Medicaid Waivers: Types, Eligibility, What It Covers, and How to Apply

The Citizen Health Team

September 11, 2026

Key takeaways

• A Medicaid waiver is a state program that covers long-term services and supports at home or in the community, such as in-home nursing, therapies, personal care, and respite. What's offered varies by state.
• Standard Medicaid counts household income; many Medicaid waivers count only the child's. 
• The most common type of Medicaid waiver pays for care at home instead of in an institution, though states also use waivers for other purposes, like running Medicaid through managed care plans.
• Waiver eligibility depends on level of care, not income alone. Many programs count only the individual's income, not the whole family's.
• Home and community-based services (HCBS) waiver services often include personal care, respite, in-home nursing, home modifications, and medical equipment that traditional Medicaid may not cover.
• For children with rare or complex conditions, a waiver is often the only way to cover specialized equipment, in-home nursing, or care coordination that regular Medicaid won't.
• States use several authorities under Section 1915 of the Social Security Act plus Section 1115 demonstrations, so names and rules differ everywhere.
• Waiting lists are common, so getting on a list early and keeping documentation current usually matters more than finding the "perfect" program.

Most people meet this topic the same way. Someone at a hospital or a school mentions "the waiver," you nod like you know what that means, then go home and try to figure it out at 11 p.m.

A Medicaid waiver is not a form or a favor. It is a pathway that pays for care at home instead of in a facility, and it can cover things regular Medicaid will not, like personal care, respite, and home modifications. 

Every state runs its own version under its own name, which is most of why this is so hard to look up.

The other reason it is hard is that almost every step asks you for the same medical history, in a slightly different format, from files scattered across providers. 

Having those records in one organized place can make the rest of this manageable.

Below we explain what a waiver is, how it differs from regular Medicaid, the main program types, who qualifies, what's covered, and how to apply, including who to call and what to ask them.

What Is a Medicaid Waiver?

A Medicaid waiver is formal permission from the federal government for a state to set aside specific Medicaid rules so it can serve a particular group differently.

Why is that permission needed? Traditional Medicaid was built with an institutional bias. It reliably pays for care delivered in a nursing facility, but historically not for the same care delivered at home. The money followed the bed, not the person.

Medicaid waivers close that gap. Under Section 1915 of the Social Security Act, a state can ask the Centers for Medicare and Medicaid Services (CMS) to waive certain rules so it can provide home and community-based services to people who meet an institutional level of care.

Institutional level of care doesn't mean your family member is in a hospital or nursing facility, or that anyone thinks they should be. It means the state has assessed their needs at the level it would normally fund in one of those settings, so the waiver can pay for that support at home instead. Each state writes its own version of that test and uses its own assessment tool, which is one of the reasons waivers look so different from one state to the next.

Each approval also carries its own budget and service list, which is why your neighbor's waiver in another state may look nothing like yours.

How a Medicaid Waiver Differs From Regular Medicaid

Medicaid is the joint federal and state program that covers health care for people with limited income and assets.

Your state may not call it Medicaid. It's Medi-Cal in California, MassHealth in Massachusetts, TennCare in Tennessee, Apple Health in Washington, and SoonerCare in Oklahoma. 

Waivers are named the same way, so asking a caseworker about "the Medicaid waiver" may not get you far. Your state's Medicaid profile and CMS's state waivers list will tell you what yours are called.

Eligibility works in two parts. You have to fit an eligibility group, such as children, seniors, or people with a qualifying disability, and meet the income limits for that group. A disability doesn't replace the income test. It changes which rules you're measured against, and those rules are often more generous.

That second part is where waivers come in. Families are often told they "have Medicaid" and "need the waiver" in the same breath, which sounds like a contradiction. It isn't. 

A waiver sits on top of your existing coverage and funds a broader set of daily supports, and it often counts only the individual's income rather than the household's, which is why a family turned down for standard Medicaid can still qualify.

Medicaid vs Waiver: Where the two diverge

The difference families feel most is simple: a waiver can fund the medical and non-medical care that keeps someone out of a nursing home.

The Different Types of Medicaid Waivers

Knowing which Medicaid waiver your state uses makes every phone call easier. Some are true waivers, and some are state plan options doing similar work.

The most useful way to sort one is by what they change. Some pathways change who can qualify financially, which matters if your household income is too high for regular Medicaid. 

Others only change what's covered once you already have Medicaid.

If your income is too high for regular Medicaid

These can look at the individual's income instead of the whole household's.

If you already have Medicaid and need more services

These don't change financial eligibility. They expand or reshape what's covered.

No state offers every option, and many run several at the same time under different names. Medicaid.gov's HCBS authorities page lists what each authority allows, and your state Medicaid agency can tell you which ones it actually operates.

