Care at home and caregivers

Medicaid care at home (HCBS waivers)

Medicaid home and community-based services pay for help at home, like personal care, homemaker help and adult day care, so people who would otherwise need a nursing home can stay home. States offer them through programs often called waivers, each for certain groups such as older adults. Spots can be limited, and many states keep waiting lists.

Checked Oct 28, 2026

Rules set by the Centers for Medicare & Medicaid Services

An older woman and her grown daughter go through a folder of papers at the kitchen table

Who may qualify

Who may qualify for Medicaid care at home (HCBS waivers)
Care needs	You need the level of care your state requires for a nursing home or similar setting
Medicaid	You must qualify for your state's Medicaid. States can use nursing home income rules, so people who would only qualify in a nursing home may qualify at home.
Who each program serves	States aim each waiver at certain groups, such as older adults, and can add limits by age or condition
Number of spots	Each state sets the most people a waiver will serve

Source: Medicaid.gov (Centers for Medicare & Medicaid Services) (source 1)

What you may get

What Medicaid care at home (HCBS waivers) pays
Services may include	Case management, homemaker help, home health aide, personal care, adult day health, habilitation and respite care
Other help	States can add services that help you move out of a nursing home or avoid one
Where it's offered	47 states and DC run at least one 1915(c) waiver, and several states include home care in their regular Medicaid plan

Source: Medicaid.gov (Centers for Medicare & Medicaid Services) (source 1)

Dates, renewals and waiting lists

Dates and renewals
Waiting lists (2025)	41 states keep waiting or interest lists, with more than 600,000 people on them
Average wait (2025)	32 months, though most people waiting can get other kinds of Medicaid home care meanwhile

Source: KFF (source 7)

Good to know

Your state chooses which home care programs it offers, who they serve and which services they include, within broad federal rules.
If you get home and community-based services at 55 or older, your state must seek repayment from your estate after death. It can't while a spouse, a child under 21, or a blind or disabled child survives.
Giving away or selling things for less than they're worth in the five years before you apply can lead to a denial of waiver services.
The Eldercare Locator, 1-800-677-1116, connects older adults and their families to services near them.

Sources: Medicaid.gov (Centers for Medicare & Medicaid Services) (source 1), Administration for Community Living (source 8)

What people get wrong

MythMedicaid only pays for long-term care in a nursing home.
Not true. In 2021, 86.2 percent of people using Medicaid long-term care got it at home or in the community.
MythMy spouse would have to spend everything before I could get care at home.
Usually not. Medicaid's spousal impoverishment rules, which also apply to home and community-based services, protect part of a couple's savings for the spouse at home.

Sources

Medicaid.gov (Centers for Medicare & Medicaid Services), Home & Community-Based Services 1915(c) (official government site). Checked Oct 28, 2026.
Medicaid.gov (Centers for Medicare & Medicaid Services), Home & Community Based Services Authorities (official government site). Checked Oct 28, 2026.
Medicaid.gov (Centers for Medicare & Medicaid Services), Home & Community Based Services (official government site). Checked Oct 28, 2026.
Medicaid.gov (Centers for Medicare & Medicaid Services), Spousal Impoverishment (official government site). Checked Oct 28, 2026.
Medicaid.gov (Centers for Medicare & Medicaid Services), Estate Recovery (official government site). Checked Oct 28, 2026.
Medicaid.gov (Centers for Medicare & Medicaid Services), Eligibility Policy (official government site). Checked Oct 28, 2026.
KFF, A Look at Waiting Lists for Medicaid Home- and Community-Based Services from 2016 to 2025. Checked Oct 28, 2026.
Administration for Community Living, Eldercare Locator (official government site). Checked Oct 28, 2026.

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