For a lot of families, this question comes up almost by accident. Someone starts researching nursing home costs for a parent, learns that Medicaid can help pay for that, and then wonders whether the same is true for care at home instead. It often is, but the path looks nothing like nursing home Medicaid, and most families never hear about it until they go looking for it themselves.

The program that funds Medicaid-covered care at home is called a Home and Community-Based Services waiver, usually shortened to an HCBS waiver. Every state offers at least one version, but the names, income limits, and waiting lists differ widely. Alabama calls its program the Elderly and Disabled Waiver. Tennessee calls its CHOICES. Texas calls its STAR+PLUS HCBS Waiver. The differences can make research confusing for a family trying to figure out what applies where they live.

This guide walks through how HCBS waivers generally work: who typically qualifies, what the application process looks like, what a Miller Trust is for families whose income runs slightly over the limit, and where to find the specific program name and rules for your state.

What Is a Medicaid HCBS Waiver?

HCBS waivers were created under Section 1915(c) of the Social Security Act. They let states use Medicaid funds to pay for care delivered at home or in the community, instead of requiring a Medicaid recipient to move into a nursing facility to receive covered long-term care.

  • Each state designs its own waiver, so program names and covered services vary.
  • Waivers are separate from Medicare. Medicare does not pay for ongoing personal care or homemaker help.
  • Waivers are also separate from standard Medicaid. A person can be ineligible for regular Medicaid due to income, yet still qualify for an HCBS waiver under different financial rules.
  • Most states are not required to enroll everyone who qualifies immediately. Many waivers have a limited number of slots and a waiting list, discussed further below.

Who Typically Qualifies

Eligibility generally comes down to three tests: income, assets, and a functional need for care. States set the exact numbers, but most follow a common federal framework.

Income Limits

  • Most states set the HCBS waiver income limit at 300 percent of the SSI Federal Benefit Rate. For 2026, that works out to approximately $2,982 per month for a single applicant.
  • For a married couple where both spouses are applying, the combined limit is generally around $5,964 per month in 2026.
  • When only one spouse applies, income belonging to the non-applicant spouse is typically not counted toward the applicant’s limit, though spousal protections vary by state.
  • A handful of states use a different formula, such as a percentage of the Federal Poverty Level, so the exact figure can differ. Confirm the current number for your state through the links later in this guide.

Asset Limits

  • Most states cap countable assets at $2,000 for a single applicant and $3,000 for a couple where both spouses apply.
  • A primary home the applicant lives in, one vehicle, and personal belongings are generally excluded from the countable asset total, subject to home equity limits that adjust annually.
  • A few states set higher asset limits. Mississippi, for example, allows $4,000 in countable assets for a single applicant, double the standard figure used by most states.
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The Level-of-Care Requirement

Meeting the income and asset limits is not enough on its own. Applicants also need to be assessed as needing a Nursing Facility Level of Care, meaning the kind of hands-on help typically provided in a nursing home, even though the person plans to receive that help at home.

  • The assessment generally measures ability to perform Activities of Daily Living: bathing, dressing, eating, mobility, toileting, and continence.
  • Needing help with two or more of these activities is a common (though not universal) threshold.
  • A diagnosis involving cognitive impairment, such as dementia, often factors into the assessment as well, since supervision needs can be significant even when physical ADLs are less affected.
  • The assessment is typically conducted by a state agency, a contracted case management organization, or a managed care plan, depending on the state.

How the Application Process Works

The exact steps and terminology vary by state, but the general sequence looks similar almost everywhere.

  • Contact your state Medicaid agency, a local Area Agency on Aging, or an Aging and Disability Resource Center to start the process and confirm which waiver programs are available in your state.
  • Complete a functional assessment to establish the level-of-care requirement described above.
  • Gather and submit financial documentation, including income statements, bank records, and property information.
  • Wait for a financial and functional eligibility determination. Arizona’s ALTCS program, for example, generally completes this review in about 45 to 60 days.
  • If approved but the waiver has limited slots, you may be placed on a waiting list rather than enrolled immediately.
  • Once enrolled, a case manager typically develops an individualized service plan outlining which services and how many hours of care are approved.

Applying as early as possible, even before care is urgently needed, is one of the most consistent pieces of advice across state programs. Waitlist position is often determined by application date, so families who wait until a crisis hits may face a longer delay than those who apply proactively.