Where to Check What Your State Offers

Availability changes as states add, rename, and close programs, so the lookup matters more than any list:

• Katie Beckett and TEFRA: Kids' Waivers state-by-state list. Note the "Income Waiver" column, which shows whether parental income is disregarded.
• Community First Choice (1915(k)): Medicaid.gov Community First Choice page.
• 1915(i) and 1115 demonstrations: CMS State Waivers List. Filter by authority and status, and search your state's two-letter abbreviation. 
• Everything else: your state Medicaid agency. Medicaid.gov's state contact directory has a phone number and eligibility page for every state, plus territories 

Many states do not use the words "Katie Beckett" or "TEFRA" for their program. If a caseworker draws a blank on one term, ask the question behind the name: "Do you have any program that lets a child with significant disabilities qualify based on the child's own income rather than the household's?"

If your state does not offer the pathway you wanted, ask your state Medicaid agency for a full list of its waivers rather than asking about one by name. Most states run several at once, aimed at different groups, and one may fit even if the pathway you researched does not exist there.

Who Is Eligible for a Waiver

Waiver eligibility comes down to two questions: does the person meet the financial rules, and do they need the level of care an institution would provide? Common eligibility criteria include:

• Level of care. A clinical assessment determines whether someone needs the level of care a facility would provide. States usually measure this against a nursing home, a hospital, or an intermediate care facility, meaning a residential setting for people with intellectual or developmental disabilities.
• Age and diagnosis. Some waivers serve children with complex needs, adults with developmental disabilities, or people aged 65 and older, depending on the program.
• Residency. You must live in the state offering the waiver.
• Financial criteria. Income and asset limits apply, though many programs waive parental income for children and some exclude a spouse's income.

That last point changes outcomes. Medically fragile children often qualify even when family income would rule out standard Medicaid. 

“Medically fragile” describes a child with a chronic condition who needs ongoing skilled nursing care, medical technology such as a feeding tube, ventilator, or tracheostomy, or close monitoring to stay stable, where a lapse in that care could quickly become serious. 

There is no single national definition, and states word it differently, which is worth knowing before you read your own state's criteria.

What Medicaid Waiver Services Cover

Medicaid HCBS waiver services go well beyond the standard benefit package. The exact list depends on your state and the specific waiver, but most include some mix of:

• Personal care assistance with activities of daily living
• In-home nursing for people with complex medical needs
• Respite care so family caregivers can rest
• Physical, occupational, and speech therapy
• Case management and care coordination
• Home modifications like ramps, grab bars, or widened doorways
• Assistive technology, medical equipment, and supplies
• Transportation to health care services
• Supported employment, supported living, and day programs for adults

For children with rare or complex conditions, a waiver is also often the most reliable route to equipment traditional Medicaid will not fund, including power wheelchairs, communication devices, and feeding pumps.

Your care team submits a letter of medical necessity (a written explanation from the clinician of why the item is needed), the program checks it against the approved list and budget, and denials can frequently be appealed with stronger documentation. 

Since equipment gets replaced as a child grows, keeping every prior authorization and denial letter together makes each new request faster.

How to Apply for a Medicaid Waiver

Applications run through your state, not the federal government. Each step below names who to contact and what to do if the obvious route is closed to you:

Step 1: Find out which waiver fits your situation

States run several waivers at once, each for a different group. Which one fits usually comes down to the person's disability or diagnosis and their age. 

A child with a developmental disability and an adult recovering from a stroke are typically applying to different programs.

Your waiver will have a state-specific name, so start with the official lists:

• Medicaid.gov State Waivers List: filter by your state to see every approved waiver, its official name, and who it serves.
• HHS 1915(c) Waivers by State: plain-language summaries of each waiver's services and age range.
• dial.acl.gov: a federal directory of state and local disability organizations that can point you to the right program.

If more than one fits, ask each agency whether applying affects your place on another list. 

If none does, call your state Medicaid agency and describe the situation rather than naming a program.

Step 2: Find the Agency That Runs the Relevant Waiver in Your State

Now that you know which waiver you want, find out who operates it. It is often not the Medicaid office. 

So, match your waiver to the likely operator:

• Developmental or intellectual disability → Department of Developmental Services or Disabilities
• Children with complex medical needs → Department of Health, often a Children with Special Health Care Needs program
• Physical disability or brain injury → varies; start with Medicaid

If you land in the wrong office, ask to be transferred to the waiver's program administrator or waiver coordinator. That role exists in every state and is the person who can answer eligibility questions.

If you reach the right agency but no one calls back, your state's Protection and Advocacy organization and its Developmental Disabilities Council are both federally funded, free, and used to unsticking exactly this.

