Medicaid HCBS Waivers

What Are HCBS Waivers?

Medicaid Home and Community-Based Services (HCBS) waivers allow states to provide services to people with disabilities in their homes and communities instead of in institutions like nursing homes or intermediate care facilities. The name "waiver" comes from the fact that states are "waiving" certain Medicaid rules, particularly the requirement that services be provided in institutional settings, in order to serve people in less restrictive environments.

Congress authorized HCBS waivers through Section 1915(c) of the Social Security Act in 1981. The program was a direct response to the deinstitutionalization movement and the recognition that most people with disabilities prefer to live in their communities. Today, HCBS waivers serve over 3 million people nationwide and represent the largest category of Medicaid long-term services and supports spending.

Each state designs its own HCBS waiver programs, which means the names, services, eligibility criteria, and waiting lists vary dramatically from state to state. Some states have a single comprehensive waiver; others operate a dozen or more waivers targeting different populations or need levels.

Types of HCBS Waivers

While every state structures its waivers differently, most fall into these categories:

• Intellectual and Developmental Disability (I/DD) Waivers: The most common type, serving people with conditions like autism, intellectual disability, cerebral palsy, and Down syndrome. These waivers typically offer the broadest range of services, including residential support, day programs, employment support, respite care, and personal assistance.
• Aged and Disabled Waivers: Serve elderly individuals and people with physical disabilities who would otherwise require nursing home care. Services include personal care, home modifications, adult day care, and meals.
• Children's Waivers: Some states operate waivers specifically for children with significant disabilities, providing services like in-home nursing, respite care, adaptive equipment, and family support.
• Brain Injury Waivers: Targeted services for people with traumatic brain injuries, including cognitive rehabilitation, behavioral support, and community reintegration services.
• Technology-Dependent Waivers: For individuals who require ventilators, feeding tubes, or other medical technology, providing in-home nursing and medical equipment.

Eligibility Requirements

HCBS waiver eligibility has two components: financial eligibility and functional/level-of-care eligibility.

Financial Eligibility

Most HCBS waivers use "institutional" financial eligibility rules, which are more generous than regular Medicaid. Under these rules, only the income and resources of the individual with a disability are counted, not the entire household. For children, this means parental income is typically not counted. The income limit is usually 300% of the SSI federal benefit rate (approximately $2,829 per month in 2026), and the resource limit is $2,000 for an individual.

Functional Eligibility

You must demonstrate that you need the "level of care" that would be provided in an institution. For I/DD waivers, this typically means showing significant limitations in adaptive behavior and the need for ongoing support with daily living activities. An assessment tool specific to your state will be used to determine if you meet this threshold.

An important note: many families assume they make too much money for Medicaid waivers. In most states, this is not true. HCBS waivers look at the disabled individual's income, not family income. A child with no income of their own will almost always meet the financial criteria.

How to Apply

1. Identify the right waiver:Contact your state's Medicaid agency or developmental disability agency to find out which waivers are available and which one best fits your needs.
2. Get on the waiting list immediately: Many states have multi-year waiting lists. Your place in line is based on when you apply, so do not wait. See our Waiting Lists guide for strategies.
3. Complete the application: This typically requires a Medicaid application (if not already enrolled), diagnostic documentation, and a functional assessment.
4. Undergo a level-of-care assessment:A state-designated assessor will evaluate the individual's functional abilities and support needs to determine if they meet the institutional level of care.
5. Develop a service plan: Once approved, you will work with a case manager to develop a plan of care that identifies the services you will receive and the providers who will deliver them.

Common Services Covered

While services vary by state and waiver, commonly covered services include: