Why Waivers Exist

Standard Medicaid rules require that services be available statewide to all eligible individuals. This works well for medical services like doctor visits and hospital care, but it creates challenges for home care programs, which can be expensive and complex to administer.

Waivers allow states to "waive" certain standard Medicaid rules — specifically, the requirement to serve everyone statewide — so they can create targeted programs for specific populations with capped enrollment. This gives states the flexibility to design innovative home care programs without unlimited financial exposure.

Section 1915(c) HCBS Waivers

The most common type of Medicaid waiver for home care is the Section 1915(c) Home and Community-Based Services (HCBS) waiver. These waivers allow states to provide home and community-based services as an alternative to institutional care (nursing homes or intermediate care facilities).

To qualify for a 1915(c) waiver, individuals must meet the level of care required for institutional placement — meaning they would need a nursing home if home care were not available. This is a key eligibility criterion that distinguishes waiver programs from standard Medicaid home care.

What Waiver Programs Can Cover

HCBS waivers can cover a wide range of services that are not available under standard Medicaid, including:

• Personal care and homemaker services
• Respite care for family caregivers
• Adult day health services
• Home modifications and assistive technology
• Supported employment
• Behavioral support services
• Transportation to medical appointments
• Nutritional counseling and meal delivery
• Consumer-directed care — including hiring family members as paid caregivers

Waiting Lists

Because waiver programs are capped, many states have waiting lists. The length of waiting lists varies enormously — from a few months in some states to several years in others. States like Texas, Florida, and Georgia have historically had very long waiting lists for some waiver programs.

If you need services and your state has a waiting list, apply as soon as possible. Your position on the list is typically based on your application date, and some states prioritize individuals with the most urgent needs.

Types of Waiver Programs

Most states operate multiple waiver programs targeting different populations:

• Aged and Disabled (A&D) waivers — for seniors and adults with physical disabilities
• Developmental Disabilities (DD) waivers — for individuals with intellectual or developmental disabilities
• Traumatic Brain Injury (TBI) waivers — for individuals with acquired brain injuries
• Technology-Dependent waivers — for individuals who require medical equipment at home
• Children's waivers — for children with complex medical needs

How to Apply for a Waiver Program

To apply for an HCBS waiver program, contact your state's Medicaid agency or the agency that administers the specific waiver program (often the Department of Aging, Department of Developmental Services, or a similar agency). You will need to apply for Medicaid first if you are not already enrolled, and then apply separately for the waiver program.