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Medicaid HCBS Waivers (Home and Community-Based Services)

Federal Medicaid waiver program under Section 1915(c) allowing states to provide home and community-based services as an alternative to institutional care. Services include respite care, personal care assistance, adult day health, home modifications, and more. States design their own waivers within federal guidelines.

Home and community-based services as alternative to nursing home placement. Services vary by state but typically include: personal care/attendant services, respite care, adult day health, home modifications, assistive technology, case management, and skilled nursing. As of 2025: 259 active 1915(c) waivers in 47 states + DC, 15 states with 1115 HCBS waivers, 10 states with 1915(k) Community First Choice. Over 5.1 million people receive Medicaid home care annually. All 50 responding states pay family caregivers through at least one program. 49 states (all except Alaska) allow self-direction. 44 states allow payment to legally responsible relatives via waiver. Family caregiver payments range $10-$22/hour depending on state. 11 states offer structured family caregiving programs ($40-70/day). Waitlists are common. See data/inventory/hcbs-waivers-by-state.json for the complete state-by-state waiver inventory.

Some details for this program are still being verified. Check the official source for the most current information.

Eligibility

  • Household income at or below 300% of the Federal Poverty Level
  • U.S. citizenship or qualified immigrant status required
  • Care recipient must have a qualifying disability or need for assistance
  • Must require a nursing facility level of care

Services

Home and community-based services as alternative to nursing home placement. Services vary by state but typically include: personal care/attendant services, respite care, adult day health, home modifications, assistive technology, case management, and skilled nursing. As of 2025: 259 active 1915(c) waivers in 47 states + DC, 15 states with 1115 HCBS waivers, 10 states with 1915(k) Community First Choice. Over 5.1 million people receive Medicaid home care annually. All 50 responding states pay family caregivers through at least one program. 49 states (all except Alaska) allow self-direction. 44 states allow payment to legally responsible relatives via waiver. Family caregiver payments range $10-$22/hour depending on state. 11 states offer structured family caregiving programs ($40-70/day). Waitlists are common. See data/inventory/hcbs-waivers-by-state.json for the complete state-by-state waiver inventory.

How to apply

Apply online or find more information at the official program page.

  • medicaid (depends_on): Must be Medicaid-eligible or meet institutional level of care