State Medicaid plans or state plan amendments often indicate what types of services Medicaid covers in your state. You can find more information about state Medicaid plans on Medicaid.gov.
You can also contact your state Medicaid office to determine which services are covered. Under a Medicaid waiver, a state can waive certain Medicaid eligibility requirements, covering care for people who might not otherwise be eligible for 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 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 set by the state and based on 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 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)
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 a facility to receive care.
States can set additional requirements for the waiver to target services to groups of people with specific needs.
1915(j) self-directed personal assistance services
This program provides individuals with active roles in the services they receive. Through self-directed personal assistance services, participants can:
- Direct types of care that they receive that they 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 decide whether this program will be statewide or limited to certain areas.
Read Medicaid.gov's overview of 1915(j) self-directed personal assistance services.
1915 (k) Community First Choice
This option expands Medicaid opportunities for the provision of home and community-based LTSS, facilitates community integration, and provides an enhanced federal match of six additional percentage points.
Read Medicaid.gov's overview of 1915(k) Community First Choice.