Medicaid Agency

Official Website: https://medicaid.alabama.gov

The Alabama Medicaid Agency, which began operations on January 1, 1970, is a state/federal program that pays for medical and long-term care services for low-income pregnant women, children, certain people on Medicare, disabled individuals and nursing home residents. The individuals must meet certain income and other requirements. Many of our programs have transformed over the years, but our vision and values have remained the same.

Forms & Documents

Browse all Medicaid Agency government forms

1 - 20 of 112 forms

Form Title Topics
ABA Therapy Behavior Assessment Form - Form must be completed and submitted as supporting documentation for an ABA therapy PA request - Fillable - Revised 6/20/19
ABA Therapy Prior Authorization Instructions for Providers
ABA Therapy Provider Tip Sheet
Adjustment Request Form (providers only)
Adult Growth Failure PA Request Form - 1/30/08
Agreement between Nursing Facility and Resident/Representative for Care
AIDS Wasting Request PA Request Form - 1/30/08
Antipsychotic Agents - Attachment A
Antipsychotic Agents - Attachment B
Antipsychotic Agents - Attachment B - Effective 1/1/19
Antipsychotic Agents - Attachment C
Antipsychotic Prior Authorization Criteria
Appendix C
Attachment to Form 342 for Wheelchair Evaluation Request
Attestation of compliance of Residential Treatment Facility
Augmentative Communication Device (ACD) Evaluation Report Form
Biographical Data Sheet/Consent Form
Certification and Documentation for Abortion (providers only)
Check Refund Form (providers only)
Child Growth Failure/Mecasermin PA Request Form- 9/10/12

Contact Information & Office Locations

All 12 contact points

Auburn Office

Address:
687 North Dean Road
Suite 300
Auburn, AL 36830

Phone numbers:
  • (866) 371-4072 (toll free)
Fax numbers:
  • (877) 814-8309

Birmingham Office

Address:
468 Palisades Blvd.
Birmingham, AL 35209-5154

Phone numbers:
  • (866) 371-4073 (toll free)
Fax numbers:
  • (877) 814-8302

Decatur Office

Address:
2119 Westmead Dr. SW
Suite 1
Decatur, AL 35603-1050

Phone numbers:
  • (866) 371-4074 (toll free)
Fax numbers:
  • (877) 814-8304

Dothan Office

Address:
2652 Fortner St.
Suite 4
Dothan, AL 36305-3203

Phone numbers:
  • (866) 371-4075 (toll free)
Fax numbers:
  • (877) 814-8305

Florence Office

Address:
412 S. Court Street
Suite 200
Florence, AL 35630-5664

Phone numbers:
  • (866) 371-4076 (toll free)
Fax numbers:
  • (877) 814-8303

Gadsden Office

Address:
200 West Meighan Blvd.
Suite D
Gadsden, AL 35901-3200

Phone numbers:
  • (866) 371-4077 (toll free)
Fax numbers:
  • (877) 814-8306

Headquarters

Address:
501 Dexter Avenue
Montgomery, AL 36104

Phone numbers:
  • (334) 242-5000 (main line)

Huntsville Office

Address:
6515 University Drive, NW
Suite B
Huntsville, AL 35806-1775

Phone numbers:
  • (855) 733-3160
Fax numbers:
  • (877) 295-8813

Mobile Office

Address:
2800 Dauphin Street
Suite 105
Mobile, AL 36606-2400

Phone numbers:
  • (866) 371-4078 (toll free)
Fax numbers:
  • (877) 814-8308

Montgomery Office

Address:
3060 Mobile Highway
Montgomery, AL 36108

Phone numbers:
  • (866) 621-6509 (toll free)
Fax numbers:
  • (877) 814-8307

Selma Office

Address:
106 Executive Park Lane
Selma, AL 36701

Phone numbers:
  • (866) 371-4079 (toll free)
Fax numbers:
  • (877) 814-8311

Tuscaloosa Office

Address:
907 22nd Avenue
Tuscaloosa, AL 35401-5822

Phone numbers:
  • (866) 371-4080 (toll free)
Fax numbers:
  • (877) 814-8310

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