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Medicaid (Title XIX of the Social Security Act)


d.) Waivers

The Secretary may grant a state a waiver to provide services not typically covered by the Medicaid program, such as adult day care and home health aides, if the services are necessary to prevent institutionalizing the participant.  Waivers can be used to target specific groups, such as individuals with developmental disabilities or HIV/AIDS or can be used to provide specific programs, such as homemaker and respite care services for eligible enrollees.  All states operate multiple waiver programs.   

In order to be granted a waiver for home and community-based services, the state must evaluate eligible enrollees’ need for institutionalized services104 and if the enrollee is age 65 or older, his need for SNF or ICF services.105  If the state determines from these evaluations that the individual should receive home and community-based services, the state must establish a written plan of care for the individual and provide all services pursuant to that plan of care.106  The Secretary may also grant a waiver to states to provide coverage for community-based care for children under age five who would otherwise require care in a hospital or nursing facility and who have AIDS or were born dependent on heroin, cocaine or phencyclidine and for whom adoption or foster care assistance is or will be made available.107

For each waiver, the state must annually report to the Secretary on the projected number of individuals to receive services under the waiver,108 the impact of the waiver on the type and amount of medical assistance provided109 and on the health and welfare of recipients.110



  • 104. Social Security Act § 1915(c)(2)(B), 42 U.S.C. 1396n(c)(2)(B)
  • 105. Social Security Act § 1915(d)(2)(B), 42 U.S.C. 1396n(d)(2)(B).
  • 106. Social Security Act § 1915(c)(1), 42 U.S.C. 1396n(c)(1)(inpatient services); Social Security Act § 1015(d)(1)(individuals age 65 and up).
  • 107. Social Security Act § 1915(e)(1)(B), 42 U.S.C. 1396n(e)(1)(B).
  • 108. Social Security Act § 1915(e)(2)(C), 42 U.S.C. 1396n(e)(2)(C).
  • 109. Social Security Act § 1915(d)(2), 24 U.S.C. 1396n(d)(2).
  • 110. Social Security Act § 1915(c)(2)(E), 42 U.S.C. 1396n(c)(2)(E)