When Christy Hamrick sat through nearly 45 minutes of testimony at her daughter’s Medicaid fair hearing in Montgomery, she expected to be arguing about eligibility criteria. Instead, she said, she spent much of the June hearing confronting paperwork she did not recognize.
Hamrick, who lives in Gulf Shores, is one of a growing number of Alabama parents who say the state’s Medicaid agency has denied or threatened home-based waiver services for their children with severe disabilities — and that the files used to justify those decisions were altered after the fact.
A Denial That Followed a Move
Hamrick’s 7-year-old daughter, Savannah, has Down syndrome and level 2 autism. She is nonverbal, prone to eloping, and needs constant supervision for her own safety and for her medication. For months, Hamrick says, the family managed — but the support that keeps Savannah home came through a Medicaid waiver program, and when the family relocated from Georgia, they assumed the transition would be straightforward.
Savannah had been enrolled in an equivalent program in Georgia. When the family submitted an Alabama application in spring 2025, Hamrick expected a similar outcome. Instead, Alabama Medicaid denied home-based waiver services, setting off more than a year of appeals, hearings and confusion that she is still navigating.
The waiver at issue is intended to do one thing: pay for services and support that allow a person with significant disabilities to remain safely at home and in the community rather than being placed in an institution. For Savannah, that means supervision she cannot go without and help managing medication.
Allegations of Altered Forms
At the heart of Hamrick’s appeal is a nursing-home-level-of-care form — a scored document that helps determine whether a child with disabilities qualifies for the program. Hamrick said she flagged an earlier version of the same form during the appeal process after her case manager shared it, because something about it looked wrong.
She learned, she said, that Savannah’s primary care doctor had received the form pre-filled. The doctor signed and returned it because she believed Hamrick had completed it.
“I said, ‘You didn’t fill it out?’ and she goes, ‘No, I didn’t fill it out,'” Hamrick said. “She goes, ‘It was already filled out. I thought you filled it out.’ I said, ‘No, ma’am, I did not fill that out.'”
Under the process as Hamrick understood it, families sign a blank form so Medicaid can contact the child’s doctors, and the physician then completes the medical criteria. At the June 29 hearing in Montgomery, Hamrick said the state presented the form again — this time with edits she had never seen.
“Someone had gone back, highlighted and crossed it all out,” Hamrick said. “They wrote in there that her doctor changed it and backdated it.”
Hamrick said she has copies of the original form and that Savannah’s doctor kept the original faxed version. Medicaid has not publicly addressed her specific allegations, and the agency has flatly denied that waiver enrollments are being denied based on any quota or budgetary target.
A Pattern Families Say They Recognize
Hamrick’s account closely mirrors complaints from two Fairhope families who previously said that eligibility paperwork in their children’s waiver cases had been changed before denials were issued. Those families shared the same case manager; Hamrick’s case involves a different Medicaid employee, and her accusations are her own.
She was one of nearly a dozen Alabama families caring for children with severe physical or developmental disabilities who came forward following an investigative article earlier this summer that highlighted an increase in denials on the agency’s Elderly and Disabled Waiver program. Multiple families have reported being denied despite qualifying for years, and several have described new, heightened scrutiny applied to their applications.
State lawmakers have taken notice. After complaints mounted, legislators said the state’s agencies appeared to have increased scrutiny of who actually qualifies for public benefits — a push they connected to broader pressures on social spending — and called for a review of whether the eligibility criteria are being applied correctly.
The state’s disability advocacy community has also weighed in. The Alabama Disabilities Advocacy Program has previously filed a federal civil rights complaint with the U.S. Department of Health and Human Services on behalf of waiver recipients, arguing that families were not receiving the written justifications and hearing rights that federal Medicaid law requires when services are denied.
Reinterpreting the Criteria
Hamrick’s case also raises a different question: how the state interprets its own rules. In January, she participated in a Zoom appeal with a Medicaid nurse, her case manager and other agency workers. When she was allowed to ask questions, she walked through the nursing-home-level-of-care criteria point by point and argued that Savannah met each one.
Hamrick — like other families — said Medicaid staff advised that children under 18 do not satisfy the form’s “Criteria A,” which relates to medication assistance. She said no documentation or explanation exists that interprets the criteria that way.
“I was told Criteria A no longer applies to children and could not be checked or used,” Hamrick said in a follow-up timeline she provided documenting her experience.
She also discovered during her recent appeal that the state’s file did not include all of Savannah’s doctors. The case manager had not contacted or listed all of the child’s providers, she said, and records she emailed — along with records faxed by Savannah’s primary care doctor — were missing from the reapplication file.
“How could they have ever made a proper decision when, one, these were falsified documents, and, two, they didn’t have all the information, and that was their job to make sure they had it,” Hamrick said.
Another Family, Another Denial
The same concerns are shared by Matthew Monson of Ozark, roughly 90 miles northwest of the coast. Monson’s daughter, Violet, was diagnosed with Rett syndrome at 18 months old, a rare genetic disorder that caused her to lose the words she had developed as a toddler and left her nonverbal. She has muscle apraxia and needs help with everything from toileting and eating to dressing and brushing her teeth.
“All of those things that every parent has to do for a newborn, we have to do constantly, continually, and we’ll have to do forever,” Monson said.
Violet has received benefits through the Elderly and Disabled waiver for roughly 10 years. Monson, the principal of Gadsden City High School, said the family had gone through prior renewals without issue until this summer, when they received a denial letter after following the same process they always had.
The family appealed, but the appeal was denied July 31, with services set to terminate Aug. 14 unless a fair hearing changed the outcome. According to Monson, the denial stated that the annual reevaluation showed Violet no longer required the level of care provided and would not, but for the provision of waiver services, be institutionalized in a nursing facility.
Monson said that explanation ignores the reality facing families who will not entertain the idea of admitting their child to a care facility — and he believes that unwillingness is being held against them.
“Absolutely, absolutely, I do,” he said.
Despite the state’s determination, Monson said Violet has more diagnoses and more medical needs than she did previously. Last November she was diagnosed with type 1 diabetes, adding another life-altering condition the family manages daily.
What Is at Stake
Monson and his wife both work in public education and carry private insurance, but the waiver remains critical because Medicaid helps cover what private insurance does not: expensive diabetic supplies, regular trips to Children’s Hospital, special braces, medical equipment and other costs of Violet’s care. One communication device Medicaid helped purchase — a Tobii eye-gaze system that functions as Violet’s voice — cost tens of thousands of dollars.
If the appeal fails, Monson said, the loss would ripple beyond medical bills. It could force one parent out of the workforce entirely.
“Either my wife or I is going to have to stop working,” Monson said. “I mean, that’s just the truth of the matter.”
Hamrick, meanwhile, is waiting for an administrative judge to make a recommendation to the Medicaid commissioner, who will make the final decision on Savannah’s application. If the state denies the waiver again, she said, the next option would be an appeal to the Alabama Supreme Court.
For both families, the fight is about more than a form. They argue the waiver exists precisely so that families like theirs can keep disabled children at home, in school and in their communities — and that denying those services amounts to discrimination against children whose parents refuse institutional placement.
“This waiver was created to keep disabled individuals IN THE COMMUNITY,” Hamrick said. “By denying our children, the Medicaid office and the state of Alabama are stating our children should not be allowed in the community.”
Hamrick believes the root of the problem is structural: Alabama has no separate waiver form specific to children, and its social workers, in her view, lack adequate training. Until that changes, she said, families will keep fighting one hearing at a time.