Home and Community-Based Services (HCBS) waivers are an important part of the Medicaid program, allowing people with disabilities or chronic conditions to receive care in their homes or in their communities instead of in institutional settings. Ahead, we explore the types of HCBS waivers, services offered, eligibility requirements, and more.
HCBS waivers offer long-term services and support to people with disabilities, older adults, and others who might otherwise need institutional care. These programs give eligible individuals more flexibility to get care at home or in their community instead of in a nursing facility or otherwise.
HCBS waivers are allowed under Section 1915(b) and 1915(c) of the Social Security Act. Unlike regular Medicaid services, which can be more rigid, HCBS waivers give states the flexibility to design programs that distribute resources in a way that best meets the needs of their residents while still controlling Medicaid costs.
Eligibility for HCBS waivers varies by state but generally revolves around three key factors: level of care needed, target groups, and financial requirements.
To qualify for an HCBS waiver, an individual must demonstrate that they need a level of care normally given in a hospital, nursing facility, or intermediate care facility for individuals with intellectual disabilities (ICF/IID). The level of care is decided by a functional assessment that looks at a person's ability to complete activities of daily living like bathing, dressing, and mobility.
HCBS waivers are designed to serve specific groups of people who need long-term care.
States can develop waivers focusing on one or more of these populations, tailoring services to their particular needs. For example, some waivers might focus on children with autism, while others might be designed to support elderly individuals who need help with personal care services.
In most cases, an individual must first be eligible for Medicaid to qualify for an HCBS waiver. However, waivers allow states to extend Medicaid coverage to individuals who may not qualify under traditional Medicaid rules.
Like other Medicaid programs, HCBS waivers have financial eligibility requirements, though they are oftentimes more flexible than regular Medicaid, allowing individuals with slightly higher incomes to qualify.
Many states also offer "spend down" programs, where people with higher incomes can still become eligible by deducting medical expenses from their income.
Each state has its own eligibility rules, so the exact eligibility requirements really vary. Some states may have waiting lists due to funding limitations or high demand.
HCBS waivers are available in different forms to serve specific groups: children, adults with disabilities, and older people.
These waivers help children with developmental disabilities like autism, cerebral palsy, or Down syndrome with services including early intervention programs, specialized therapies, personal care services, and respite care for family caregivers.
Example: The IL Support Waiver for Children and Young Adults with Developmental Disabilities provides adaptive equipment, assistive technology, behavior intervention and treatment, home accessibility modifications, personal support, and more to individuals with autism, intellectual disabilities, or developmental disabilities ages 3-21 years who meet an ICF/IID level of care.
HCBS waivers for adults with physical or intellectual disabilities offer personalized services to meet each person's unique care needs. These services are meant to make daily living easier and may include things like personal care, help finding a job, transportation, or home modifications.
Example: The NE Developmental Disabilities Day Services Waiver for Adults provides prevocational services, respite, supported employment, adult day health, assistive technology, community integration, personal emergency response system, small group vocational support, and more to individuals with autism, intellectual disabilities, or developmental disabilities ages 21 or older who meet an ICF/IID level of care.
HCBS waivers for older adults are designed for those who may be at risk of moving into a nursing home but wish to remain in their homes or community. People often need extra help with daily tasks as they age, like bathing, getting dressed, preparing meals, and taking medications. These waivers offer services like personal care, adult day services, respite care for family caregivers, and home meal delivery.
Example: The GA Elderly and Disabled Waiver provides adult day health, case management, out-of-home respite, occupational/physical/speech therapy in adult day health care, home-delivered meals, structured family caregiving, and more to individuals ages 65 or older and individuals with physical disabilities ages 0-64 years who meet a nursing facility level of care.
The goal of services offered under HCBS waivers is always to provide the right mix of supports to help people live independently in their homes and communities.
Examples of waiver services include:
These are only some of the core services offered through HCBS waivers, but the list isn't exhaustive. Waivers may offer additional services like behavioral health services, assistive technology, and specialized therapies.
HCBS waivers receive funding from both federal and state Medicaid dollars,
The application process for HCBS waivers involves several key steps:
The timeline for approval can vary by state but typically takes several weeks to a few months. Once approved, services begin according to the individual's plan of care. Waiting lists may exist in some states due to limited funding or capacity.
We understand the importance of ensuring family caregivers and their loved ones have access to the resources and support they need. You can use our free program matching tool to find Medicaid waiver programs that offer a caregiver component for which you and your loved one.