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When Income Is Too High: The Miller Trust Option

Some families assume that earning slightly more than the income limit disqualifies them entirely. In many states, that is not the case. A tool commonly called a Miller Trust, or Qualified Income Trust, allows income above the limit to be deposited into a dedicated trust account each month and used according to state rules, which can bring the applicant’s countable income back under the limit for eligibility purposes.

This is a legal and financial planning tool with real complexity attached to it. Setting one up correctly, and understanding how it interacts with a specific state’s rules, generally requires guidance from a licensed elder law attorney or a Certified Medicaid Planner rather than a do-it-yourself approach.

What These Waivers Typically Cover

  • Personal care assistance, including help with bathing, dressing, and toileting
  • Homemaker services, such as light housekeeping and meal preparation
  • Respite care, giving family caregivers a temporary break
  • Adult day health programs
  • Home modifications, such as ramps and grab bars, in many states
  • Case management to coordinate the overall care plan

Covered services and hours vary by state and by individual care plan. The list above reflects services commonly included, not a guarantee of what any specific program will approve.

Waiver Programs Around the Country: A Few Examples

Program names, income figures, and waitlist realities differ enough from state to state that a national overview can only go so far. The examples below show how differently the same basic federal framework can look depending on where a family lives. Each links to Senioridy’s full state guide, which covers regional cost breakdowns alongside the state’s specific Medicaid program.

For a broader look at hourly rates and cost drivers alongside these waiver notes, see Senioridy’s In-Home Care Costs by State: 2026 Southeast & National Guide.

If There Is a Waitlist

This is often the hardest part for families to hear. Unlike regular Medicaid, HCBS waivers are generally not entitlement programs. States receive a fixed number of approved slots, and demand often exceeds supply. A family can meet every income, asset, and functional requirement and still wait months, or in some states considerably longer, before a slot opens.

  • Waitlist position is typically determined by application date, which is why applying early is consistently recommended, even before care feels urgent.
  • A few states, including Tennessee’s CHOICES and Louisiana’s LTPCS, operate without a traditional waitlist for those who qualify, which makes them notable exceptions.
  • In some states, individuals waiting for a waiver slot may access limited services through a separate Medicaid state plan pathway in the meantime. Ask your state Medicaid agency or Area Agency on Aging whether a bridge option exists in your state.

Getting Started

  • Your state Medicaid agency is the starting point for applying and for confirming the current program name, income limit, and asset limit where you live.
  • Local Area Agencies on Aging and Aging and Disability Resource Centers can help screen for eligibility and walk through the application over the phone.
  • The Eldercare Locator (eldercare.acl.gov), a service of the U.S. Administration for Community Living, can connect you with your local Area Agency on Aging by ZIP code.
  • Veterans and surviving spouses may also qualify for the VA Aid & Attendance benefit, which is not counted toward Medicaid income eligibility. As of 2026, the maximum monthly benefit is $2,424 for a single veteran, $2,874 for a veteran with a dependent, and $1,558 for a surviving spouse.
  • For families whose income is above the waiver limit and who want to understand whether a Miller Trust or another planning strategy applies to their situation, the National Elder Law Foundation maintains a directory of Certified Elder Law Attorneys.
  • The federal government’s overview of how HCBS waivers work is available at Medicaid.gov’s Home and Community-Based Services page, and the ACL’s HCBS settings overview explains the federal quality and setting standards these waivers must meet.

Finding Care Once a Waiver Is in Place

Once a Medicaid waiver is approved, families still need to find a provider willing and able to deliver the approved services. Senioridy’s in-home care directory can help you compare local agencies and start that conversation. For a broader look at funding options beyond Medicaid, including Medicare, VA benefits, and long-term care insurance, see Senioridy’s guide to how to pay for in-home care.

This article is for informational purposes only and does not constitute legal, financial, or medical advice. Medicaid HCBS waiver names, income and asset limits, covered services, and waitlist status are subject to change and vary by state and by individual circumstance. The figures cited reflect published 2026 program limits as of the date of publication. Always confirm current requirements with your state Medicaid agency, a local Area Agency on Aging, or a licensed elder law attorney before making care or financial decisions. For free, personalized guidance on Medicare-related questions, contact your State Health Insurance Assistance Program (SHIP) counselor at shiphelp.org, available in every state at no cost.

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