Medicaid Home & Community Based Services (HCBS): Programs & Waivers by State

Home & Community Based Services are services paid for by Medicaid that provide assistance to individuals in their homes or in the community at large instead of in a nursing home.

The types of services provided are not limited to health care. Instead, they include non-medical personal care, assistance with activities of daily living, home modifications to support aging in place and many other types of assistance.

The locations in which individuals can receive these services is not limited to just their homes. Instead, services can be provided in the “community” such as at an adult day care center, or in senior living such as assisted living residences or memory care communities. Adult foster care homes, homes of family members and friends are also options. It is perhaps easier to define the one location in which one cannot receive HCBS, and that is in a nursing home.

State-by-State List of HCBS Programs & Waivers

The table below contains the state and program names. In the months ahead, each program will link to page with complete details about that program’s benefits, eligibility requirements and application process. In the interim, should the program name not be linked, simply click on the state name in the left column for eligibility requirements and a program overview.

Note: This list is intended to be comprehensive. However, certain programs may have been omitted in this first draft.

Types of Medicaid that Pay for HCBS

There are multiple types of Medicaid programs that pay for Home and Community Based Services for the elderly.

Medicaid HCBS Waivers
Waivers are state-specific programs that are intended to prevent or delay the placement of elderly, frail, or disabled persons in nursing homes. To that end, waivers provide many services to beneficiaries in their homes, or places of residence including assisted living or the home of family members with whom they reside.

Medicaid waivers typically have the same eligibility requirements as nursing home Medicaid. States apply for waivers to the Centers for Medicare & Medicaid Services and receive approval typically for a 5-year period. Each waiver is approved for a specific target group (such as the elderly) and with a specific number of available slots. Consequently, there are often more applicants than there are available slots and wait-lists are common.

Aged, Blind and Disabled Medicaid
ABD Medicaid (this name varies by state) can be thought of as regular Medicaid. There are financial eligibility criteria, but not medical criteria to be eligible for the program. However, there are medical criteria to be eligible for specific benefits. Regular Medicaid is an entitlement. Therefore, persons who are eligible for HCBS under regular / ABD Medicaid are guaranteed to receive those services compared to HCBS under Waivers where persons can be wait-listed.

Services Provided under HCBS

The types of services that can be provided under Home and Community Based Service is quite broad. From care to home modifications to assistive technology, anything that a state determines can help an individual to live independently can be included as a possible benefit. One cost that cannot be paid for under HCBS is room and board in assisted living. A list of typical services follows but this is by no means a comprehensive list. Note that these services vary by state and the names of the benefits also vary. For example, what may be called a “home modification” in one state may be called an “environmental adaption” in another state.

• Assistive Technology and Devices
• Attendant Care / Personal Care
• Care / Case Management
• Caregiver Training
• Chore Services
• Community Transition Services
• Companion Services
• Durable and Home Medical Equipment
• Environmental Accessibility Adaptations (Home Modifications)
• Financial Management Services
• Home Delivered Meals
• Home Health Care
• Homemaker Services
• Non-Medical Transportation
• Nursing Services
• Personal Emergency Response Systems (PERS)
• Respite Care
• Transportation