Step 3: Ask the four questions that matter

On the call, ask:

• Which waivers serve someone of this age and diagnosis
• The current waiting list length for each
• Whether you can join more than one list
• Whether the state has an emergency pathway

Write down the date, who you spoke with, and what they said.

No confirmed diagnosis yet? Ask what documentation the state accepts in the meantime.

Some programs assess on functional need rather than diagnosis, so you may be able to start the process before a diagnosis is settled. This matters most for rare conditions, where getting a formal diagnosis can take months or years.

If they cannot answer, ask to be transferred to the waiver or intake coordinator by name rather than calling the main line again.

Step 4: Request the level of care assessment

Nearly every waiver requires a formal evaluation called a Level of Care Assessment, usually by a state assessor or contracted nurse, sometimes at home and sometimes by phone or video.

Ask which assessment tool they use and whether you can be present. Describe a hard day rather than a good one, since assessments capture average need, and bring a two-week log of the assistance you provide if you can.

Step 5: Gather your documentation

You will typically need to gather these documents:

• Medical records and diagnoses
• Letters of medical necessity
• Proof of residency
• Financial records

If you do not have these at hand, request your medical records from each provider who treated your family member.

• Ask for the medical records department, sometimes called health information management
• Request the complete file rather than picking record types, especially if you are unsure what the program wants
• Ask for the expected turnaround when you submit, so you know when to follow up

Ask what the clinician's letters usually include, and ask that functional limitations be described specifically rather than by diagnosis alone.

No fax machine or printer? Ask the office how they prefer to receive documents securely. 

Many accept messages through their own patient portal, which is built to carry medical information, and hospital records departments will usually release records to you electronically. 

Regular email is not designed for medical information, so use the portal where one exists and ask the agency to confirm its secure options before sending anything another way.

Step 6: Apply, then manage the wait

Add your name even if you are not ready to start services, and apply to more than one program where your state allows it. Many states require you to reconfirm your spot periodically, sometimes by mail or phone, so ask how often and mark it on your calendar. Missing one check-in is a common way families get quietly dropped from a list.

Ask two things when you apply:

• How many people are ahead of you
• How long recent applicants waited.

Wait times vary enormously, from no wait at all in some states to several years or longer in others. Also ask whether spots are assigned by date applied or by level of need. If it is need-based, a change in your family member's condition may be grounds for reassessment and moving up.

While you wait, ask what interim supports exist. The nonprofit ARCH National Respite Network maintains a respite locator, and the National Organization for Rare Disorders (NORD's) Medicaid eligibility map explains financial rules by state.

If your family member qualifies for Supplemental Security Income (SSI), an Achieving a Better Life Experience (ABLE) account is worth asking about. 

It lets a person with a qualifying disability save money without those funds counting against SSI and Medicaid asset limits, up to a cap. 

Above roughly $100,000, SSI benefits can be affected, and Medicaid treats the balance differently, so check the current limits with your state's ABLE program before you move money into one.

Step 7: Work with your care coordinator after approval

Most programs assign a coordinator who builds your service plan, connects you with providers, and handles renewals. Ask for their name, direct line, email, and who covers their caseload when they are out.

Then ask for four things in writing:

• Your approved service plan, including the hours authorized for each service
• The full list of agencies contracted with your waiver in your area
• Your annual renewal date
• How to request a plan change if needs increase mid-year

Coordinators carry heavy caseloads, so keep your own records: a copy of the plan, service hours actually delivered, and any change in condition with the date it started. Set a reminder 60 days before renewal.

Step 8: Find staff, because approval is not the same as staffing

Funding pays for hours. Someone still has to be available to work them, and because these services are community-based, they depend on local agencies and local staffing. 

Shortages of home care aides and nurses are common, so many families are approved and then wait again. 

Start the week you are approved:

• Call several agencies from the contracted list, not just the first one your coordinator names
• Ask each about current availability in your zip code and for your specific hours, since overnight and weekend shifts are hardest to fill
• Ask whether your waiver allows self-direction, which lets you hire someone you already know, and in some states a family member. If the answer is yes, ask in the same call what training or certification that person needs in your state, since the requirements differ by state and by waiver
• Tell your coordinator in writing if you cannot find staff, since unused hours can affect future budgets and some states track unmet need

If you are still without coverage after a few weeks, ask your coordinator whether the state has a rate exception, a nursing shortage protocol, or an interim respite option while you keep looking.

What if you are denied?

A denial is often a documentation problem, not a final answer. Both eligibility and service denials can be appealed.

• Ask for the denial in writing, with the specific reason. That is usually your state Medicaid agency for eligibility denials, or your case manager or managed care plan for service denials. If the notice does not say, call the number on it and ask.
• Note the appeal deadline on the notice, since state windows can be short
• Request the assessment or records used to decide
• Ask how to file a fair hearing, an independent review of the decision
• If services are being reduced, ask whether they continue during the appeal

Your state's Protection and Advocacy organization or a legal aid office can usually help at no cost.

