Who Qualifies For A Medicaid Waiver?

Are you scared at the thought of leaving the comfort of your home for healthcare in a nursing home? Don’t worry, apply for a Medicaid waiver!

Access to quality health is a fundamental right for every citizen, but unfortunately, not everyone has the money or resources. As unfair as it sounds, the world works on capitalism, and the health industry is one of its primary victims.

Many low-income families in the United States can’t afford to have expensive treatments and health facilities. Still, some government-funded and private programs allow incentives for all classes.

One of the most widely used programs in the country is Medicaid. But this is different from Medicare. Let’s get into details.

What is Medicaid?

Medicaid is a government-run program that allows low-income families to treat their patients by providing them many incentives. Since this is long-term care, the government enables services to be given to patients inside their homes’ comfort if they are eligible for a Medicaid waiver. We’ll talk more about the waiver later.

Different states have another Medicaid program targeted to other people, so depending upon what type of program suits you best, you could opt for it.

What is Medicare?

Where Medicaid is specifically designed for low-income households, Medicare is for all Americans above the age of 65 and disabled persons below the age of 65. Regardless of your income or asset worth, Medicare aims to provide services to all seniors in the country.

If you fall into the eligibility criteria of both Medicaid and Medicare, you can avail both at the same time. This is possible because both programs provide different services so you can benefit most of them this way.

Medicaid Waiver Program

A Medicaid waiver is waiving off some rules that apply to the Medicaid program. Targeting low-income families if they have this waiver, the government allows them to be treated in their homes instead of a nursing institution.

This waiver is beneficial, especially for states to allow their people to get treatment at homes because this way, the costs of institutes and nursing homes are cut down.

Not only for seniors, but Medicaid waiver programs are also eligible for children with autism and ADD. The Medicaid Waiver has all the different information that may be useful for you.

Medicaid Waiver COVID

Keeping the current pandemic in mind, the existence of Covid-19 has affected all government-funded programs, and Medicaid is no different. Medicaid and CHIP (Children’s Health Insurance Program) has worked hard to provide up-to-the-mark services during the coronavirus time. Medicaid waivers are being used by states to better manage health crises by using it for private testing and even facilitate uninsured persons (only for COVID-19 testing and hospital visits).

Medicaid’s reach into the most impoverished communities has been tremendous by increasing federal payments to states for the cost of medical care by 6.2% and giving states a new option to cover the uninsured for testing and related visits. They have also appealed to expand the program to be able to treat COVID-19 associated illnesses.

Medicaid waiver is also referred to as HCBS (Home and Community-Based Services), where long-term care is given to patients in their own homes. The services covered in an HCBS program are:

  • Personal care services and supervision, at home or in an assisted living facility
  • A home health aid
  • Nursing
  • Medical supplies and medical equipment
  • Chore and homemaking services, such as shopping, laundry, and cleaning
  • Hot meal delivery services
  • Respite care to relieve a primary caregiver
  • Counseling services
  • Home and vehicle modifications, such as ramps and safety rails, to increase independence
  • Support and case management
  • Assistance transitioning from a nursing home into the community
  • Access to senior centers or adult group daycare
  • Transport to and from non-emergency medical appointments
  • Non-medical transportation services
  • Personal emergency response systems

These services may be altered according to each state and its specific requirements.

Who qualifies for Medicaid Waiver?

If you’re enrolled in the HCBS program of Medicaid, you will be covered if you’re above the age of 65 and have a low-income background. People with limited resources are welcome to avail this opportunity.

Still, even if you’re eligible for HCBS waivers, you might not qualify for Medicaid waivers. The whole point of Medicaid waivers is to have people get treated in their homes; this means that they must need a certain level of care. If there is a risk of being institutionalized because that level of care is required, the patient may be eligible for the waiver.

Other than this, the financial criteria are also in play. As specified earlier, these waivers are given to low-income families who have limited resources and financial means.

The Medicaid application can be denied if you don’t fall under the criteria, but you can appeal the decision. They will tell you what went wrong with the application, and if you can fix it, you can get the waiver.

Medicaid Waiver Application

To apply for the waiver, first, you need to apply for Medicaid itself.

To do so, you will have to fill out an application that will require information such as your financial status, family size, health condition, health history of the family, etc. When that is done, you create an account through the Health Insurance Marketplace. If your application is accepted, the Health Insurance Marketplace will notify you about the status.

To apply for waivers, you should contact your state’s Medicaid office. They will tell you how you can apply for the waiver and any loopholes in their particular requirement. It is a relatively straightforward process to apply for a waiver, but it could take a little time to process and accept your application.


Medicaid programs are launched and led by the government to assist low-income families and ensure they also receive quality health care. The waiver allows them to receive long-term care from their homes.

Applying for the waiver isn’t hard; maybe the waiting period could use a lot of your time. Different states have different requirements, so wherever you are, it is best to check with the government and see what they’re offering in terms of the waiver. Find out the eligibility criteria before even getting into it.

Sandra Johnson

Sandra Johnson

Sandra Johnson was a few years out of school and took a job as a life insurance agent in California, selling coverage door-to-door for Prudential. The experience taught her about the technical components of insurance and its benefits for individuals and society, as well as the misunderstandings people often have about insurance. She has over ten years’ experience in the insurance industry, having worked as both a Broker and Underwriter, assisting clients across a broad range of industries. At Insurance Noon, Sarah diligently gathers all the required information and curates up pieces to provide meaningful insurance solutions. Her personal value proposition is to demonstrate a genuine interest in always adding value for clients.Her determined approach to guiding clients has turned her into a platinum adviser to multiple insurers.

Leave a Reply