Medicaid Waivers for Home Care and Assisted Living

Medicaid waiver programs pay for long-term care outside a nursing home: aides who help with bathing and dressing at home, adult day programs, respite for family caregivers and, in many states, care services in assisted living. They exist for people who need the level of care a nursing home gives but would rather get it at home or in the community. For many families, a waiver is the difference between keeping a parent at home and a nursing home move.

This guide explains how waivers work, what they cover and don’t, why waiting lists are common, and how to apply. Every state runs its own programs under its own names, so the examples below come from the states’ own pages.

What Medicaid Waiver Programs Are

Federal Medicaid law lets states “waive” some standard rules to offer home and community-based services (HCBS). The best-known type is the section 1915(c) waiver. Medicaid.gov says nearly all states and the District of Columbia offer HCBS waivers, and about 257 waiver programs are active nationwide.

Within broad federal rules, each state decides:

• Who is eligible. States can target waivers to older adults, people with physical disabilities or a particular diagnosis, and to certain areas of the state.
• What’s covered. Common services are case management, homemaker help, home health aides, personal care, adult day health and respite. States can add others that help people stay out of institutions or move back home.
• How many people it serves. States choose the maximum number of people each waiver covers. That cap is the reason waiting lists exist.

One condition runs through every waiver: the person must need a level of care that would qualify for a nursing home or other institution under the state’s rules. A waiver isn’t for light help with chores; it’s for people whose needs are serious enough that a nursing home would otherwise be the option.

Some states also offer home care through their regular Medicaid plan rather than a waiver, such as Community First Choice in Alaska, Maryland, Montana and Washington, or state plan personal care in North Carolina, North Dakota and West Virginia. Those benefits don’t have enrollment caps the way waivers can.

Medicaid Waivers vs Nursing Home Medicaid

	Nursing home Medicaid	HCBS waiver
Where care happens	A Medicaid-certified nursing home	Home, a relative’s home, adult day, and in many states assisted living or adult foster care
Medical need	Nursing facility level of care	The same nursing facility level of care
Waiting lists	Not allowed	Allowed, and common
Rent and meals	Included in the nursing home rate	Not paid; the person pays room and board
Income and assets	State limits, often a $2,982 income cap and a $2,000 asset limit in 2026	Usually the same limits, and states can use the spousal protections
Hours of care	Around the clock	Set by an assessment and care plan
Transfer penalties and estate recovery	Apply	Also apply

The money rules are close to identical. CMS’s 2026 figures set the common income cap at $2,982 a month and the asset limit at $2,000 for one person, and states can protect a spouse at home with the same spousal impoverishment rules used for nursing homes. The Medicaid nursing home eligibility guide explains those rules, and the Medicaid long-term care checker shows your state’s figures.

The 60-month look-back on transfers of assets applies to waiver services too. Federal law lists home and community-based waiver services alongside nursing home care.

Does Medicaid Pay for Assisted Living?

This is one of the most common questions families ask, and the answer has two parts.

Medicaid doesn’t pay assisted living rent or meals. Federal rules bar federal Medicaid funds for room and board in home and community-based services, with narrow exceptions for respite stays in a facility and for a live-in caregiver’s share of costs. Your parent pays that part from income, savings or other help.

Many states do pay for the care. Through a waiver or the state plan, Medicaid can pay for personal care, medication help and supervision in assisted living. Examples from state pages:

• Illinois runs the Supportive Living Program, where the waiver pays for services and the resident pays room and board.
• Ohio’s Assisted Living Waiver requires participants to pay a state-set monthly room and board amount, the current SSI federal rate minus $50, and includes memory care.
• California’s Assisted Living Waiver is available in 15 counties, including Los Angeles, San Diego and Sacramento.
• New York’s Assisted Living Program is limited to 4,200 residents, and approximately 85% are Medicaid recipients.
• Washington funds a Specialized Dementia Care Program in a small number of assisted living facilities for people living with Alzheimer’s or another dementia.
• South Carolina’s Optional State Supplementation program pays a state cash supplement for residents of licensed community residential care facilities with net income up to $1,804 a month.

