An HCBS waiver lets you receive long-term care services in your home or community instead of in an institution

HCBS stands for Home and Community-Based Services. A waiver is a formal exception that allows a state to pay for these services even when federal rules would normally require you to live in a nursing home or other facility to receive them. Without the waiver, Medicaid would only cover institutional care. With it, you can stay in your own home, an apartment, or a group setting while Medicaid pays for the support you need.

Each state runs its own HCBS waiver program, so what services are covered, how many people can receive them, and how long the waiting list is varies by state. The waiver does not change your Medicaid status — you still need to meet your state's income and asset limits to may have access to for Medicaid itself. The waiver straightforward changes where you can receive care and what types of services Medicaid will pay for.

Key Takeaways

  • An HCBS waiver allows Medicaid to pay for care in your home or community instead of only in institutions like nursing homes.
  • Each state designs and operates its own waiver program, so covered services, costs, and waiting lists differ by location.
  • You must still meet your state's Medicaid income and asset limits; the waiver does not change those rules.
  • Common HCBS services include personal care, homemaker support, adult day programs, and respite care for family caregivers.
  • Many states have waiting lists because federal funding is limited, and you may wait months or years before services begin.

What services does an HCBS waiver typically cover

The federal government sets broad categories of services that waivers can fund, but each state chooses which ones to include. Personal care — help with bathing, dressing, toileting, and eating — is the most common service. Homemaker services cover cleaning, laundry, and meal preparation. Many waivers also pay for adult day programs, where you attend structured activities during the day while a caregiver works or rests.

Respite care is another frequent service: it pays for temporary care so your family caregiver can take a break. Some waivers cover supported employment, helping you find and keep a job. Others pay for assistive technology, home modifications like ramps or grab bars, or transportation to medical appointments. A few states cover day habilitation, which provides training in daily living skills. The exact menu depends on your state and sometimes on your specific needs.

How waiting lists work and why they exist

Most states have more people who want HCBS services than the federal budget allows them to fund. When demand exceeds capacity, states create waiting lists. You may be added to the list when you first request services, and then wait months or years before your name reaches the top and services actually begin. Some states prioritize people with the greatest need or those in crisis situations, moving them ahead in the queue.

A few states have closed their waiting lists entirely, meaning new people cannot be added until someone leaves the program. Other states have multiple waiting lists for different types of waivers — one for elderly people, one for people with developmental disabilities, one for people with physical disabilities — and your position on one list does not affect your position on another. Your state Medicaid office can tell you whether a list is open, how long the typical wait is, and whether you would be prioritized based on your situation.

Income and asset rules for HCBS waivers

To receive services through an HCBS waiver, you must meet your state's Medicaid financial limits. Most states use the same income and asset thresholds for waiver services as they do for nursing home coverage. In 2024, the federal income limit for most people is around 100 percent of the federal poverty level, though some states set it higher. Asset limits vary — some states allow you to keep up to $2,000 in countable assets, while others are more generous.

Your home and one vehicle are usually not counted as assets, and neither is money in a special needs trust if it was set up correctly. Medicaid looks at your income and assets in the month you explore, and then recertifies periodically — usually once a year. If your income or assets change, you must report it to your state Medicaid office. The rules are complex and vary by state, so ask your local Medicaid office or a benefits counselor to explain what counts in your situation.

How to find out about waivers in your state

Start by contacting your state Medicaid office directly. You can find the phone number on your state's Medicaid website, which you can locate by searching "[your state] Medicaid" in any search engine. Tell them you want information about HCBS waivers for your situation — whether you are elderly, have a disability, or are caring for a family member. They can tell you which waivers exist, what they cover, whether the waiting list is open, and how to request services.

You can also call 211, a free referral service available in most parts of the United States. Dial 2-1-1 or visit 211.org, enter your zip code, and ask for information about HCBS waivers or long-term care services in your area. A counselor can explain your options and help you understand next steps. If you are already receiving Medicaid, your caseworker can also answer questions about waivers and tell you whether you might be a good fit for one.

The difference between HCBS waivers and other long-term care options

If you do not receive an HCBS waiver, Medicaid will only pay for care in an institution — a nursing home, assisted living facility, or group home licensed as an intermediate care facility. You would have to move to that setting to have Medicaid cover your care. With an HCBS waiver, you can stay where you are and have services come to you, or move to a smaller community setting like a group home while still receiving Medicaid support.

Some people also have the option of a consumer-directed waiver, which gives you more control over hiring and managing your own caregivers instead of having the state assign them. Others may may have access to for Program of All-Inclusive Care for the Elderly (PACE), which combines medical care and long-term services in one program, or for state-funded programs that do not use Medicaid. Your state Medicaid office can explain which options are open to you based on your age, disability status, and location.

What happens after you request HCBS waiver services

Once you contact your state Medicaid office and express interest in an HCBS waiver, they will send you an process or direct you to one online. You will need to provide proof of your income, assets, citizenship, and medical condition. If the waiting list is open, you will be added to it. If it is closed, you may be placed on a priority list and contacted if space opens up.

If your name reaches the top of the list, the state will schedule an assessment. A nurse or social worker will visit you or meet with you by phone to understand your needs and determine what services would help you most. Based on that assessment, they will create a care plan listing the specific services you will receive and how often. Once the plan is approved, services typically begin within a few weeks. You will be assigned a case manager who checks in regularly and adjusts your plan if your needs change.

Frequently Asked Questions

Do I have to be on Medicaid already to request an HCBS waiver?

No. You can request a waiver even if you are not yet receiving Medicaid, as long as you meet your state's income and asset limits. However, services will not begin until Medicaid coverage is active. If you are not yet on Medicaid, the state will help you explore for it at the same time you request the waiver.

What if I am on the waiting list and my situation becomes urgent?

Tell your state Medicaid office when ready. Some states have a priority or crisis track that can move you ahead if you are in danger or your caregiver becomes unable to help. You may also be able to receive temporary services while waiting for the full waiver to begin, though this varies by state.

Can I lose HCBS waiver services if my income increases?

If your income rises above your state's Medicaid limit, you would lose Medicaid coverage and the waiver services would end. However, some states have work incentive programs that let you keep Medicaid even if you earn more, especially if you are working. Ask your caseworker about programs like Medicaid Buy-In or Plans to Achieve Self-Support (PASS).

How much do HCBS waiver services cost?

There is no cost to you for HCBS waiver services if you are on Medicaid — the state pays the provider directly. You may have a small Medicaid copay for some services depending on your state, but it is usually minimal. If your income is very low, you may owe nothing at all.

Can I choose which provider gives me services?

This depends on your state and the type of waiver. Some states let you choose your provider from a list of approved agencies. Others use a consumer-directed model where you hire and manage your own caregiver. Ask your state Medicaid office what choice you have in your area.