What is a HCBS Waiver?

A Home and Community Based Services (HCBS) waiver is an authorization from Medicaid that allows a beneficiary to receive treatment at home or in a community setting, rather than being required to enter an institution. The HCBS waiver program was initiated in the 1980s. Individual states administer their own waiver programs and have specific information on how to apply for their programs. Social workers and counselors can assist people with the process.

Historically, Medicaid only provided funding to institutions like nursing homes. People eligible for Medicaid who needed skilled nursing services, personal care, and related services were forced to enter institutions in order to access benefits. Disability rights activists protested that this amounted to forced institutionalization and isolation from society, and also pointed out that providing care at home or in community settings could be less expensive, making it cost effective for Medicaid to adopt this option as an alternative to institutionalization for some patients. As a result, the HCBS waiver program was created.

An HCBS waiver can be obtained for someone who wishes to remain at home or in a community setting and needs case management, home health services, respite care, day care, personal care, and certain other services. The waiver application must demonstrate that the cost of providing those services at home or in the community is equal to or less than the cost of institutionalization. Keeping the waivers cost neutral is designed to make sure that Medicaid continues to be a cost-effective program.

Receiving an HCBS waiver can allow someone to stay at home or in a familiar environment, rather than being obliged to live in an institution. The provision of respite care and day care is designed to allow people to keep family members at home while reducing the stress and work associated with long-term caregiving by offering people support services based in their communities. HCBS waivers can be used for older adults, people with physical disabilities, and people with intellectual disabilities, all of whom may need varying levels of support services.

Periodic legal challenges have been used to ensure that people have the right to access services under HCBS waivers. One notable challenge occurred in 1999 with the case Olmstead versus L. C., in which the Supreme Court ruled that unnecessary institutionalization of people with disabilities was a violation of the Americans With Disabilities Act. This landmark Supreme Court decision has been used in a number of subsequent legal challenges to appeal HCBS waiver denials and promote full integration of people with disabilities into society.