Medicaid Waiver Programs: What They Cover, Who Qualifies and How to Apply in 2026

Medicaid waiver programs are state-run Medicaid programs that pay for long-term care at home, in adult day centers or in assisted living for people who would otherwise need a nursing home.

If you are looking into Medicaid waiver programs for a parent or spouse, you have probably found that every state uses a different name and a different set of rules. This guide explains how the programs work across the US, what they pay for (and what they never pay for), the 2026 income and asset limits most states use, why waiting lists are so common, and the steps to apply.

What is a Medicaid waiver?

Regular Medicaid must cover nursing home care for anyone who qualifies, but it doesn’t have to cover most home care. A waiver fixes that gap. Under Section 1915(c) of the Social Security Act, the Centers for Medicare & Medicaid Services (CMS) lets states set aside three normal Medicaid rules:

• Statewideness, so a state can offer a waiver in only some counties.
• Comparability, so a state can offer services only to a target group, such as older adults or people with dementia.
• Income and resource rules, so a state can use higher, nursing-home-style income limits for people living at home.

In return, the state must show that waiver care costs no more, on average, than nursing home care would. That “cost neutrality” rule is why waivers are aimed at people who already need a nursing home level of care.

You will see these programs called HCBS waivers (home and community-based services), 1915(c) waivers, elderly waivers, aged and disabled waivers, or a brand name like Ohio’s PASSPORT. They all describe the same idea.

How common are they?

According to KFF’s 2025 state survey (published January 2026), 47 states run 1915(c) waivers, adding up to 259 separate programs, and 46 states have a waiver for people 65 and older or with physical disabilities. Four states (Arizona, New Jersey, Rhode Island and Vermont) run home care only through larger Section 1115 demonstrations instead. About 5.1 million people used Medicaid home care in 2023, compared with 1.4 million in institutional long-term care.

Types of Medicaid waiver programs

“Waiver” is often used loosely for any Medicaid program that pays for long-term care outside a nursing home. Here are the main types a family is likely to run into.

Program type	What it is	Waiting list?
1915(c) HCBS waiver	The classic waiver. Targets a group (for example, adults 65+) who need a nursing home level of care.	Often. States cap the number of slots.
Section 1115 demonstration	A broader experiment that can fold long-term care into managed care plans. Examples include Arizona’s ALTCS, Texas STAR+PLUS and Florida’s Statewide Medicaid Managed Care Long-Term Care program.	Sometimes.
1915(i) state plan HCBS	Home care for people who need help but not a nursing home level of care.	No enrollment caps allowed.
1915(k) Community First Choice	A state plan option for personal attendant care, with extra federal funding.	No.
State plan personal care	Personal care as a regular Medicaid benefit in states that choose to offer it.	No, it’s an entitlement.
PACE	Not a waiver, but a Medicare-Medicaid program for people 55+ that provides all care through one local center.	Limited to areas with a PACE center.

The practical point: if your state has a long waiting list for its elderly waiver, ask the Medicaid office whether personal care is available through the regular state plan or Community First Choice. Those benefits can’t be capped the same way.

What do Medicaid waiver programs pay for?

Every state picks its own services, but most elderly and aged-and-disabled waivers include:

• Personal care (help with bathing, dressing, toileting and eating)
• Homemaker and chore services (light housekeeping, laundry, shopping)
• Adult day care or adult day health
• Respite care so a family caregiver can take a break
• Home-delivered meals
• Case management, including a care plan built around the person’s needs
• Home modifications such as ramps and grab bars
• Personal emergency response systems (medical alert buttons)
• Non-medical transportation
• Assisted living services, in states whose waiver covers them
• Self-directed care, where the person can hire their own aide, sometimes a relative

Georgia’s Elderly and Disabled Waiver, for example, lists adult day care, alternative living services, personal care, home-delivered meals and respite for family caregivers (Georgia.gov).

What waivers never pay for

Federal rules (42 CFR 441.310) bar 1915(c) waivers from paying for room and board. In assisted living, that means the waiver can cover the care portion of the bill, but the resident still pays rent and meals, usually from Social Security or SSI. Our guide to whether Medicaid pays for assisted living explains how that split works and which states have the most generous programs.

