Increase access to HCBS and achieve a corresponding reduction in the waiting list. Independent evaluation findings demonstrate substantial progress toward expanding access to HCBS services. Net enrollments excluding new appropriations increased from a historical average of 204 annually to 301 and 293 in Years 2 and 3 respectively with the CWP currently supporting 443 participants enrolled from the waiting list as of the date of this application. Evaluation findings conclude that the demonstration is making meaningful progress toward expanding access and reducing the percentage of total enrollments that are emergency enrollments, thus implementing services for participants to prevent future emergencies.
Goal 2: Increased independence of participants. CWP has demonstrated significantly stronger employment and self-direction outcomes than the existing legacy waiver programs (i.e., ID and LAH waivers). The independent evaluator concluded that the demonstration is making significant progress toward increasing participant independence.
Goal 3: Increased Community Integration. Independent evaluation findings determined that the demonstration has made significant progress in achieving community integration objectives. Additionally, Adult Family Home and Supported Living Services were launched through the CWP as new service options for individuals with ID.
Goal 4: Prevention of Escalation of Needs. Independent evaluation findings determined that there are lower crisis rates among CWP participants than legacy waiver participants, fewer emergency enrollments in CWP counties as compared to counties not included in CWP demonstration where only the legacy waivers operate and evidence that the demonstration model supports family preservation and early intervention strategies.
Goal 5: Provider Stability and Quality. The independent evaluation identified continued progress toward provider stability and quality objectives while identifying workforce retention as an area for ongoing improvement.
Throughout the extended Demonstration, Medicaid plans to continue ensuring that Medicaid recipients fully understand their rights and responsibilities by providing timely and adequate notice of eligibility changes, waiver requirements and exemptions, and provide information about appeal rights and due process.
Key Objectives
There are several continued key objectives within the Demonstration extension application as identified below:
- Expanding access to services;
- Increasing employment outcomes;
- Increasing self-direction;
- Increasing community integration;
- Reducing crisis events;
- Improving provider stability;
- Lowering average per-person expenditures.
Because the Demonstration's design is producing positive outcomes, Alabama does not propose significant structural modifications during the requested extension period.
Benefit Coverage
The 1115a Demonstration extension intends to eliminate the fifth (5) enrollment group associated with the CWP, however, this will not reduce the medical benefits currently offered to individuals through the State's Medicaid program. All expenditures for services will be authorized under the 1915(c) authority for Groups 1-4. The 1115a authorities will continue to benefit the enrollees in the concurrent 1915(c) CWP.
Eligibility Requirements
The 1115a Demonstration operates concurrently with the CWP 1915(c) waiver authority, which provides a range of HCBS to individuals ages 3+ with intellectual disabilities (ID). Due to the request to eliminate the fifth (5) enrollment group, there will be four (4) continued distinct enrollment groups. For Medical eligibility, individuals must meet Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) level of care, retrieve a diagnosis of ID with an age of onset prior to 22, obtain an 1.Q. test score of 72 and below, and display significant functional limitations in key areas of life activities. For financial (i.e. Medicaid) eligibility, there will continue to be an income limit (updated annually due to Cost of Living Adjustment (COLA)) per month and resource limit of $2,000 as of the first day of each month.
Cost Sharing
Medicaid is not proposing any changes to the current Medicaid State Plan cost sharing requirements through this waiver.
Annual Enrollment and Annual Expenditures
With the State's proposal to eliminate enrollment Group 5, the anticipated unduplicated enrollment for the extension period is zero (0). All forthcoming expenditures will be under the 1915( c) authority. Historical and Projected expenditures for the associated Group 5 expenditure authority is indicated below:
State of Alabama
Community Waiver Program
Waiver: 11-W-00365/4
Historical Expenditures (Total Computable)
| DY1 | DY2 | DY3 | DY4 | DY5 | |
| DY Begin Date | 10/21/2021 | 10/1/2022 | 10/1/2023 | 10/1/2024 | 10/1/2025 |
| DY End Date | 9/30/2022 | 9/30/2023 | 9/30/2024 | 9/30/2025 | 9/30/2026 |
| MEG: Section 1115 Group 5 | |||||
| Member Months | - | $ 7.00 | - | - | - |
| Total Expenditures | - | $ 982.00 | - | - | - |
| Per Capita | - | $ 140.29 | - | - | - |
Source: Community Waiver Program PDMA Reporting.
| DY1 | DY2 | DY3 | DY4 | DY5 | |
| DY Begin Date | 10/1/2026 | 10/1/2027 | 10/1/2028 | 10/1/2029 | 10/1/2030 |
| DY End Date | 9/30/2027 | 9/30/2028 | 9/30/2029 | 9/30/2030 | 9/30/2031 |
| MEG: Section 1115 Group 5 | |||||
| Member Months | - | - | - | - | - |
| Total Expenditures | - | - | - | - | - |
| Per Capita | - | - | - | - | - |
Hypothesis and Evaluation Parameters
Based on five (5) years of implementation experience and the findings documented in the Interim Evaluation Report, the demonstration has successfully achieved its overall goals and advanced the objectives of Title XIX by expanding access to HCBS, improving participant independence and community integration, preventing institutionalization, strengthening provider quality, and achieving these outcomes at substantially lower per-person costs than traditional service models.
