Most people who qualify for a Medicaid nursing home would rather stay in their own home, and Medicaid Home and Community-Based Services (HCBS) waivers are how Medicaid pays for that. Each state runs its own named waivers with its own rules, waitlists, and covered services, so the practical details are local. Below is how HCBS waivers work everywhere, and then a directory that opens your own state's guide.

In This Guide

What Medicaid HCBS Waivers Are

Home and Community-Based Services, usually shortened to HCBS, are the long-term supports Medicaid pays for outside of an institution. Instead of covering a bed in a nursing facility, an HCBS program covers the help a person needs to keep living in their own home, a family member's home, or another community setting: personal care, in-home aides, adult day programs, respite for family caregivers, home modifications, and more.

Many of these programs are authorized under Section 1915(c) of the Social Security Act, the federal law that lets a state ask the federal government for permission, a "waiver," to offer this kind of care to people who would otherwise need institutional placement. A 1915(c) waiver runs in fixed terms: its first approval normally runs three years (CMS can approve five years for a waiver that enrolls people eligible for both Medicare and Medicaid), and the state can then ask to renew it for up to five years at a time, which is one reason program details change over time.

The key thing to understand is that there is no single benefit called "the Medicaid HCBS waiver." Each state runs its own named waivers, often several of them for different groups, and the one built for aged and physically disabled adults is usually the one families are looking for. That's why the last step in this guide is to open your own state's page.

What's the Same Everywhere, and What Your State Controls

It helps to separate the parts that are federal from the parts your state decides.

The federal floor is the same everywhere. Nursing-home care is a mandatory Medicaid benefit, so it's part of every state's Medicaid plan, at a minimum for the core "categorically needy" eligibility groups. Apart from home health services, which are also mandatory, home and community-based care is optional: a state can offer it through its regular Medicaid plan or through waivers, and a waiver lets it limit services to specific groups and cap enrollment. That single difference is why HCBS looks so different from state to state while nursing-home coverage looks broadly similar.

What each state controls is nearly everything practical: the names of its waivers, which groups they serve, the exact services covered, the financial rules it applies, whether there's a waitlist, and how you apply. Federal rules do add some requirements on top. Under CMS's Ensuring Access to Medicaid Services rule, for example, states must generally make sure that, starting July 9, 2030, providers spend 80 percent of the Medicaid payments they get for homemaker, home health aide and personal care services under a 1915(c) waiver on pay for the direct care workers who deliver them. But the day-to-day shape of the program is a state decision. That's exactly the part a national page can't answer for you, and it's why the directory below matters.

How a Medicaid HCBS Waiver Works: The Two Tests

Qualifying for an HCBS waiver almost always means clearing two separate tests.

The first is functional: a nursing-facility level of care. The waiver is for people who are assessed as needing the kind of institutional-level care a nursing home provides but who want to receive it at home instead. If someone wouldn't qualify for a nursing home, they generally won't qualify for the waiver.

The second is financial: your state's Medicaid rules for long-term care. Many states judge waiver applicants' finances as if they were living in a nursing home, applying the same income and asset rules they use for nursing-home Medicaid, and where a state uses a special income limit, it's in most cases 300% of the Supplemental Security Income (SSI) federal benefit rate. The exact figures are state-specific, so check your state's guide or our Medicaid income limits by state page for the number that applies to you. If your income is above the limit for a waiver, our guide to what to do when your income is too high for a Medicaid waiver walks through the options state by state.

Once you meet both tests and enroll, a care manager typically assesses your needs and builds a plan of the specific services the waiver will pay for. That plan has to be reviewed at least every 12 months, and sooner if your needs change significantly or you ask. If you're wondering whether that plan can cover round-the-clock help, see whether Medicaid pays for 24-hour home care.

Why Waitlists Happen

The most important difference between an HCBS waiver and nursing-home Medicaid is that a waiver can cap how many people it serves at one time. Nursing-home care is a mandatory benefit, so if you qualify, you get it. A waiver works differently: it lets a state limit services to specific groups and cap enrollment, and when demand exceeds slots, applicants go on an interest list or waitlist.

That's why applying early matters, and why "Am I approved for Medicaid?" and "Is there a waiver slot open?" are two separate questions. Some states also hold federal Money Follows the Person grants, which help someone leaving a nursing home or other inpatient facility move into a qualifying community residence: their own or a family member's home, an apartment with its own lease, or a home where no more than four unrelated people live. Your state's guide explains where its waitlist stands and how enrollment works.

Find Your State's HCBS Waiver Guide

Pick your state for its Medicaid HCBS waiver guide: the named waiver programs, who they serve, what they cover, the financial rules, the waitlist, and how to apply where you live.

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Frequently Asked Questions

What is a Medicaid HCBS waiver?

It's a state Medicaid program, authorized under Section 1915(c) of the Social Security Act, that pays for long-term care in your home or community instead of a nursing facility. States run their own named waivers with their own rules, so the specifics depend on where you live.

Can I choose to get care at home instead of in a nursing home?

You can ask for it. If you're assessed as needing a nursing-facility level of care, an HCBS waiver is the route to receiving that care at home instead. But a waiver isn't guaranteed the way nursing-home coverage is: you have to meet your state's rules, and in many states wait for an open slot. When you're assessed as likely to need that level of care, you must be told about the feasible alternatives under the waiver and given the choice between institutional and home and community-based care.

Why is there a waitlist for a Medicaid waiver?

Unlike nursing-home coverage, a waiver can serve only a set number of people at once, so when more people apply than there are slots, states use an interest list or waitlist. Qualifying for Medicaid and getting a waiver slot are two separate steps.

Do HCBS waivers have income limits?

Yes, and they're set by your state. Many states apply the same long-term-care income and asset rules to waiver applicants that they use for nursing-home Medicaid. Check your state's guide or our income-limits-by-state page for the figure that applies to you.

Learn More

MedicaidMedicaid by State: Eligibility, Coverage, and How to ApplyMedicaid works differently in every state, from who qualifies to what's covered and how to apply. See what varies and jump to your state's full guide. MedicaidMedicaid Long-Term Care and Nursing Home Coverage by StateMedicaid pays for nursing-home care in every state, but the income cap, level-of-care test, and rules vary. The federal floor, what changes, and your state. MedicaidMedicaid Income Limits by State: Which Number Applies to YouMedicaid income limits for 2026 depend on your pathway: expansion adults, aged and disabled, or nursing-home care. See the figures and your state's limits. MedicaidHow to Apply for Medicaid by StateHow to apply for Medicaid: the ways you can apply, the documents to gather, how long a decision takes, and the application guide for your state. Care TypesNursing Home vs. Home CareNursing home vs. home care: 2026 national costs, what each provides, what Medicare and Medicaid pay in each setting, and the signs that tell you which one fits. CaregiverLive-In Caregiver for an Elderly Parent: The Rules, the Real Cost, and Who PaysA live-in caregiver is usually owed minimum wage for every hour worked; room and board is only a capped credit. The rules, agency vs. private hire, who pays.

Find personalized help understanding your state's Medicaid HCBS waivers and applying for home care at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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