Waivers rarely pay for 24-hour, round-the-clock care at home. Hours are set by an assessment, and many people get a set number of aide hours per week while family fills the rest.

Who qualifies for a Medicaid waiver in 2026?

You generally need to pass three tests: a target group, a care-need test and a financial test.

1. Target group

Elderly waivers are usually open to people 65 and older, and many also take younger adults with physical disabilities. Ohio’s PASSPORT waiver, for instance, serves people 65+ and people 60 to 64 with a physical disability (Ohio Department of Medicaid).

2. Nursing home level of care

A nurse or assessor visits and scores how much help the person needs with activities of daily living (bathing, dressing, eating, moving, toileting) and whether there are safety or memory concerns. Each state sets its own cutoff. Someone with moderate dementia who wanders, or someone who needs hands-on help with several daily activities, often qualifies.

3. Financial limits

Test	Common rule	2026 figure
Monthly income	Up to 300% of the SSI federal benefit rate	$2,982 a month ($994 × 3). Rises to $3,087 in 2027 when the SSI rate becomes $1,029.
Countable assets (single)	Usually $2,000	Varies by state. A few states set higher limits.
Home	Usually exempt if you or a spouse live there, up to a home equity cap	The federal minimum home equity limit is $752,000 in 2026; states may use up to $1,130,000.
Married couples	Spousal protections let the at-home spouse keep part of the income and assets	Ask your state for its 2026 spousal allowances.

Sources: SSA SSI federal payment amounts; KFF (most states cap income at 300% of SSI and limit assets to $2,000). Your state’s figures may differ.

If income is too high: in many states, income over the cap can go into a Qualified Income Trust (often called a Miller trust) so the person still qualifies. Other states use a “medically needy” spend-down. If assets are too high: spending down on allowed items is legal, but gifts made in the five years before applying can trigger a penalty. An elder law attorney can help you plan this safely.

Most waivers also ask the person to pay part of their income toward care each month (sometimes called patient liability or share of cost) after a personal needs allowance. The amount depends on the state and the person’s income.

Medicaid waiver waiting lists: what to expect

This is the part most guides skip. Unlike nursing home Medicaid, a 1915(c) waiver is not an entitlement. Each state chooses how many people it will serve, and when slots are full, new applicants wait.

KFF’s 2024 waiting list survey found:

• More than 710,000 people on waiting or interest lists (354,299 on waiting lists and 356,440 on interest lists).
• 40 states with waiting lists.
• About 24% of people waiting were older adults or people with physical disabilities. Most (73%) were people with intellectual or developmental disabilities.
• An average wait of 40 months across all groups, with waits for groups other than I/DD ranging from about 6 to 44 months.
• More than half of people on lists lived in states that don’t screen for eligibility first, so the numbers include some people who wouldn’t qualify.

Lists are often managed by urgency, not just date. Georgia, for example, screens applicants by phone to decide how urgent their need is, and that affects their place on the list.

How to move faster

• Apply as soon as the need is likely, not when it becomes a crisis. Your place in line usually starts when you’re screened.
• Report changes. A fall, hospital stay or caregiver illness can raise a person’s priority.
• Ask about every program, including state plan personal care, Community First Choice, PACE and state-funded programs, while you wait.
• Check nursing home transition slots. Some states reserve waiver slots for people moving home from a nursing home after a Medicaid-paid stay.

How much a waiver can save: 2026 cost comparison

The reason families pursue a waiver is cost. Here are national median prices from the CareScout 2025 Cost of Care Survey, released March 2026 (the most recent national figures available in 2026).

Type of care	National median cost	Yearly cost	Can a waiver help?
Non-medical home caregiver	$35 an hour	$80,080 (44 hours a week)	Yes, for assessed hours
Adult day health care	$95 a day	$24,700 (5 days a week)	Yes
Assisted living	$6,200 a month	$74,400	Care portion only, in states that cover it
Nursing home, semi-private room	$315 a day	$114,975	No, regular Medicaid covers this
Nursing home, private room	$355 a day	$129,575	No

For a closer look at local prices, see our guides to in-home care costs, assisted living costs and nursing home costs.

