What Are Medicaid Waiver Programs?

Written by: Vanessa Jerusalimiec (*Amsive Digital)  |  Reviewed by: Shelley Wyant  |  *MHP partners with Amsive Digital on news content

What Are Medicaid Waiver Programs?

If you or a loved one requires complex medical care, you may be considering moving to a nursing facility. Both Medicare and Medicaid limit the long-term care benefits you can receive at home, but you may have another option. A Medicaid waiver program can help you get the level of care you need, either in the comfort of your own home or through community-based services in your area.

What is a Medicaid Waiver?

A Medicaid waiver can provide comprehensive health care at home so you don't need to move to a long-term care facility. Medicaid waivers, under Section 1915(c) of the Social Security Act, cover Home and Community Based Services (HCBS) to help adults live comfortably at home. Most states include HCBS programs as part of their state Medicaid programs.

Medicaid waiver programs are commonly available to individuals with chronic health conditions that can include:

  • Alzheimer’s disease
  • Cerebral palsy
  • Epilepsy
  • Traumatic brain injury
  • Autism
  • HIV
  • Physical or intellectual disabilities
  • Mental health concerns

What’s Covered?

If you qualify for a Medicaid waiver, you can receive care in your home, in an assisted living facility, or in an adult care home. A Medicaid waiver program may provide a home health aid, a care aid, or someone who can assist you with the tasks of daily living like getting up, showering, or eating meals. Additional services can include physical therapy, transportation services, meal delivery, or adult day care services. Some states also offer case management, respite care, and homemaker services. All Medicaid waiver programs must:

  • Ensure that each person receives appropriate care
  • Protect each person’s health and welfare
  • Create an individualized care plan for program members

To find out exactly what's covered, check the Medicaid waiver programs available in your state. Each state can develop their own Medicaid waiver programs, so coverage varies. 

Are You Eligible for a Medicaid Waiver Program?

Eligibility for Medicaid waiver programs is determined by each state, but some guidelines are the same in most states. One common requirement is that you must need a high level of care, similar to care offered in a nursing facility. This could include needing daily access to medical services, requiring personal care services, and needing help with the tasks of daily living. Other eligibility requirements set by each state can include age, diagnosis, or health condition.

What is the Difference Between Medicaid and a Medicaid Waiver?

Medicaid is a state-run program that provides health care coverage to over 76 million Americans. This includes low-income adults, older adults, children, and people with disabilities. Anyone who qualifies for Medicaid can get coverage.

A Medicaid waiver program is also administered at the state level, and it offers comprehensive care to adults who need a high level of care. If you qualify for a Medicaid waiver program, you can receive care in your home rather than moving to a nursing facility. The program offers personalized health care options to improve quality of life and standards of care. Each state determines eligibility requirements and may also set a limit on how many individuals can receive care under a Medicaid waiver program.

How to Apply for a Medicaid Waiver Program

To apply for a Medicaid waiver program, check your eligibility by contacting your state Medicaid program, or your local State Health Insurance Assistance Programs (SHIP). If you have a complex health condition, a Medicaid waiver program can help you access the care you need in your home or in your community.

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