Applying for a Medicaid Waiver: Home and Community Care

Most older adults would rather receive care at home, with family, or in an assisted living residence than move into a nursing home. Medicaid can help pay for that care, usually through home and community-based services (HCBS) waiver programs. Applying for a waiver is different from applying for nursing home Medicaid. There are usually two separate tracks (a financial application and a care assessment), the programs can have waiting lists, and the services you get depend on a written care plan. This guide explains each step in plain language. Each state guide names the waiver programs in that state and how to start.

Figures change periodically. Double-check current amounts before relying on them.

What a waiver is

A “waiver” is a program a state runs with federal permission to “waive” some normal Medicaid rules so it can pay for long-term care outside a nursing home. Waivers typically pay for services such as:

personal care (help with bathing, dressing, eating, toileting and moving around);
homemaker and chore services;
adult day health programs;
respite care for family caregivers;
home-delivered meals;
personal emergency response systems;
home modifications and medical equipment not otherwise covered;
case management;
care services in assisted living or adult foster care (in many states, room and board is not covered).

Some states also offer home care through the regular Medicaid “state plan” (for example, personal care services or Community First Choice) or through managed long-term services and supports. PACE is another option in some areas. See HCBS waivers and Managed long-term services and supports.

The two tracks: money and care need

Applying for a waiver usually involves two decisions, often made by two different agencies:

Financial eligibility. The state Medicaid agency (often a county or regional office) decides whether income and assets are within the limits. In many states the waiver income limit is 300 percent of the SSI benefit ($2,982 a month in 2026), and the asset limit for a single person is often $2,000. Some states use other rules. Married applicants generally receive spousal protections similar to those in nursing homes. The look-back applies to waiver applicants in most states as well.
Functional (medical) eligibility. A nurse, social worker or assessor decides whether the person needs a nursing-home level of care (or, for some programs, a lower level). The assessment may be done by the state, an Area Agency on Aging, an Aging and Disability Resource Center, a case management agency or a managed care plan, depending on the state. See Nursing home level of care.

Both tracks must say yes, and there must be an open slot in the program, before services start.

Step 1: Find the right program

Start by finding which programs exist in your state and which one fits. Questions to ask:

Is there a waiver for older adults, for adults with physical disabilities, or a combined “aged and disabled” waiver?
Does it cover care at home only, or also in assisted living or adult foster care?
Is there a waiting list, and how are people placed on it (first come, first served, or by priority such as risk of nursing home placement)?
Does the state also offer home care through the regular Medicaid program, which may have no waiting list?
Is care delivered through a managed care plan?

Your local Area Agency on Aging or Aging and Disability Resource Center can usually explain the options at no charge. The state guides list the main programs.

Step 2: Get on the waiting list early (if there is one)

Many waivers have a cap on the number of people enrolled. When slots are full, applicants wait. Waiting lists can last months or even years in some states. Because the list is often ordered by date, it usually makes sense to ask for placement on it as soon as care needs are likely, even if the person is not yet ready to start services. Some states screen people before adding them to the list; others add them first and screen later. See Waiver waiting lists.

Some states give priority to people moving out of a nursing home, people at immediate risk of institutional placement, or people leaving a hospital. The Money Follows the Person program can also help people who have been in a nursing home for more than 60 days move back to the community.

Step 3: The assessment

The assessor will usually visit the home (or hospital or nursing home) and ask questions about daily activities, health, memory, medications, falls and the help family members already provide. Tips:

Describe a bad day, not just a good day. People often minimize their needs in front of a visitor.
Have a family caregiver present who can describe what help is really needed and how often.
Bring medical information, including a list of diagnoses and medications.
Mention supervision needs, such as wandering, leaving the stove on or forgetting medications. Cognitive impairment counts even when physical needs are low.

If the person is found not to meet the level of care, the notice should explain how to appeal.

Step 4: The financial application

File the Medicaid application with the state agency and say clearly that the person is applying for home and community-based waiver services, so that the right rules are applied. Gather the same documents as for a nursing home application: identity papers, income proof, account statements, insurance and funeral information, deeds and records of any transfers. See the Application documents checklist.

Income works differently for waiver recipients than for nursing home residents. A waiver participant still has to pay rent, food and utilities, so states allow them to keep more income for living expenses (a “maintenance needs allowance”). In some states, income above a set amount must be paid toward the cost of waiver services, similar to a nursing home patient liability. In states with an income cap, a Miller trust may be needed. See How Medicaid waivers protect income.

Step 5: The care plan

Once approved, a case manager or care coordinator works with the person and family to write a care plan (sometimes called a person-centered service plan). It lists the services, how many hours, and who will provide them. Review it carefully:

Does the number of hours match the real need?
Are all needed services listed, including respite for the family caregiver?
Can the person choose providers, or hire their own caregivers through a consumer-directed option?
In many states, a family member can be paid as a caregiver. See Paid family caregivers.

If services are denied, reduced or ended, you have the right to written notice and a fair hearing.

Waivers and assisted living

Many states use waivers to pay for care services in assisted living. Medicaid generally does not pay the room and board portion, so the resident usually pays rent and meals from their own income, and the facility must accept Medicaid waiver payment. Not every assisted living residence participates. See Will Medicaid pay for assisted living?, Room and board and Finding assisted living that accepts Medicaid.

Common problems

Applying to the wrong program. A general Medicaid application may be processed under ordinary rules unless it is clear that long-term care is requested.
Waiting too long to join a waiting list. A crisis may force a nursing home move simply because no waiver slot is open.
Underreporting needs at the assessment. This can lead to a finding of “not eligible” or too few hours.
Missing financial verification deadlines. As with nursing home applications, a missed deadline often means a denial.
Not knowing about the look-back. Gifts made to family can cause a penalty for waiver services too, in most states.
Losing track of the two decisions. Families sometimes receive a financial approval and assume services will start, when the functional assessment or a waiting list is still pending.

Getting experienced help

Waiver applications combine financial rules, medical assessments and program rules that vary greatly from state to state. Help is most valuable for married couples, people with income near or over the cap, people with gifts or transfers in the past five years, and anyone facing a long waiting list who may need a nursing home in the meantime. A Certified Medicaid Planner can explain which program fits, how to protect income and assets for a spouse at home, and how to move between programs if needs change. As a rough guide, published fees for help with an application range from about $500 to $6,000, full planning from about $2,500 to $15,000 or more, and hourly help from about $150 to $600. Free information about programs is available from the local Area Agency on Aging, the Aging and Disability Resource Center and the state Medicaid agency.

Frequently asked questions

Is there a waiting list for every waiver? No. Some waivers have open enrollment, and some states offer home care through the regular Medicaid program without a waiting list. Others have long lists.

Can my mother live with me and receive waiver services? Usually yes. Services can be delivered in a family member’s home, and in many states a family member other than a spouse can be paid as a caregiver.

What if she needs more care than the waiver provides? Waivers often cap hours or costs. If needs exceed what the waiver can provide safely, the case manager may suggest more services, a different program or a nursing home.

Does estate recovery apply to waiver services? Yes. States must seek recovery for long-term care services, including waiver services, received at age 55 or older, with some exceptions. See Estate recovery.

Do the spousal protections apply? Yes. Federal law requires states to apply spousal impoverishment protections to waiver applicants through at least September 30, 2027. See Spousal impoverishment.

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.