Medicaid Waivers (HCBS): Services, Eligibility, and Application Steps

Types of Medicaid Waivers

1915(c) Home and Community-Based Services Waivers

These are the most common waiver programs. They provide services to people who would otherwise require institutional care (nursing home, intermediate care facility, or hospital).

1915(i) State Plan HCBS

Similar to 1915(c) waivers but don't require institutional-level care. States can offer them without caps on enrollment. These often serve people with mental health conditions or less intensive needs.

1915(k) Community First Choice

Provides attendant care services and supports for activities of daily living. States that adopt this option receive enhanced federal funding.

1115 Demonstration Waivers

Broader waivers letting states test innovative approaches to Medicaid, including expanded HCBS, managed care for people with disabilities, or coverage for populations not traditionally covered.

Who Qualifies for Waiver Services?

Eligibility for HCBS waivers typically requires meeting three criteria:

1. Medicaid Eligibility

You must qualify for Medicaid. For many waiver programs, states can use more generous financial eligibility rules—often up to 300% of the SSI federal benefit rate (approximately $2,982/month in 2026). This means some people who don't qualify for regular Medicaid may still qualify for waiver services.

2. Target Group

Each waiver serves a specific population. Common target groups include:

• People with intellectual and developmental disabilities (I/DD)
• People with physical disabilities
• Elderly individuals (typically 65+)
• People with traumatic brain injuries
• People with HIV/AIDS
• Children with complex medical needs
• People with mental health conditions
• People with autism spectrum disorder

3. Level of Care Requirement

For most 1915(c) waivers, you must demonstrate that without waiver services, you would need institutional care. An assessment team evaluates your functional abilities—things like bathing, meal preparation, medication management, and mobility. If your needs are significant enough that you'd qualify for a nursing home, you meet this requirement.

Services Commonly Covered Under HCBS Waivers

• Personal Care Services: Hands-on assistance with bathing, dressing, toileting, transferring, and eating.
• Homemaker/Chore Services: Help with cleaning, laundry, meal preparation, and shopping.
• Respite Care: Temporary relief for unpaid family caregivers.
• Adult Day Services: Structured daytime programs offering supervision, social activities, meals, and sometimes health services.
• Supported Employment: Job coaching, employment training, and ongoing support to help work in competitive, integrated settings.
• Residential Services: Support in group homes, supported living arrangements, or host family settings.
• Home Modifications: Ramps, bathroom modifications, widened doorways, stair lifts.
• Assistive Technology: Communication devices, adapted computers, environmental controls.
• Transportation: Non-medical transportation to community services, employment, shopping, and social activities.
• Case Management/Support Coordination: Help coordinating services, developing care plans, and connecting with resources.

How to Apply for Waiver Services

Step 1: Identify Your State's Waiver Programs

Research what waiver programs exist in your state. Most states have separate waivers for different populations. Resources include your state's Medicaid agency website, Aging and Disability Resource Centers (ADRCs), and Centers for Independent Living.

Step 2: Contact the Administering Agency

Depending on the waiver, applications may go through the state Medicaid office, state developmental disabilities agency, Area Agency on Aging, or local county social services department.

Step 3: Complete the Application

The application typically involves basic demographic information, financial documentation, disability documentation, and functional assessment. Some states have waiting lists, so apply as soon as possible.

Step 4: Undergo Assessment

A case manager, nurse, or assessment team will evaluate your needs, usually through an in-home visit, assessing self-care, mobility, health status, cognitive functioning, and current support system.

Step 5: Develop Your Service Plan

If approved, you'll work with a case manager to create a person-centered service plan outlining your goals, what services you'll receive, and who will provide them.

Step 6: Select Providers

Options typically include home care agencies, self-directed services (where you hire and manage your own workers, potentially including family members), or combination approaches.

Waiver Waiting Lists

Unfortunately, many states have significant waiting lists for waiver services, especially for people with intellectual and developmental disabilities. Some lists extend for years.

While waiting:

• Stay in contact with the administering agency
• Update your information if circumstances change
• Ask about emergency or crisis slots that may be available
• Explore other programs (state plan services, private pay options, family support programs)
• Connect with advocacy organizations working on waiting list issues

FAQs

Managing Your Benefits While on a Waiver

If you receive SSI alongside waiver services, keep in mind that your benefits interact. The waiver services themselves don't count as income, but some living situations affect your SSI payment.

Purple helps SSI recipients track resources and spending to maintain benefit compliance—whether you're on a waiver or not. Understanding how all your benefits work together is key to maintaining stability.

Official Resources

• HCBS Overview
• Waiver Authorities
• Vocational Rehab by State