What is a Medicaid HCBS waiver?
A Medicaid HCBS waiver is a state program that uses Medicaid money to pay for long-term care in your own home or community rather than in a nursing home, where HCBS stands for home and community-based services and waiver means the state has federal permission to bend some ordinary Medicaid rules to make that possible.
What this means
- Covered services commonly include personal care, homemaker help, adult day services, respite for a family caregiver, home modifications, meals and emergency response systems.
- To qualify you generally have to meet both a financial test and a level-of-care test, meaning you would otherwise need nursing home care.
- Because it is a waiver rather than an entitlement, states can cap the number of people served, which is why waiting lists exist.
- Many waivers include a self-directed option that allows a family member to be the paid caregiver.
What to do first
- Call your state Medicaid agency and ask which waivers serve older adults in your state and what the current wait is.
- Ask your Area Agency on Aging for free options counseling before you apply, so you apply to the right waiver.
- Request a level-of-care assessment, and be honest about your worst days rather than your best.
- Ask to be placed on the waiting list immediately, even while you are still gathering documents.
Medicaid Home and Community-Based Services, Including Paying a Family Caregiver
Medicaid can pay for help at home instead of a nursing home, and in most states it can pay your own family member to give that help.
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What you'll need
- Proof of income and assets
- A doctor's assessment of your care needs
- Photo identification
- Bank statements going back five years for the look-back review
- Deed or lease
- Any notices, letters, or court papers you have received
- Medicare and insurance cards
Deadlines and timing
- Waiting lists in some states run for years. Nothing happens until you are on the list.
- Financial eligibility rules include a look-back at assets given away. Talk to a free legal aid attorney for older adults before transferring anything.
- Waivers must be renewed and you will be reassessed periodically.
Where to go
- Medicaid Home and Community-Based Services, Including Paying a Family Caregiver: https://www.medicaid.gov/about-us/where-can-people-get-help-medicaid-chip
- Free Legal Help for People 60 and Older: https://www.lsc.gov/about-lsc/what-legal-aid/i-need-legal-help
Reviewed by Jason Burns, Editorial Steward · Last verified August 25, 2026
Sources
- Home and Community-Based Services · Centers for Medicare & Medicaid Services
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