You Have More Leverage Here Than It Feels Like

A Medicaid waiver can open access to the care services that make home possible, and the process rewards persistence more than it rewards getting everything right the first time. Knowing which program to pursue, what documentation to gather, and how to work with your coordinator is most of the work.

Citizen Health was built by patients and caregivers for families in such positions.

It brings your medical records together in one secure place, helps you prepare summaries and documents for applications and appeals, and keeps track of what happened when, so less of this sits in your head.

Get started with Citizen Health, and make the next call the only thing you have to think about today.

Frequently Asked Questions (FAQs)

What is a Medicaid waiver, and how is it different from regular Medicaid?

A Medicaid waiver is federal permission for a state to set aside certain rules so it can offer home and community-based services to people who would otherwise need institutional care. Regular Medicaid qualifies people mostly on income, while a waiver adds services like personal care and respite and qualifies people on level of care as well.

What Medicaid waiver programs are available for children with disabilities?

Most states offer 1915(c) HCBS waivers that serve children, and many also offer a Katie Beckett or TEFRA program based on the child's income alone. Names and waiting lists vary by state, so look up your state's list and call the agency that administers it.

What's the difference between an HCBS waiver and a Katie Beckett waiver?

A 1915(c) home and community-based services waiver funds supports at home and usually caps slots, creating waiting lists. A Katie Beckett or TEFRA program extends Medicaid to children by counting only the child's income. Whether it can be waitlisted depends on how your state set it up. 

What are the most popular Medicaid waiver options for home care?

Large home care programs that come up often include New York's consumer-directed program, Texas STAR+PLUS HCBS, Florida's Statewide Medicaid Managed Care Long-Term Care, Michigan's MI Choice, and Maryland's Community Options waiver. Several allow self-direction, meaning participants choose their own aides and manage the budget.

Who qualifies for a Medicaid waiver in Ohio?

In Ohio, applicants generally need the level of care provided in an institution, such as a nursing facility, while choosing to receive services at home instead. Eligibility also depends on financial criteria and Ohio residency. Children and adults with disabilities, chronic conditions, or age-related needs may qualify.

What is a Medicaid waiver in California?

A Medicaid waiver in California lets the state offer services to people who would otherwise need institutional care. Participants receive care at home or in the community, including supports standard Medicaid does not typically cover, such as in-home assistance, respite, and case management.

What is the income limit for a Medicaid waiver in Indiana?

Income limits in Indiana vary by program. Many use a threshold tied to a percentage of the federal Supplemental Security Income benefit rate, commonly around 300%, and asset limits also apply. Confirm current figures with the Indiana agency that administers the specific waiver.

Who is eligible for a Medicaid waiver in Florida?

Florida requires state residency, Medicaid financial eligibility, and a need for the level of care typically provided in a hospital or nursing facility. Waivers there serve children and adults with disabilities, seniors, and people with specific medical needs who prefer care at home.

What services are covered under Medicaid waivers?

Coverage commonly includes personal care assistance, in-home nursing, respite, home modifications, assistive technology, adult day health services, transportation, and case management. The exact list depends on the state and specific waiver, so ask for the written service list when you apply.

How do I apply for a Medicaid waiver?

Contact your state Medicaid office or the agency that administers waiver programs, then request a level of care assessment. You will typically need documentation of medical need, residency, and finances. Citizen Health can help you organize those records before you apply.

Can children qualify for Medicaid waivers?

Yes. Children with disabilities or significant health care needs can qualify if they meet their state's medical and financial criteria, and some programs count only the child's income rather than the family's.

Are there waiting lists for Medicaid waiver programs?

Many states maintain waiting lists because enrollment is capped and demand is high. Wait times vary widely, which is why applying early and asking how priority is determined is worth doing before services are needed.

What are the best Medicaid waiver programs by state?

No official national ranking exists. What determines whether a program is good for your family is narrower: does it serve your age group and diagnosis, how long is the wait, and does it fund the services you need?

Which states allow Katie Beckett waivers?

Roughly half of states operate a Katie Beckett or Tax Equity and Fiscal Responsibility Act (TEFRA) pathway, and many others reach the same families through a 1915(c) waiver that counts only the child's income. Program names vary widely by state, so check the Kids' Waivers list rather than searching for "Katie Beckett" alone.

What if my state does not have the waiver I need?

Ask a broader question. Most states run several home and community-based waivers at once, aimed at different groups, and one may fit your family member even if the program you researched does not exist there. Request a full list of your state's waivers from the state Medicaid agency, and ask your state's Protection and Advocacy agency what exists locally, at no cost.

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