Centers for MEDICARE & MEDICAID Services

Medicaid Services

HCBS Waivers Section 1915 (c) (This waiver is designed to provide services and financial support on a case by case basis over and above the standard Medicaid benefits at no cost to the recipient).

States may offer a variety of services to consumers under an HCBS (Home and Community Based Services) waiver program and the number of services that can be provided is not limited.  These programs may provide a combination of both traditional medical services (i.e. dental services, skilled nursing services) as well as non-medical services (i.e. respite, case management and environmental modifications including home and vehicle).  Family members and friends may be providers of waiver services if they meet the specified provider qualifications.  However, in general spouses and parents of minor children cannot be paid providers of waiver services.

States have the discretion to choose the number of consumers to serve in a HCBS waiver program.  Once approved by CMS (Centers for Medicare & Medicaid), a state is held to the number of persons estimated in its application but has the flexibility to serve greater or fewer numbers of consumers by submitting an amendment to CMS for approval.

Application & Approval Process

The state Medicaid agency must submit to CMS for review and approval an application for an HCBS waiver, and the State Medicaid Agency has the ultimate responsibility for an HCBS waiver program, although it may delegate the day-to-day operation of the program to another entity.  Initial HCBS waivers are approved for a three-year period, and waivers are renewed for five-year intervals.

Forty-eight states and the District of Columbia offer services through HCBS waivers, and Arizona operates a similar program under section 1115 research and demonstration authority.  There is no federal requirement limiting the number of HCBS waiver programs a state may operate at any given time, and currently there are approximately 287 active HCBS waiver programs in operation throughout the country.

To start the application process click on Medicaid Waiver to locate your local office.