To fully evaluate the impact of the CWP, twenty-seven (27) of the original measures will continue to be used through the extension period. Measures related to enrollment Group 5 will be eliminated due to discontinuation of this enrollment group, per the State's request within the proposed extension application. Each measure will address one (1) or more hypotheses and is designed to answer one (1) or more evaluation question. The evaluation will rely on both administrative data and information collected through participant and provider surveys. Together, these data will depict the ways in which the interventions that comprise the demonstration achieve the overall goals by activating specific drivers as illustrated in the driver diagram. Evaluation hypotheses, measures and data sources can be identified on pages 1 7-19 of the drafted proposed extension application.
The measures have been developed in alignment with the stated aim of the demonstration, and the five (5) primary drivers are outlined below:
- Increased access to needed services and supports;
- Increased independence of participants;
- Increased community integration of participants;
- Prevention of escalation of needs of participants;
- Increased stability and quality of providers.
The State will plan to submit a Full Evaluation Design; Annual Monitoring Reports; Midpoint Evaluation Report and a Final Evaluation Report during the requested extension period.
Continuation of the Demonstration will allow Alabama to build upon these successes, continue reducing its waiting list, expand opportunities for self-direction and competitive integrated employment, and further transform the State's HCBS system for individuals with intellectual disabilities.
Waiver Authority Sought
Using the authority of section 1115(a)(l) of the Social Security Act (the Act), the State requests the following waivers of State plan requirements contained in section 1902 of the Act be continued subject to the existing STCs:
Comparability- Section J 902(a)(l 7)
To the extent necessary, to enable Alabama to establish annual expenditure caps and enrollment groups within the 1915(c) waiver.
Amount, Duration, and Scope- Section 1902(a)(J0)(B)
To the extent necessary, to enable Alabama to offer a different package of services and/or the same services with different amount, duration, and/or scope to the different enrollment groups within the one 1915(c) waiver.
Reasonable Promptness- Section 1902(a)(8)
To the extent necessary, to enable Alabama to reallocate the overall annual unduplicated available slots between the four 1915(c) waiver enrollment groups and between the five regions.
Freedom of Choice- Section 1902(a)(23)(A)
To the extent necessary, to enable Alabama to limit the freedom of choice of providers for Support Coordination services to staff employed by ADMH-DDD, for counties where the Community Waiver Program will operate in Regions 1, 3, 4, and 5 and to limit Support Coordination services to willing and qualified public corporations (that do not have a conflict of interest) outlined in STC 28, that contract with ADMH, known as 310 Boards, for counties where the CWP will operate in Region 2 (or ADMH-DDD if no willing and qualified 310 Boards are available). To the extent necessary, to enable Alabama to limit the number of preferred providers for services authorized in the 1915(c) waiver to maintain sufficient provider capacity as described in the STCs.
Comment and Public Input Process
As required by federal regulation, Medicaid is now opening a formal thirty-five (35) day comment period. A copy of the proposed Demonstration extension application, Interim Evaluation report, full and abbreviated public notices and additional information can be found on Medicaid's website at
https://medicaid.alabama.gov/content/6.0_LTC_Waivers/6.1_HCBS_Waivers/6.1.9_Community_Waiver_Program.aspx.
Upon request, a hard copy of all documents can be made available for public review at Medicaid's Central Office and each District Office location. Please note that public comments submitted in response to this notice are considered public documents and can be shared on the Medicaid website.
Written comments concerning the Demonstration extension application and Interim Evaluation report should be submitted on or before September 15, 2026 at 5:00 p.m. CST, to the following e-mail address: PublicComment@medicaid.alabama.gov or by mail to: Administrative Secretary, Alabama Medicaid Agency, 501 Dexter Avenue, P.O. Box 5624, Montgomery, Alabama 36103-5624. Comment letters must be postmarked by September 15, 2026 to be accepted. All written comments submitted in response to this notice are considered public documents and can be shared on the Medicaid website.
Additionally, two public hearings enabling opportunities for public comment on the Demonstration extension application and Interim Evaluation report will be held at the following locations:
August 20, 2026 at 1 :00 p.m.
Alabama Medicaid Birmingham District Office: 600 Beacon Parkway West, Suite 300, Birmingham, Alabama 35209
September 8, 2026 at 2:30 p.m. (Medicaid Advisory Committee (MAC) public meeting)
Alabama Medicaid Agency: 501 Dexter Avenue, Montgomery, AL 36103-5624
Medicaid will provide teleconference accessibility for both public hearings. Please see the Medicaid website at https://www.medicaid.alabama.gov/calendar/default.aspx for dial-in information.