Not every assisted living community takes part in its state’s Medicaid program, so ask each one directly. The assisted living vs nursing home guide compares the two settings, and the assisted living checklist covers what to ask.

Waiver Programs in Selected States

Each state names its programs differently. This table shows a selection from state Medicaid and aging agency pages. Your state page lists the full set for your state, with links.

State	Main program for older adults	Settings covered	What to know
California	Multipurpose Senior Services Program, Home and Community-Based Alternatives Waiver, Assisted Living Waiver	Home, adult day, assisted living in 15 counties	DHCS publishes enrollment and waitlist data for the HCBA waiver
Florida	Statewide Medicaid Managed Care Long-Term Care	Home, adult day, assisted living	The Department of Elder Affairs manages a wait list and releases people monthly by priority
Indiana	PathWays for Aging Waiver (60 and older)	Home, adult day, assisted living	The PathWays and Health and Wellness waivers share 55,969 slots through June 30, 2026, with a waiting list
Massachusetts	Frail Elder Waiver	Home, adult day, respite	An eligible person may enroll at any time
Michigan	MI Choice Waiver	Home, adult day, respite	Services like a nursing home’s, delivered at home or another residential setting
North Dakota	Home and Community-Based Services Waiver	Home, adult day, memory care, respite	The 2026 waiver application says there is no wait list
Ohio	PASSPORT, Assisted Living Waiver	Home, adult day, assisted living, memory care	PASSPORT starts with a pre-admission screening by phone
Pennsylvania	Community HealthChoices, LIFE (PACE)	Home, adult day, respite	LIFE serves people 55 and older in areas with a LIFE provider
Texas	STAR+PLUS Home and Community Based Services	Home, adult foster care, assisted living, respite	Serves people who would otherwise need nursing home care
West Virginia	Aged and Disabled Waiver	Home, adult day	The program reports an average waitlist time of 44 days last fiscal year
Wisconsin	Family Care, IRIS	Home, adult day, assisted living, respite	IRIS lets participants direct their own care

Some states also run state-funded programs for people who don’t qualify for Medicaid, such as Tennessee’s OPTIONS for Community Living (with a sliding fee), Rhode Island’s @Home Cost Share and Oregon Project Independence. Washington’s Tailored Supports for Older Adults program allows resources up to $84,354 for a single person in 2026.

Waiting Lists and How to Get on One

Because states can cap waiver enrollment, waiting lists are common. Medicaid.gov notes the contrast directly: states can’t put people on waiting lists for nursing home care, but they can for home and community-based services. Indiana, Kentucky, Maryland, Montana and Florida all describe waiting lists on their own pages; Louisiana gives offers to priority groups first, such as people referred by protective services.

What helps:

• Apply as soon as your parent might qualify. A place on the list often depends on the date you apply or ask for services.
• Ask about priority groups. Some states make offers to priority groups first. Louisiana’s list includes people referred by protective services and nursing home residents whose only payer is Medicaid.
• Ask whether a nursing home stay changes things. Some programs, such as Alabama’s Community Transition Waiver, serve people moving from a nursing home back home.
• Use other help in the meantime. State plan personal care, adult day care, respite care and caregiver support programs can fill the gap.

How to Apply for a Medicaid Waiver

1. Find the front door. Many states route applications through an Aging and Disability Resource Center or the local Area Agency on Aging. The Eldercare Locator (1-800-677-1116) can connect you.
2. Ask for a functional assessment. A nurse or case manager reviews your parent’s needs to decide whether they meet the nursing facility level of care.
3. Apply for Medicaid if your parent isn’t already enrolled. The state Medicaid agency or county office reviews income and assets, usually with five years of financial records.
4. Get on the waiting list if there is one, and ask how offers are made.
5. Build the care plan. Once enrolled, a case manager works with your family to set services and hours.
6. Choose providers. Your parent picks from approved agencies, or in self-directed programs, hires workers directly.

If your parent is denied, the notice explains how to request a fair hearing.

