Home and Community-Based Services (HCBS) Waivers

Home and Community-Based Services (HCBS) Waivers are an umbrella term used to categorize programs provided by the state and Medicaid. These programs often cover long-term care services and support in a home or community setting. HCBS waivers are known differently in each state, such as Georgia’s Community Care Services Program and California’s Home and Community-Based Alternatives (HCBA) waiver. Additionally, each state may offer several HCBS waivers to cover eligible residents’ various needs. 

Services include:

HCBS waivers widely depend on each state, hence, coverage differs. However, common services include:

• Adult Day Health Services – recreational programs and health services in a supervised community setting.
• Behavioral Supports – services related to behavioral changes. 
• Case Management/ Support and Service Coordination – helps with coordinating and planning their care plans. 
• Community Transition Services – assistance for those moving from an institutional setting back to the community.
• Environmental Accessibility Adaptations/ Home Modifications – modifying one’s environment to improve accessibility and safety. 
• Homemaker Services – assistance with household chores. 
• Home Health Aide Services – assistance with daily living activities.
• Home-delivered meals. 
• Respite Care – relief for primary caregivers/ family caregivers.
• Personal Care Services – support to activities of daily living. 
• Private Duty Nursing – skilled nursing at home. 
• Therapies – physical, occupational, speech-language pathology, and respiratory therapies. 
• Transportation – assistance with travel to medical appointments. 

States provide a combination of these services to lessen eligible residents’ financial burdens. Additionally, other services that are not usually covered by Medicaid can be subject to approval if they are cost-effective and necessary to prevent institutionalization. 

Eligibility

1. Medical/ Functional Eligibility (Level of Care)

• A level of functionality is assessed, which qualifies residents for special care, including nursing facility level of care, hospital level, or intermediate care facility for individuals with intellectual disabilities. 
• The ability to perform Activities of Daily Living (ADLs) is evaluated, alongside instrumental activities of daily living (IADLs) and cognitive or behavioral needs. 

2. Financial Eligibility

• Applicants must meet the Medicaid standard of income and asset limits.
  • In Georgia, CCSP eligibility requires income limits of an average of $2,829 per month or 300% FBR per individual in 2025, while asset limits are $2,000 for an individual and $3,000 for a couple. 
  • California, on the other hand, has abolished the asset limit for most Medicaid programs since January 2024. However, income limits still exist at around $1,801 per month in 2025. 
• Spousal impoverishment rules may also come into effect to protect a part of a spouse’s income and assets. 

3. Other Requirements

• Residency
• Citizenship
• Need for Services
• Waiver Capacity
• Depending on the state, HCBS waivers provide services to those 55+ or 65+. 

How to Apply for HCBS Waivers

• Identify HCBS Waiver programs.
  • States may have several HCBS programs; hence, research the right waiver that fits your needs. State Medicaid agencies, Departments of Human Services, or Departments of Aging and Disability provide good resources. 

• Reach out to the Administering Agencies
  • Local agencies provide more detailed information on requirements, eligibility, and the application process.