Understanding Medicaid Waivers

Medicaid itself is a federal-state health insurance program — but Medicaid waivers are something different. A waiver is a federal authorization that allows a state to use Medicaid funding for home and community-based services (HCBS) that would not otherwise be covered under standard Medicaid.

In plain terms, waivers pay for the supports that help people with disabilities live in the community rather than in institutional settings. Depending on the waiver and the individual’s needs, funded services can include:

In-home personal care and support
Day habilitation and community participation programs
Supported employment services
Residential habilitation and group home supports
Respite care for family caregivers
Assistive technology and home modifications
Transportation to services and community activities

Waivers are not entitlements. Unlike SSI or Medicaid itself, most waiver programs have enrollment caps — meaning eligible individuals may wait months or years before receiving services. Understanding this distinction and planning accordingly is one of the most important things a family can do early in the disability planning process.

As of recent federal data, more than 700,000 individuals with intellectual and developmental disabilities are on waiting lists for Medicaid HCBS waiver services nationwide. In Pennsylvania alone, the wait for some waiver programs has historically exceeded several years.