Medicaid waiver lookup

What are HCBS waivers?

Section 1915(c) of the Social Security Act lets a state apply for a Medicaid waiver to fund home- and community-based services for people who would otherwise need institutional care — a nursing facility, an ICF/IID, or a hospital. Each waiver targets a specific population (older adults, people with intellectual or developmental disabilities, people with brain injuries, medically fragile children, and so on) and authorizes a specific menu of services beyond what regular Medicaid covers.

Why do they vary state-to-state?

Every state designs its own waivers and submits them to CMS for approval, so naming, eligibility, and scope drift considerably. What one state calls an Aged & Disabled Waiver another calls a Community Choices Waiver or an Elderly & Adult Waiver. The populations covered, the services authorized (personal care, respite, homemaker, adult day, supported living), the billing format (HHAeXchange, Sandata, an in-house portal, paper 837P), and whether prior authorization is required all differ. Most states run several waivers in parallel — California operates six, Texas five — so an agency serving multiple counties or populations may need to track authorizations across several waiver programs at once.

How does Caregiver Scheduling integrate?

Caregiver Scheduling tracks authorizations per client per waiver — authorized hours, units, start and end dates — and warns schedulers before a slot is booked that would push a client over their authorized monthly or weekly cap. As authorizations approach expiry we surface them on the dashboard so reauthorization paperwork can go out before service is interrupted. When it's time to bill, we generate claims in the format your state aggregator requires, with the visit data already captured by EVV on the caregiver's phone.