PACE: Another Way to Get Care at Home

PACE, a program of all-inclusive care for older adults, is a Medicare and Medicaid program available in some areas. To join, your parent must be at least 55, live in a PACE service area, need a nursing home level of care as certified by the state, and be able to live safely in the community with PACE’s help.

PACE covers medical care, prescriptions, adult day care, home care and nursing home care when needed, all coordinated by one team. People with Medicaid pay no monthly premium. Pennsylvania calls its PACE program LIFE, and North Carolina lists 11 PACE organizations in 14 locations.

Other Ways to Pay for Care at Home

A waiver usually covers part of the care, not all of it. These sources often fill in:

• Medicare pays for home health care when your parent is homebound and needs part-time skilled care, but not for ongoing personal care. The home health vs home care guide explains the difference, and the Medicare nursing home guide covers skilled nursing stays.
• VA benefits, including Aid and Attendance and the VA’s home care programs, can help veterans and surviving spouses. See VA long-term care.
• Long-term care insurance often pays for home care and assisted living as well as nursing homes. See long-term care insurance.
• Private pay covers whatever’s left. The in-home care guide describes the types of help and how families arrange them.

If you’re weighing home, assisted living and a nursing home, the care options guide matches the help your parent needs to the settings that provide it, and the guide to paying for a nursing home covers what happens if care at home stops being safe.

Frequently Asked Questions

Does a Medicaid Waiver Pay for 24-Hour Care at Home?

Usually not. Waivers pay for a set number of service hours based on an assessment and a care plan, and some state programs say outright that they don't cover round-the-clock care, such as New Mexico's Community Benefit and Louisiana's Adult Day Health Care waiver. Families typically combine waiver hours with family care, adult day or other help.

Can a Family Member Be Paid Through a Medicaid Waiver?

In some states and programs, yes. Self-directed options such as Wisconsin's IRIS program let participants choose their own workers, and Missouri's Structured Family Caregiving Waiver supports care at home by family for people living with Alzheimer's or a related disorder. Rules about which relatives can be paid vary, so ask your state's program.

Will Medicaid Take My Parent's House if My Parent Uses a Waiver?

Not during your parent's life because of the waiver itself. After death, Medicaid.gov says states must seek repayment from the estates of people who were 55 or older for home and community-based services, as they do for nursing home care. Recovery can't happen while a spouse, a child under 21 or a blind or disabled child survives, and states must offer hardship waivers.

Is PACE a Medicaid Waiver?

PACE is a separate Medicare and Medicaid program, available in some areas, for people 55 and older who need a nursing home level of care but can live safely in the community. It covers adult day care, home care, medical care, prescriptions and nursing home care when needed. Medicare.gov says people with Medicaid pay no monthly premium.

What Happens While My Parent Is on a Waiting List?

Your parent can still use other help: Medicaid state plan personal care where the state offers it, services through the local Area Agency on Aging, adult day programs and respite. If care at home is no longer safe, nursing home Medicaid has no waiting list. Keep your contact information current with the waiver program so you don't miss an opening.

More on Paying for Care

• Medicare and Nursing HomesSkilled nursing facility coverage, the 3-day stay rule and costs
• Medicaid for Nursing HomesIncome and asset limits, spousal protections and the look-back period
• VA Long-Term CareVA nursing home care, state veterans homes and pension benefits
• Long-Term Care InsuranceWhat policies cover, partnership programs and alternatives
• Paying for a Nursing HomeMedicare, Medicaid, VA, insurance and private pay compared
• Memory CareSecured dementia care in assisted living and nursing homes, state rules and how to pay

This guide explains long-term care in plain language from official sources. It isn't medical, legal or financial advice; a doctor, your state Medicaid agency or an elder law attorney can advise on your situation.

Sources

1. Medicaid.gov: Home and community-based services 1915(c)
2. Medicaid.gov: Nursing facilities
3. Medicaid.gov: Estate recovery
4. eCFR: 42 CFR 441.310, limits on federal payment for HCBS (room and board)
5. Medicare.gov: PACE
6. SSA.gov: Social Security Act section 1917 (transfers of assets)
7. Medicaid.gov: 2026 SSI and spousal impoverishment standards