Medicaid HCBS Waiver Programs: A Family Guide
Home- and Community-Based Services (HCBS) waiver programs let Medicaid pay for disability and long-term care support in someone's home or community instead of in a nursing facility or institution. Each state designs and names its programs differently — this guide explains the five main program categories, links to state-specific program guides, and walks you through how to find and apply for the program that fits your family's situation.
WaiverPath is not a government agency, law firm, Medicaid provider, or benefits advisor. We help you organize information, documents, and follow-up tasks. Always verify requirements with the official agency or a qualified professional.
Program categories
Most HCBS waiver programs fall into five categories based on the population they serve. A person usually qualifies for programs in one primary category, though some programs serve overlapping populations. Confirm which programs your state offers and which fit your situation with your state Medicaid agency or a case manager.
Intellectual and Developmental Disability (I/DD) Waivers
State examples
Indiana FSW / CIH, Florida iBudget, Texas HCS / TxHmL, Ohio IO / Level One, Pennsylvania Consolidated / Community Living / P∕FDS, Georgia COMP / NOW, Kentucky MPW / SCL, New Mexico DD Waiver / Mi Via, Arkansas CES Waiver
Who typically qualifies
Individuals with an intellectual disability (ID) or developmental disability (DD) — typically documented by a psychological evaluation showing an IQ below 70–75 with adaptive behavior deficits, or a qualifying diagnostic condition such as autism spectrum disorder, cerebral palsy, Down syndrome, or a related condition with onset before age 22.
How to apply
Contact your state's I/DD agency — often called a Division of Developmental Services, Department of Developmental Services, or similar. Most states use a county- or region-based intake office or a Local Intellectual Disabilities Authority (LIDA) to start the process. Confirm the correct intake office for your county with your state's official I/DD agency.
Waitlist note
I/DD waivers carry some of the longest waitlists in the country — wait times can range from months to more than a decade depending on the state and county. Filing a complete application as early as possible, even before a slot is likely, protects your place in line. Confirm waitlist figures with your state agency.
Aging and Physical Disability (APD) Waivers
State examples
Florida SMMC LTSS, Ohio PASSPORT, Pennsylvania Community HealthChoices (CHC), Texas STAR+PLUS LTSS, Georgia CCSP / SOURCE / ICWP, Kentucky HCB
Who typically qualifies
Adults — often 18 or older, sometimes 60 or 65 and older depending on the specific program — who need a nursing-facility level of care but choose to receive services in the community. Physical disability and age-related functional limitations are the primary eligibility factors, not an I/DD diagnosis.
How to apply
Contact your state Medicaid agency, your Area Agency on Aging (AAA), or a managed care plan if your state uses managed long-term services and supports (MLTSS). A functional assessment (typically a level-of-care determination) is required for all APD waivers. Confirm the intake process with your state agency.
Waitlist note
APD waivers in some states have shorter waits than I/DD waivers, but availability varies widely by state, county, and current program enrollment. Confirm current availability with your state agency or local AAA.
Children's Waivers and the Katie Beckett / TEFRA Option
State examples
Katie Beckett (TEFRA) in Florida, Georgia, and most states; state Children's Autism Waivers; Medically Fragile waivers (e.g., New Mexico Medically Fragile Waiver); Indiana CIH Waiver; Arkansas CES Waiver for children
Who typically qualifies
Children under 18 — sometimes up to 21 — who have significant medical needs, disabilities, or complex care requirements. The Katie Beckett / TEFRA option is notable because the child's eligibility is based on the child's own circumstances, not parental income — making it accessible for families who otherwise earn too much for standard Medicaid. Confirm the specific age and income rules with your state Medicaid agency.
How to apply
Apply through your state Medicaid agency. For the Katie Beckett option specifically, the family submits an application documenting the child's disability and care needs; parental financial information is not counted for eligibility. States administer the option differently — some use a separate application, others handle it through the standard Medicaid process. Confirm the current process with your state agency.
Waitlist note
Some children's waivers have no waitlist (particularly Katie Beckett / TEFRA, which is an entitlement in some states), while others have limited slots. Confirm slot availability and waitlist status with your state agency.
Traumatic Brain Injury (TBI) Waivers
State examples
Kentucky ABI Waiver / ABI LTC, Pennsylvania specific TBI provisions under CHC and ODP, Texas TBI provisions under CLASS and STAR+PLUS
Who typically qualifies
Adults who have experienced a traumatic or acquired brain injury — including injuries from accidents, strokes, aneurysms, or other non-congenital causes — and need community support to avoid or exit institutional care. Documentation typically includes medical records confirming the brain injury, a functional assessment, and evidence that the individual requires a nursing-facility level of care.
