When people think of Medicaid and long-term care, they often picture nursing homes. But for many seniors and individuals with disabilities, that’s not the first—or best—option. Thanks to Home and Community-Based Services (HCBS), Medicaid can help eligible individuals receive care in their homes or communities, rather than being moved into institutional facilities.
HCBS is a growing part of the Medicaid system. It’s designed to promote independence, improve quality of life, and reduce the need for more expensive care. If you or a loved one is facing a health condition that requires long-term assistance, HCBS might be a way to stay at home safely—with help from Medicaid.
What Are Home and Community-Based Services?
HCBS refers to a wide range of Medicaid-funded support services that help people with physical, intellectual, or developmental disabilities—and older adults—live independently or with minimal assistance.
Instead of relocating to a nursing facility, eligible individuals can receive care in more familiar environments, like their own home, a family member’s home, or a group living arrangement. The services provided depend on the person’s needs, but all aim to support daily living and personal care.
HCBS is often delivered through Medicaid waivers, which allow states to offer more flexible benefits beyond standard Medicaid rules.
Who Qualifies for HCBS?
Eligibility for HCBS varies by state, but generally requires two things:
Financial eligibility for Medicaid based on income and assets
Functional eligibility, meaning the person must require a level of care that would typically be provided in a nursing home
Some HCBS programs prioritize certain populations, such as people with Alzheimer’s disease, adults with physical disabilities, or children with special needs. Most states also have waitlists for HCBS waivers, so applying early is important.
You can apply for HCBS through your state’s Medicaid office or long-term care services department. An assessment is usually required to determine both medical and functional needs.
What Services Are Included in HCBS?
The goal of HCBS is to support daily life while maintaining dignity and independence. These services can include a mix of medical, personal, and social supports based on individual needs.
Here are common types of HCBS Medicaid may cover:
Help with activities of daily living (bathing, dressing, eating)
In-home nursing or therapy services
Meal delivery or nutritional support
Adult day health programs
Home modifications (like grab bars or ramps)
Transportation to medical appointments
Personal emergency response systems
Respite care for family caregivers
Care coordination or case management
Each state has its own approved list of services and program rules, so coverage can differ significantly. However, the focus is always on helping people stay in their communities as safely and independently as possible.
How HCBS Differs from Nursing Home Care
While nursing home care is often fully covered by Medicaid once someone qualifies, it is also more restrictive and expensive. HCBS programs give individuals more freedom, comfort, and choice, while often costing the system less overall.
The trade-off? Access to HCBS is not guaranteed in every case. Because these programs are often run through Medicaid waivers, states can cap enrollment and create waitlists. Unlike institutional care, HCBS is considered an optional benefit by the federal government—so availability depends on state funding and policy decisions.
Still, most states are expanding HCBS options as demand grows and people express a strong preference to age in place.
Pros and Cons of Choosing HCBS
Before deciding whether HCBS is the right fit, it helps to weigh the benefits and potential limitations.
| Pros | Cons |
|---|---|
| Allows individuals to remain in their homes | Not always available in every area or state |
| Supports family caregivers with relief options | May involve waitlists due to limited funding |
| More personalized and flexible care | Requires strong care coordination across providers |
| Often less expensive than institutional care | Eligibility assessments can be complex |
Choosing HCBS isn’t always easy, but for many families, it offers a more compassionate and sustainable approach to long-term care.
A Growing Focus on Community-Based Care
In recent years, federal and state programs have pushed for more investment in HCBS. Programs like Money Follows the Person (MFP) are designed to help Medicaid recipients transition from institutional care back into the community, with HCBS as the support structure.
These shifts reflect both changing preferences and a growing understanding that people tend to have better outcomes when they’re cared for at home, surrounded by loved ones and in control of their routines.
If you’re exploring long-term care for yourself or a family member, don’t assume a facility is your only option. HCBS may offer the same level of support in a setting that feels more like home—because it is.
What to Ask When Exploring HCBS Options
To determine whether HCBS is right for you or your loved one, start by gathering information from your local Medicaid or aging services agency. Ask questions like:
What HCBS programs are available in my area?
Is there a waitlist for services?
How is eligibility determined?
What providers or agencies deliver HCBS locally?
Can services be coordinated with family caregivers?
Getting clear answers will help you navigate the system and make informed decisions about care.
Where It Leads
Home and Community-Based Services represent a powerful shift in how we approach long-term care. For many, Medicaid’s HCBS programs offer a pathway to independence, dignity, and a better quality of life—without having to leave home behind.
While the rules and access vary from state to state, the potential is the same: the chance to get the care you need in the place that matters most.
