Certain Medicaid Home and Community-Based Services (HCBS) Waivers may involve entering a waiting list before receiving service. Read on to learn why some waivers require a waiting list and how these lists work.
What is a Medicaid HCBS Waiver?
As allowed by federal law, Connecticut has opted to "waive" some of Medicaid's rules - so that you have more choice about how and where you receive services. In doing so, it has extended home and community-based Medicaid services to individuals who would otherwise qualify for care in a nursing home or institution.
These Medicaid HCBS Waiver programs provide services and supports to older adults, individuals with intellectual disabilities, acquired brain injuries, mental illnesses, chronic diseases, among other conditions.
The services include: home health services, home care, personal care, adult day services, rehabilitation, respite care, day treatment, psycho-social rehabilitation services, recovery services, clinic services for individuals with chronic mental illness, and more.
However, as these HCBS Medicaid Waiver programs are optional, unlike regular Medicaid, enrollment may be capped due to funding levels. In other words, once enrollment hits its funding cap for each respective HCBS Medicaid Waiver, individuals are placed onto waiting lists.
The Eligibility Process
People in need of Medicaid HCBS Waiver programs must first go through a process to determine eligibility. The eligibility requirements and the process is different for each waiver. After eligibility has been confirmed, depending on the waiver, you may be placed on a waiting list.
The list can be maintained on a first come, first served basis or can be prioritized based on the individual’s birth date, level of need, whether the individual is in transition or other indicators of urgent medical or social need. There may also be 'prioritization' factors such as whether the individual is already receiving support from another HCBS Medicaid Waiver or is transitioning from an institutional setting to a home or apartment.
Individuals on the waiting list do not actually receive waiver services until a slot becomes available, though they may be eligible for other Medicaid services.
Moving Through the Waiting List
Availability for HCBS Medicaid Waiver slots may take some time, especially if demand is high.
It is important to stay in contact with the agency that determined your eligibility to gauge your status on the waiting list. That knowledge may influence how you plan for your future. If you're on a waiting list most likely you will want to pursue other services and supports available.
Use My Place CT to find services and supports and other interim options.