All states operate one or more Medicaid waivers.  These are referred to by the Social Security Act section granting waiver authority.  The Secretary of the US Department of Health and Human Services (HHS) is the individual that is authorized to grant these waivers.  In many, but not all, cases, these waivers are coordinated with efforts involving other programs like Medicare or the health insurance exchanges.

Many of the state Medicaid waivers fall under two different sections in the Omnibus Budget Reconciliation Act of 1981:

• Freedom of choice: Section 1915(b) waivers.  This section outlines the guarantee to beneficiaries of freedom of choice of healthcare and other providers and permits states to implement service delivery modules (involving managed care plans) that may restrict providers other than in emergency situations.  States may use this provision to waive certain requirements.
• Home and community-based services (HCBS): Section 1915(c) waivers. This section authorizes states to provide HCBS as an alternative to care in nursing homes, hospitals and intermediate care facilities for individuals with intellectual disabilities.  This statute outlines services related to homemaker/home health aides, personal care, adult day programs, respite care services and habilitation, to name a few.

States with Medicaid Waivers that may cover assisted living and home care: