Guide
Medicaid home care waivers (HCBS): what they are and how to apply
Updated October 15, 2026 · Reviewed against official sources
For many Latino families, the hope is that mom or dad can stay at home, close to the grandkids and their church. Medicaid pays for nursing home care in every state, but home care depends on the programs each state chooses to offer.
What a waiver is and why it's called that
Medicaid's rules were first written with care in an institution in mind. Since 1983, section 1915(c) of the Social Security Act has allowed states to ask for a waiver of some of those rules so they can pay for services at home and in the community. According to CMS, 47 states and the District of Columbia have at least one 1915(c) waiver.
Each waiver is designed for a specific group (for example, people 65 or older, or adults with a physical disability), and the state can limit it even further by age or diagnosis. The state also sets the maximum number of people it serves and must show that the program doesn't cost more than care in an institution.
The program names you'll hear
| Program | What it is | Does it require a nursing home level of care? |
|---|---|---|
| 1915(c) waiver | A waiver for a specific group, with a number of slots set by the state | Yes |
| 1915(i) | Home services under the state plan; the state must offer them to everyone who qualifies | Not necessarily: it uses needs-based criteria set by the state |
| 1915(k), Community First Choice | Personal attendants at home; the state gets 6 extra percentage points of federal funding | Yes |
| 1915(j) | Self-directed personal assistance under the state plan | Depends on the program |
| Section 1115 demonstration | Projects with their own rules, approved by the federal government | Depends on the state's design |
Also, in some states the Medicaid plan includes personal care at home without the need for a waiver. That's why the best question isn't "Is there a waiver?" but "What Medicaid programs are there so my mom can get help at home?"
What services they can include
According to CMS, a waiver can offer services such as case management, homemaker services (help with household chores), personal care and respite care for the caregiver. Programs under 1915(i) often add home modifications. Depending on the state, there is also adult day care, home-delivered meals and services in assisted living. Medicaid doesn't pay the rent or meals in assisted living, only the care part.
In many programs, your loved one can self-direct their services and hire their own caregiver, sometimes a son or daughter. Read how to get paid to care for a family member.
Who qualifies
Usually, three things are required:
- Qualifying for Medicaid based on income and assets. For these programs, many states use the special income rule of up to 300% of SSI: $2,982 a month in 2026, according to CMS. The asset limit is often $2,000, but it varies. Read Does Medicaid pay for a nursing home?.
- Needing that level of care. For a 1915(c) waiver, the law requires that, without these services, the person would need the care of a hospital, a nursing home or another institution. A nurse or a state assessor measures how much help they need to bathe, get dressed, eat or move around, and whether they need supervision because of memory problems. Our Katz and Lawton scales help you prepare (they're only a guide, not the official assessment).
- Belonging to the group the program serves and living in the area where it's offered.
If your loved one is married, the protections for the spouse who stays at home also apply to people who get these services, at least until September 30, 2027, according to CMS. See Medicaid, the family home and assets.
A change coming in 2028
Federal law P.L. 119-21 creates a new 1915(c) waiver option starting July 1, 2028: states will be able to provide home services to people who don't meet the institutional level of care, using needs-based criteria. It's an option, not a requirement: each state will decide whether to use it, and it must show that this doesn't significantly lengthen the wait for people who do need that level of care.
Waiting lists: why they exist and what to do
Because the state sets how many people each waiver serves, many states have waiting lists. Sometimes they go by other names: in Texas, for example, it's an "interest list," and in Florida a priority score is assigned after a phone screening.
What helps most:
- Sign up early, even if your loved one is still managing well. Time on the list counts from the day you sign up.
- Answer every letter and let them know if your address changes.
- Ask for a new assessment if your loved one's health gets worse; in some states that changes their priority.
- Ask what's available in the meantime: Older Americans Act programs (meals, respite, help at home), the PACE program, an adult day center or the support described in help for family caregivers.
- If your loved one already lives in a nursing home and wants to move back to the community, ask about Money Follows the Person. According to CMS, 45 states, the District of Columbia and two territories, including Puerto Rico, have received funding from this program.
How to apply, step by step
- Call your state's Medicaid agency or your local Area Agency on Aging. If you don't know where to call, use the Eldercare Locator: 1-800-677-1116, Monday through Friday from 9 a.m. to 8 p.m. Eastern time; if you prefer Spanish, ask for it when you call.
- Ask what home care programs exist for older adults in your county and whether there's a waiting list.
- Apply for Medicaid if your loved one doesn't have it yet. Often the application and the assessment move forward at the same time.
- Get ready for the assessment: have the medication list handy, along with specific examples of what your loved one can no longer do alone.
- Review the service plan with the care coordinator or case manager: hours, services and who provides them.
- If the service is denied or you're given fewer hours, you have the right to ask for a fair hearing. Check the deadline in the letter.
Helpful questions for the agency or the care coordinator
- What programs are there for my loved one, and which one is the best fit?
- Is there a waiting list? How long does it usually take, and how is priority decided?
- What services are included, and roughly how many hours?
- Can we choose the agency or self-direct the services? Can a family member get paid?
- Does the program pay for services in assisted living or at an adult day center?
- Are there coordinators or caregivers who speak Spanish?
State programs we've already explained
- Texas: STAR+PLUS, with its interest list for STAR+PLUS HCBS.
- Florida: SMMC Long-Term Care.
- California: IHSS and Medi-Cal.
- New York: MLTC and CDPAP.
Find home care agencies and adult day centers near you, or try our guided search.
Frequently asked questions
Does a waiver pay for a caregiver 24 hours a day?
Usually not. Each program approves hours based on the assessment, and many families combine them with their own caregiving or an adult day center.
Can my dad lose his house because he gets these services?
Not while he lives in it. After his death, the state may try to recover what Medicaid paid for long-term care services, including home care services, with several protections for the family. We explain it carefully in Medicaid, the family home and assets.
What if my loved one is undocumented or only recently got their immigration status?
The rules changed in 2026. Read immigration status and benefits and talk with an immigration lawyer at a nonprofit organization before applying.
What if they need more help than the program provides?
Ask for a new assessment. If that's still not enough, look at how to pay for long-term care.
This guide is for information only and is not legal or financial advice. Each state designs its own programs and changes them over time.
Sources
- Medicaid.gov, Home & Community-Based Services Authorities: https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities (accessed October 15, 2026)
- Medicaid.gov, Home & Community-Based Services 1915(c): https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915c (accessed October 15, 2026)
- Medicaid.gov, Home & Community-Based Services 1915(i): https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915i (accessed October 15, 2026)
- Medicaid.gov, Community First Choice (CFC) 1915(k): https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/community-first-choice-cfc-1915-k (accessed October 15, 2026)
- CMS/CMCS, Informational Bulletin of April 26, 2012 (Community First Choice final rule): https://www.medicaid.gov/sites/default/files/Federal-Policy-Guidance/Downloads/CIB-04-26-12.pdf (accessed October 15, 2026)
- Medicaid.gov, About Section 1115 Demonstrations: https://www.medicaid.gov/medicaid/section-1115-demonstrations/about-section-1115-demonstrations (accessed October 15, 2026)
- Medicaid.gov, Self-Directed Services: https://www.medicaid.gov/medicaid/long-term-services-supports/self-directed-services (accessed October 15, 2026)
- CMS/CMCS, Informational Bulletin of November 18, 2025 (Medicaid provisions of P.L. 119-21, section 71121): https://www.medicaid.gov/federal-policy-guidance/downloads/cib11182025.pdf (accessed October 15, 2026)
- CMS/CMCS, Informational Bulletin of December 9, 2025 (2026 SSI and spousal protection standards): https://www.medicaid.gov/federal-policy-guidance/downloads/cib12092025.pdf (accessed October 15, 2026)
- CMS/CMCS, Informational Bulletin of August 15, 2023 (spousal protections in HCBS through September 30, 2027): https://www.medicaid.gov/federal-policy-guidance/downloads/cib08152023.pdf (accessed October 15, 2026)
- Medicaid.gov, Money Follows the Person: https://www.medicaid.gov/medicaid/long-term-services-supports/money-follows-person (accessed October 15, 2026)
- Medicaid.gov, Estate Recovery: https://www.medicaid.gov/medicaid/eligibility-policy/estate-recovery (accessed October 15, 2026)
- ACL, Eldercare Locator: https://acl.gov/HousingandServices/FindHelp (accessed October 15, 2026)
This is general information, not medical, legal or financial advice. Rules vary by state and by year: confirm with the official agency that applies to you.
Keep reading
Does Medicaid pay for care?
Yes, Medicaid pays for a nursing home if your loved one qualifies. 2026 limits, the 5-year look-back, spouse protections, waivers and how to apply.
Home care
A caregiver from an agency or hired by your family, Medicare home health and Medicaid (IHSS, STAR+PLUS): typical costs and your duties as an employer.
PACE program
PACE, the Medicare and Medicaid Program of All-Inclusive Care for the Elderly: who qualifies, what it covers, what it costs, and how to find a center.
Adult day care
What adult day care is, how it differs from adult day health care, what it costs and how to pay for it with Medicaid, PACE, CBAS or the VA.
