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State Medicaid Plans and Waivers

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State Medicaid plans or state plan amendments often indicate what types of services are covered under Medicaid. You can find more information about state Medicaid plans on Medicaid.gov.

You can also contact your state's Medicaid office and ask them about LTSS coverage. To find contact information for your state's Medicaid office, visit the State Resources Map, click on your state, and click the Medicaid agency link.

State Medicaid Waivers

LTSS can be covered by waiver. Under a Medicaid waiver, a state can waive certain Medicaid program requirements, allowing the state to provide care for people who might not otherwise be eligible under Medicaid.

HCBS 1915 Waiver Programs

Through certain waivers, states can target services to people who need LTSS. These waivers are called home- and community-based services (HCBS) 1915 waivers.

All of the HCBS 1915 waiver programs:

  • Are authorized under Section 1915 of the Social Security Act.
  • Are fee-for-service programs, meaning that the provider is paid for each service the patient receives (such as a test or procedure)
  • Require individuals to meet criteria that are set by the state and based on a person's level of need

1915(c) HCBS Waivers

Through the 1915(c) waiver program, a state can help people who need LTSS and are Medicaid-eligible by supporting and designing its HCBS services based on their needs. Waivers vary from state to state, and many states offer more than one type of 1915(c) waiver.

These waivers cannot be limited to a certain ethnic or racial group but can be limited in other ways:

  • May be statewide or geographically limited in coverage
  • May be limited to a certain medical diagnosis (e.g., mental health, developmental disability)
Resources

Learn more about these waivers and find out what types of 1915(c) waivers might be available for your program.

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1915(i) HCBS Waivers

This waiver, which may be provided under a state's Medicaid plan, allows the state to provide certain HCBS to people who have incomes lower than 150% of the Federal Poverty Level and do not need to live in an institution to receive care.

States can set additional requirements for the waiver to target services to groups of people with specific needs. States can also choose to allow the HCBS to be self-directed, meaning that individuals receiving services can direct their own care.

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See Medicaid.gov's overview of 1915(i) waivers.

1915(j) Self-Directed Personal Assistance Services

This program allows individuals to have active roles in the services they receive. Self-directed personal assistance services allow participants to:

  • Direct types of care that they receive and understand but cannot do (e.g., a person with a physical disability may wish to direct his or her own exercise program)
  • Choose who will be involved in providing their care
  • Include their own preferences, choices, and abilities in the service plan

States can target this program to people who already receive services under 1915(c) waivers and may want to direct their own care. States can limit the number of people who self-direct their care and can decide whether this program will be statewide or limited to certain areas.

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Read Medicaid.gov's overview of 1915(j) Self-Directed Personal Assistance Services.

1915 (k) Community First Choice (CFC)

This plan option allows states to provide home and community-based attendant services and supports to eligible Medicaid enrollees under their state plane. The CFC option expands Medicaid opportunities for the provision of home and community-based long-term services and supports (LTSS) and is an additional tool that states can use to facilitate community integration while receiving enhanced Federal match of six additional percentage points for CFC services and supports. This plan option was established under the Affordable Care Act of 2010.

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Read Medicaid.gov’s overview of 1915(k) Community First Choice.

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