Medicaid waiver vs regular Medicaid vs Medicare

	Medicaid waiver	Regular Medicaid	Medicare
Long-term personal care at home	Yes	Only in some states	No
Long-term nursing home care	No (separate benefit)	Yes	No, only short skilled stays
Enrollment cap	Yes	No	No
Means-tested	Yes	Yes	No
Care need required	Nursing home level	Not for basic coverage	Skilled need for home health

Medicare is a common source of confusion. It pays for part-time skilled home health care when someone is homebound, but not for ongoing help with bathing or dressing. That’s the gap waivers fill. If a parent may eventually need full-time care, read how Medicaid pays for nursing homes too, because the financial rules are largely the same.

How to apply for a Medicaid waiver: 7 steps

1. Find your state’s programs. Search your state Medicaid agency’s site for “home and community-based services,” or call the Eldercare Locator at 1-800-677-1116 to reach your local Area Agency on Aging.
2. Ask for a screening. Many states start with a phone screen by the Area Agency on Aging or an Aging and Disability Resource Center. Georgia uses a statewide line, 866-552-4464.
3. Gather documents. Proof of identity, citizenship or immigration status, income (Social Security letters, pension statements), bank statements (often for the past 60 months), property deeds, insurance policies and a doctor’s statement of need.
4. Apply for Medicaid itself if the person isn’t already enrolled. The waiver and the Medicaid application are often separate steps.
5. Complete the care assessment. A nurse or case manager visits to decide whether the person meets the level-of-care test. Have the main caregiver present and describe a bad day, not a good one.
6. Get on the list or get a slot. If no slot is open, ask for written confirmation of your place and how priority works.
7. Build the care plan. Once enrolled, a case manager helps choose services and providers. Ask about self-direction if you’d like a family member to be the paid caregiver.

If an application is denied or services are cut, you have the right to appeal. The notice must explain how. States allow up to 90 days to ask for a hearing, and appealing before a cut takes effect (usually within about 10 days of the notice) can keep services going while you wait.

Changes to Medicaid waiver programs in 2026 and beyond

• A new kind of waiver from July 2028. The 2025 federal budget law (P.L. 119-21) lets states create 1915(c) waivers for people who need help but don’t meet a nursing home level of care. States must show the new waiver won’t increase average waits for existing waivers, and KFF expects low uptake (NASDDDS fact sheet).
• Federal funding pressure. KFF estimates the same law cuts federal Medicaid spending by $911 billion (about 14%) over 10 years. Because waivers are optional, they are among the programs states can trim when budgets tighten.
• New rights and reporting under the 2024 Access Rule. States must now run grievance systems for HCBS (from July 2026). From July 2027 they must report on waiting lists and how long people wait for services and post the results online. CMS guidance from October 2026 (SMD #26-005) sets out how states will report the share of payments that reach direct care workers, starting in 2028.
• Retroactive coverage shortens in 2027. From January 2027, Medicaid’s retroactive coverage for older and disabled applicants drops from three months to two, which makes applying promptly more important.

What if you don’t qualify?

• Veterans: the VA’s Aid and Attendance pension and Homemaker/Home Health Aide program can pay for home care. See our guide to VA Aid and Attendance.
• State-funded and Older Americans Act programs: Area Agencies on Aging often fund small amounts of homemaker help, meals and caregiver respite with no Medicaid requirement.
• Long-term care insurance: if a policy is in place, it may cover home care. Our guide asks whether long-term care insurance is worth it.
• Low-cost assisted living options: see how to pay for assisted living with no money.
• Memory care: some waivers pay for services in memory care units. Compare prices in our guide to memory care costs.

When you’re ready to compare providers that accept Medicaid, you can search home care agencies, adult day centers and assisted living communities in the SeniorCare Services directory.

Frequently asked questions

SeniorCare Services is a directory and information site, not a care provider, and this article is general information, not legal, financial or medical advice. Medicaid rules vary by state and change often. Check with your state Medicaid agency or an elder law attorney before making decisions. Figures checked November 2026.