1915(c) waiver
A 1915(c) waiver is a Medicaid home and community-based services program, named for section 1915(c) of the Social Security Act, that lets a state pay for care at home or in the community for people who would otherwise need the level of care of a hospital, nursing facility or ICF/IID. Federal rules are in 42 CFR 441 Subpart G, and Medicaid.gov lists standard services such as case management, homemaker, home health aide, personal care, adult day health, habilitation and respite care.
Why it matters
A state can run as many 1915(c) waivers as it wants, each aimed at a group it picks, such as older adults, technology-dependent children or people with intellectual disabilities (Medicaid.gov). The state defines each waiver’s services, subject to CMS approval (42 CFR 440.180), and must have adequate standards for providers. Check which waivers your provider enrollment covers.
Waivers can have waiting lists. The state sets how many people a waiver will serve each year, and that number is the waiver’s limit unless CMS approves a larger one (42 CFR 441.303(f)(6)).
Participants must need a hospital, nursing facility or ICF/IID level of care, and the state must reevaluate that at least annually under 42 CFR 441.302(c). Services follow a person-centered service plan (42 CFR 441.301(c)). A new waiver is approved for 3 years, or up to 5 if it serves people who also have Medicare, and renewals run 5 years (Social Security Act §1915(c)(3) and (h)(2)).
Example: an “Elderly and Disabled” waiver might authorize personal care, respite and homemaker hours for a client who would otherwise move to a nursing home.
Related: what a Medicaid waiver is and who pays whom, HCBS, section 1115 waiver.