How to apply
Contact your state's TBI waiver administrator — often the same agency that handles APD waivers or a dedicated Brain Injury Alliance. A MAP or functional assessment plus medical records (hospital discharge summary, imaging) are commonly required. Confirm the intake process with your state agency.
Waitlist note
Some states have no waitlist for TBI waivers (Kentucky ABI had no waitlist as of fall 2025 data), while others have limited slots. Confirm current availability with your state agency.
Mental Health and Behavioral Health Waivers
State examples
Pennsylvania Adult Autism Waiver (OCDEL/ODP), Ohio BH waivers (ODADAS), Indiana Community Integration and Habilitation (CIH) behavioral track, state-specific 1115 demonstration waivers with behavioral health components
Who typically qualifies
Adults and children with mental health or behavioral health needs who require community-based support to avoid institutionalization. Eligibility criteria vary widely by state and waiver — some focus specifically on autism spectrum disorder (adults), others cover severe mental illness, dual diagnoses, or substance use disorder. Confirm eligibility criteria for your specific state and program with the administering agency.
How to apply
Contact your state's mental health or behavioral health agency, county mental health board, or a designated provider. States vary significantly in how they administer behavioral health waivers — confirm the intake process with your state agency before applying.
Waitlist note
Waitlist status and availability vary significantly by state and program. Confirm current status with your state agency.
Guides by state
Each guide covers the specific programs available in that state, including administering agencies, how to apply, waitlist figures where available, and step-by-step guidance.
Florida
iBudget, FALD, SMMC LTSS, Katie Beckett
Georgia
COMP, NOW, CCSP, SOURCE, ICWP
Indiana
FSW, CIH, Health and Wellness, PathWays
Kentucky
MPW, SCL, HCB, ABI, Model II, CHILD
New Mexico
DD Waiver, Mi Via Self-Directed, Medically Fragile
Ohio
IO Waiver, Level One, PASSPORT, Ohio Home Care
Pennsylvania
Consolidated, Community Living, P/FDS, Adult Autism, CHC, OBRA
Texas
HCS, TxHmL, CLASS, STAR+PLUS LTSS, MDCP
Additional state guides are being added. If your state isn't listed, start with the HCBS waiver eligibility guide and contact your state Medicaid agency for program-specific information.
How to find and apply for your program
These six steps apply across all HCBS waiver categories. Individual programs have their own documentation requirements and timelines — confirm details with the administering agency before you apply.
- 1
Identify the likely program category
Start with the type of disability or care need: I/DD, aging or physical disability, children's needs, TBI, or behavioral health. One category usually fits most families. If you're unsure which category fits, contact your state Medicaid agency or a local case manager — they can point you to the right starting point.
- 2
Confirm Medicaid eligibility
Most HCBS waiver programs require the applicant to be Medicaid-eligible — or to qualify through the waiver's own income and resource rules, which may differ from standard Medicaid. Confirm current Medicaid eligibility requirements with your state Medicaid agency before applying.
- 3
Find the right state agency for your program
Each program category is administered by a different state agency. I/DD waivers typically flow through a Division of Developmental Services or similar. Aging waivers often go through the Area Agency on Aging or a managed care plan. Children's waivers go through the state Medicaid agency. The state program guides linked below identify the administering agency for your state.
- 4
Gather eligibility documentation
Most waivers require a qualifying diagnosis (psychological evaluation, medical records, or functional assessment), proof of Medicaid eligibility or income, proof of residency, and a level-of-care determination. Requirements vary by program and state — confirm the current list with the administering agency before submitting.
- 5
Submit an application and request interest-list placement
Complete and submit the program application and request to be placed on the interest list or waitlist. Keep the application date — most states use it as your place-in-line priority date. A complete, accurate application protects your position; an incomplete application may delay or lose your spot.
- 6
Track your status and respond to all agency communications promptly
Once on the waitlist, you may receive annual letters, renewal requests, or Letters of Interest with short response windows (some states require a response within 30 days or your spot is lost). Track all deadlines, keep contact information current with the agency, and respond promptly to every communication.
What to figure out before you apply
Before contacting a state agency, work through this checklist to identify the right program and gather the information you'll need. Requirements vary by program and state — confirm the current list with the administering agency.
- ✓Identify the primary disability or care-need category (I/DD, aging/PD, children's, TBI, behavioral health)
- ✓Confirm whether the applicant is currently Medicaid-eligible, or meets the program's income and resource rules
- ✓Identify the state's administering agency for the likely program category
- ✓Obtain the qualifying diagnosis documentation (psychological evaluation, medical records, or functional assessment as required)
- ✓Request a level-of-care assessment if required for the target program
- ✓Confirm the official intake process and current waitlist status with the administering agency
- ✓Obtain proof of residency and Medicaid ID number
- ✓Gather prior service records, IEPs, or support plans that document history and current needs
- ✓Prepare a contact log template to record every call, date, and representative name
- ✓Note the application completion date — it is typically your priority position on the waitlist
Frequently asked questions
What is an HCBS waiver program?
