LTSS Roadmap State Medicaid Policies

State Medicaid Plans

LTSS are sometimes covered by waivers, like the 1915 waivers described below. But some LTSS are defined in a state's Medicaid plan, or in State Plan Amendments.

• Learn more about Medicaid State Plan info at Medicaid.gov.

You can also learn more about LTSS covered in your state's Medicaid plan by asking your state Medicaid office.

• Look up your state's Medicaid office info on the State Resources Map.

HCBS 1915 Programs

All of these programs are authorized under Section 1915 of the Social Security Act. They are fee-for-service (FFS) programs that require individuals to meet State-defined criteria based on need and combination of medical services (e.g., skilled nursing) and long-term services (e.g., respite care, case management, and home modifications).

1915(c) HCBS Waivers

States offer different waivers under the 1915(c) program. View a list of all 1915(c) waivers offered by the 37 States with ITU programs. Choose your State from the list.

Overview of 1915(c) waivers from Medicaid.gov

Through this program, States can assist Medicaid beneficiaries eligible for LTSS by supporting an array of services that permit them to live in their homes or in community-based residential facilities. Under the waiver program, a State is given the ability to design its particular program according to the needs of its people. This is the major vehicle for delivering HCBS in the United States. Waivers can be statewide or geographically limited in coverage. They cannot be limited by ethnic or racial group but may be limited by diagnostic groups (e.g., mental health, developmental disability).

Examples of Tribes that currently contract with States to administer 1915(c) waivers:

• White Earth Band of the Ojibwe
• Leech Lake Band of the Ojibwe
• Oneida Tribe of Wisconsin
• Cherokee Nation

1915(i) HCBS Waivers

Overview of 1915(i) State plan HCBS on Medicaid.gov

This program, provided under a State Medicaid plan HCBS benefit, enables the State to provide set HCBS to individuals who earn less than 150% of the Federal Poverty Level (FPL) and require less than institutionalized care. State options include having HCBS benefit one or more specific populations and having any or all HCBS to be self-directed.

1915(j) Self-Directed Personal Assistance Services Under State Plan

Overview of 1915(j) Self-directed Personal Assistance Services under State Plan on Medicaid.gov

This program allows the participants to engage in and direct their services. For example, individuals with physical disabilities may wish to direct their exercise program, medication administration, or other skilled tasks that they cannot do, but can understand and direct. As part of this plan participants can choose who to be involved in care as needed or wanted. Participants’ preferences, choices, and abilities are identified in the service plan along with strategies that will address preferences in the service plan. States can target people already receiving services under 1915(c) waivers to enter this program, particularly if clients wish to self-direct their care.

Independence at Home Demonstration Project

Independence at Home Fact Sheet

This project is new under the Affordable Care Act (ACA) and runs from June 1, 2012 to May 31, 2015. It is testing a service delivery and payment incentive model for home-based care to Medicare beneficiaries with multiple chronic conditions. It is currently being tested with 16 practices.