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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. Federal 1915(c) waiver materials model the common special income level as up to 300% of the SSI Federal Benefit Rate rather than 300% of FPL; for 2026, that is $2,982/month for an individual before state-specific rules. 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

  • U.S. citizenship or qualified immigrant status required
  • Care recipient must have a qualifying disability

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. Federal 1915(c) waiver materials model the common special income level as up to 300% of the SSI Federal Benefit Rate rather than 300% of FPL; for 2026, that is $2,982/month for an individual before state-specific rules. See data/inventory/hcbs-waivers-by-state.json for the complete state-by-state waiver inventory.

How to apply

Use the official program page for application details: official program page.

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