HCBS stands for Home- and Community-Based Services. An HCBS waiver is a Medicaid program authorized under Section 1915(c) of the Social Security Act that allows states to waive certain standard Medicaid rules — primarily the requirement that recipients live in an institution to receive long-term services — so that eligible individuals can receive equivalent support in their own home or community. States design their own waiver programs within federal guidelines, which is why program names, eligibility rules, covered services, and application processes differ from state to state. Confirm details with your state Medicaid agency.
How many HCBS waiver programs does my state have?
Most states operate multiple HCBS waiver programs targeting different populations — I/DD, aging, physical disability, children, TBI, and behavioral health. The number ranges from a handful to more than a dozen, depending on the state. States may also operate 1115 demonstration waivers and 1915(k) Community First Choice programs with similar purposes. Use the state program guides below to see which programs exist in your state, and confirm the current program list with your state Medicaid agency.
Can a person be on more than one HCBS waiver at the same time?
Generally no — most states do not allow concurrent enrollment in two different HCBS waivers at the same time, though rules vary by state and program. However, a person can apply to or be on the waitlist for multiple waivers simultaneously. Confirm the concurrent-enrollment rules with your state Medicaid agency or case manager.
What is the difference between a 1915(c) waiver and a 1115 waiver?
Both are Medicaid waiver types authorized by the Social Security Act. A 1915(c) waiver allows states to provide HCBS to specific populations who would otherwise require institutional care — these are the most common HCBS waiver programs. A 1115 waiver (also called a demonstration waiver) gives states broader authority to restructure their Medicaid programs in ways that go beyond what 1915(c) allows. Many states use 1115 waivers to expand coverage, implement managed care, or test new delivery models. Both types require CMS approval. Confirm which type applies to a specific program with your state Medicaid agency.
Do all HCBS waiver programs have waitlists?
No — some waivers are entitlements with no waitlist, while others have significant waiting lists due to limited state funding and federal waiver enrollment caps. The Katie Beckett / TEFRA option, for example, functions as an entitlement in some states (no waitlist). Most I/DD waivers have waitlists, some exceeding several years. Aging and physical disability waivers vary. Confirm current waitlist status with your state Medicaid agency or administering agency before applying.
What services do HCBS waiver programs typically cover?
Common HCBS waiver services include personal care assistance, respite care, adult day health, home health aide services, habilitation, supported employment, assistive technology, home modifications, transportation, and case management or support coordination. The exact services available depend on the specific waiver and state. Each state's waiver service menu is defined in its CMS-approved waiver application. Confirm covered services with the administering agency for your state.
Is a diagnosis enough to qualify for an HCBS waiver?
A qualifying diagnosis is typically required but is not the only eligibility factor. Most waivers also require Medicaid eligibility (or program-specific income rules), a functional assessment showing the need for a nursing-facility level of care, and documentation of how the disability affects daily functioning. Some waivers require the disability to have originated before age 22. Eligibility requirements differ by program and state — confirm with your state Medicaid agency or administering agency.
How does WaiverPath help families navigate HCBS waiver programs?
WaiverPath is an organizer — it helps you track your waiver checklist, organize documents, log calls, set deadline reminders, and track packet progress in one place. It does not determine eligibility, submit applications, or replace the role of a case manager or social worker. WaiverPath does not provide legal or medical advice. Always confirm eligibility, documentation requirements, and application procedures with the official state agency or a qualified professional.
Related guides
- HCBS Waiver Eligibility Guide — Who qualifies by program category, eligibility assessment types, and what to expect
- Medicaid Waiver Application Checklist — Step-by-step application checklist and document list for all states
- Medicaid Waiver Waiting Lists Explained — How waitlists work, what affects your position, and what to do while waiting
- Katie Beckett Waiver Guide — National overview of the Katie Beckett / TEFRA option for children
WaiverPath is not a government agency, law firm, Medicaid provider, or benefits advisor. We help you organize information, documents, and follow-up tasks. Always verify requirements with the official agency or a qualified professional. Always confirm waiver program details, eligibility requirements, application procedures, and waitlist status with your state Medicaid agency, the administering agency, or a qualified case manager. Program names, enrollment rules, and available services change — what was accurate when this page was last reviewed may have changed. WaiverPath is an organizer, not a government agency or benefits advisor. Last reviewed: August 2026.
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