Medicaid waiver lookup

What is a Medicaid waiver?

A Medicaid waiver is federal permission for a state to set aside some standard Medicaid rules. For home care, the main one is the section 1915(c) waiver for home and community-based services (HCBS). It lets a state pay for care at home for people who would otherwise need a hospital, nursing facility or ICF/IID. The state can limit each waiver to a group it picks, such as older adults or people with intellectual disabilities. Standard waiver services include case management, homemaker, personal care and respite care (Social Security Act §1915(c), Medicaid.gov).

Not every Medicaid home care program is a 1915(c) waiver. States also pay for home care through their regular Medicaid plan, and some use a section 1115 demonstration, a broader kind of waiver.

Does Medicaid cover home health care? Yes. Every state Medicaid plan must cover home health: part-time nursing, home health aide services, and medical supplies and equipment, ordered by a practitioner under a plan of care. It needs no waiver, and eligibility doesn't depend on needing institutional care (42 CFR 440.70, 441.15). Non-medical help such as personal care, homemaker and respite is optional for states. They pay for it through the programs below.

Which Medicaid programs pay for home care?

The program decides who qualifies, whether there is a waiting list and who pays your agency.

Sources: Social Security Act §1915 and §1115; 42 CFR 441 subparts G, K and M; Medicaid.gov on HCBS authorities, section 1115, 1915(i), 1915(j) and managed LTSS.

How do waiver payments reach the caregiver?

There are two routes.

Through an agency. Your agency enrolls as a Medicaid provider and delivers the services in the client's service plan. You bill the state Medicaid agency, or the client's managed care plan if they have one, and pay the caregiver as your employee.

Through self-direction. The client, or a representative, hires and manages the caregiver. A financial management services (FMS) provider, also called a fiscal agent, collects timesheets, runs payroll, withholds taxes and pays the worker from the client's budget (42 CFR 441.545(b), Medicaid.gov). See self-direction.

Either way, in-home Medicaid personal care visits under every program in the table must be recorded with electronic visit verification (CMS).

A caregiver who lives in the same home as the person they care for may be able to exclude waiver payments from federal income tax. See Medicaid waiver payments and taxes.

Names, rules and rates differ by state. The 51 state pages below (50 states and DC) list each state's programs, who they cover, the services, the billing format and whether prior authorization is required.