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Waiver Basics

Background

Medicaid is a joint federal/state funding program that pays for most long term care provided to low income, older persons and persons with disabilities. For many years, nursing facilities and institutions were the only options for persons needing long term assistance. But when given the choice, many people choose to live in the community rather than in an institution.

Recognizing that preference, Congress established the Home and Community Based Services (HCBS) waiver as an alternative to care provided in institutions. The HCBS waiver allows states to use Medicaid funding to provide services and supports to persons living in their homes or in other community-based settings, such as group homes, adult foster homes or assisted living facilities. Persons are eligible to receive HCBS waiver services if they meet federal qualification criteria and if the cost of their home or community-based care does not exceed limits established by a state.

A state must apply to the Centers for Medicare & Medicaid Services (CMS) through an HCBS waiver application for permission to operate an HCBS waiver. States can be flexible in how they design their HCBS waiver with respect to:

  • Target populations to be served

  • Number of people to be served

  • Services provided

  • Geographic areas served

  • Administrative structure for operating the HCBS waiver

 

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