Medicaid Home & Community-Based Waivers

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Page last updated: 05/26/04

A third important optional program is the Medicaid home and community-based waiver program. Home and community-based waiver provisions allow states, with approval of the federal Health Care Financing Administration (HCFA), to waive specific requirements of the Medicaid Act 42 U.S.C. § 1396n(c) (often referenced as "section 1915c waivers"). All states participate in these optional waivers to varying degrees.

Waiver of Statewidedness: Ordinarily, the state's Medicaid plan must offer comparable coverage in all regions of a state. 42 U.S.C. § 1396a(a)(1). A waiver can be approved to offer a level of Medicaid coverage in one or more sections of the state that is not available statewide.

Waiver of Comparability: Ordinarily, the state's Medicaid plan must treat all similarly situated recipients equally. 42 U.S.C. § 1396a(a)(10)(B). A waiver could select a targeted group of recipients (such as people with traumatic brain injury) and offer them a scope of services not available to people who have different disabilities but similar needs.

Waiver of Certain Income and Resource Rules: A waiver can be implemented that exempts certain populations from the general income and resource requirements. For example, the Katie Becket waiver allows a Medicaid program to disregard parental income and resources for certain children.

These waiver programs are structured to provide an alternative to institutional care and often provide greater access to personal assistance services, assistive technology, and rehabilitation therapies than is available under other covered services within the state plan. A number of other services may be available under each state's unique waiver program or programs, such as case management, homemaker services, home health aide services, adult day health, habilitation, respite, home modifications, partial hospitalization, and psychosocial rehabilitation for people with psychiatric diagnoses. Some of these are optional services that a state may not cover in its regular state plan. Others are services that are not otherwise available as either required or optional services.