What is a Medicaid waiver?

A Medicaid waiver is a state program that pays for long-term care services at home or in the community instead of in an institution. Medicaid.gov says states can run these Home and Community-Based Services waivers under section 1915(c), must show the services cost no more than institutional care, and must follow a person-centered plan of care. Nearly every state has at least one.

Many states run waivers that serve older adults, which can include people with dementia. Medicaid.gov says each waiver targets a group, and states can narrow it by age or diagnosis. To qualify, a person must need a level of care that would otherwise qualify them for an institution, such as a nursing home, and meet Medicaid's financial rules. Your state Medicaid agency can say which waivers exist.

In some states it can help. The National Institute on Aging says Medicaid may cover some aspects of assisted living depending on the state and whether the person is eligible, and that most people pay the full cost themselves. Because each state designs its own waivers, ask your state Medicaid agency whether its waiver covers services in assisted living, and ask each community whether it accepts Medicaid.

In many states, yes. The National Institute on Aging says many states offer some form of pay for family caregivers, most commonly through Medicaid programs such as home and community-based services, adult foster care and personal care services, though laws and funding vary. The Alzheimer's Association describes participant-directed programs that let a person pay someone they choose, including a family member. Contact your state Medicaid agency.

You apply through your state, since states run their own waiver programs. Medicaid.gov says applicants must meet the waiver's target group, need an institutional level of care and meet financial rules, and that states choose the maximum number of people each waiver serves. The National Institute on Aging suggests contacting your state Medicaid agency; the Eldercare Locator at 800-677-1116 can also point you to local help.