Request for Public Comment re: CWP Section 1115a Demonstration Extension Application

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).

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 30, 2031. 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.

There are several continued goals and 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.

As required by federal regulation, Medicaid will open a formal thirty-five (35) day comment period beginning August 10, 2026 through September 15, 2026. 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

Our Mission - to promote availability of quality and innovative healthcare for Alabamians through the efficient financing of services.