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What Does a Medicaid Home Care Waiver Mean?
Date Updated: December 16, 2024
Written by:
Sarah has produced thousands of articles in diverse niches over her decade-long career as a full-time freelance writer. This includes substantial content in the fields of senior care and health care. She has experience writing about wide-ranging topics, such as types of care, care costs, funding options, state Medicaid programs and senior resources.
Reviewed by:
Kristi Bickmann, a licensed Long-Term Care Specialist, represents top-rated "Traditional" & "Hybrid" LTC companies. Serving associations such as the American Nurses Association, she's a licensed insurance agent in 27 states. Specializing in insurance products for seniors, Kristi helps hundreds of families every year protect assets, retirement, and loved ones. She understands aging concerns firsthand, having assisted her own parents. Kristi ensures accuracy on topics about senior long-term care and its consequences.
A Medicaid home care waiver means public funding covers specific in-home care services for qualifying individuals. Eligibility criteria and coverage differ among states, and wait lists may apply. Waivers cover services outside state Medicaid plans, enabling recipients to remain in the community rather than move into a nursing home.
Overview of Medicaid Waivers for Home Care
In-home care falls under home and community-based care, with individuals receiving services within the community rather than in an institutional setting, such as a hospital or nursing home. Unlike home health care, rules don't oblige states to include nonmedical home care in their regular Medicaid programs, but some states do. However, most states cover home care through Home and Community-Based Services Waiver programs.
Such programs waive certain rules to expand Medicaid coverage to those who wouldn’t otherwise qualify. Although eligibility criteria vary, seniors must meet citizenship and local residency conditions and have limited financial resources. Functional criteria also apply; in most states, seniors must prove they require a nursing home level of care and would need to move to a nursing facility if they didn’t receive in-home support. Unlike regular Medicaid, meeting eligibility conditions doesn’t create an entitlement to funding. Many states have participant caps and waiting lists.
Medicaid HCBS Waiver Coverage of Home Care Services
HCBS waiver coverage differs among states. Moreover, agencies tailor services to meet individuals’ needs and preferences. However, commonly covered services for those aging at home include:
- Aide assistance with personal care tasks, such as bathing, toileting and dressing
- Help with everyday activities, such as housekeeping, laundry, meal preparation and running errands
- Transportation and escort services to appointments
- Companionship
- Installation, monitoring and maintenance of personal safety and medical alert systems
- Home modifications
- Adult day care programs
- Respite stays
Paying for Home Care Services and In-Home Support
According to Genworth Financial, the 2024 median home care rate in the United States runs $30 per hour. Seniors who receive a Medicaid home care waiver benefit from funding to cover their home care expenses. Where funding pays partial costs, individuals must use other means to make up shortfalls. Payment options include income, savings, VA benefits and long-term care insurance.
Additionally, free, subsidized and volunteer-led programs operate in many places to support older adults living at home. These include home-delivered meal services, senior transportation schemes and elderly companion programs. Individuals can learn more about availability in their area via their local Area Agency on Aging.