How Medicaid Pays for Home Care: State-by-State Waiver Programs Explained

The average cost of full-time home care in the United States now exceeds $6,000 per month. For most families, paying out of pocket for years of care simply is not sustainable. The good news is that Medicaid home care coverage exists in every state through waiver programs that were specifically designed to keep seniors at home rather than in expensive nursing facilities. The challenge is that every state runs its own program with different names, different rules, and different application processes, which means the path to getting help depends entirely on where your loved one lives.

This guide breaks down exactly how Medicaid waiver programs work in the four states we serve: Texas, Ohio, South Carolina, and West Virginia. We will cover what services are included, who qualifies, how to apply, and what to do if your loved one ends up on a waiting list. If you have been told that Medicaid does not pay for home care, that is only partially true. Standard Medicaid has limitations, but waiver programs open the door to a range of home-based services that can make the difference between staying home and moving to a facility.

What Home Care Actually Costs Without Medicaid

Before diving into waiver programs, it helps to understand the financial reality families face when paying privately for home care. These numbers put the urgency of Medicaid home care coverage into perspective and explain why waiver programs have become essential for middle-income and lower-income families across the country.

These figures come from the Genworth Cost of Care Survey and represent median costs for 2025-2026. Notice that home care costs significantly less than nursing home care in every state. This cost differential is exactly why state Medicaid programs have embraced waiver programs: it is cheaper for the state to pay for home-based services than to pay for a nursing facility bed. That financial incentive works in your favor as a family seeking Medicaid home care coverage.

How Medicaid Waiver Programs Actually Work

Standard Medicaid, the joint federal-state program that provides health coverage to low-income individuals, covers medical services like doctor visits, hospital stays, and prescription drugs. What it generally does not cover is the day-to-day personal care that seniors need to remain safely at home: help with bathing, dressing, cooking, cleaning, and medication reminders.

That gap is where Home and Community-Based Services (HCBS) waivers come in. Under Section 1915(c) of the Social Security Act, states can request a "waiver" from the federal government that lets them redirect Medicaid funds toward home-based care services. The term "waiver" literally means the state is waiving the usual federal requirement that Medicaid long-term care dollars go exclusively toward institutional (nursing home) care.

Each state designs its own waiver program, which means the program name, the specific services covered, the eligibility criteria, and the application process all differ. Some states run multiple waiver programs targeting different populations, such as seniors, individuals with intellectual disabilities, or people with traumatic brain injuries. For elderly care specifically, the relevant waivers in our four states are:

1. Texas: STAR+PLUS Home and Community-Based Services (managed through Medicaid managed care organizations)
2. Ohio: PASSPORT (Pre-Admission Screening System Providing Options and Resources Today)
3. South Carolina: Community Choices Waiver
4. West Virginia: Aged and Disabled Waiver (ADW)

All four of these programs share the same core purpose: paying for services that help seniors avoid nursing home placement. But the details of each program matter enormously when your family is trying to navigate the application process or understand what services your loved one can actually receive.

Texas STAR+PLUS: Managed Care with Home-Based Options

Texas takes a managed care approach to its Medicaid home care waiver. Rather than running the waiver as a standalone program, Texas folded its HCBS waiver services into the STAR+PLUS managed care program. This means that when your loved one enrolls in STAR+PLUS, they are assigned to a managed care organization (MCO) that coordinates both their medical care and their home-based services through a single point of contact called a service coordinator.

Services Covered Under STAR+PLUS HCBS

The STAR+PLUS program covers a broad range of home-based services. Personal attendant services form the backbone of the program, providing hands-on help with daily activities like bathing, dressing, grooming, toileting, mobility, and meal preparation. Beyond personal care, the program also covers adaptive aids and medical supplies, minor home modifications such as grab bars and wheelchair ramps, adult foster care, assisted living as an alternative to nursing home care, dental services beyond what regular Medicaid provides, emergency response systems (medical alert devices), nursing services in the home, occupational and physical therapy, respite care to give family caregivers temporary relief, and transition assistance for individuals moving out of nursing facilities back into the community.

Who Qualifies in Texas

To qualify for STAR+PLUS HCBS services, your loved one must meet both financial and functional criteria. On the financial side, income must fall at or below 300% of the federal SSI benefit rate (approximately $2,901 per month in 2026), and countable assets must not exceed $2,000 for an individual. The primary home, one vehicle, personal belongings, and certain other assets are typically exempt from the asset calculation. On the functional side, a registered nurse conducts an assessment to determine whether your loved one requires a "nursing facility level of care," meaning they need regular assistance with activities of daily living or have medical conditions that require ongoing monitoring.

How to Apply in Texas

The application process begins by contacting the Texas Health and Human Services Commission (HHSC) at 2-1-1 or by visiting your local HHSC benefits office. You can also apply online through YourTexasBenefits.com. Once the Medicaid application is approved, your loved one will be enrolled in a STAR+PLUS MCO, and a service coordinator will conduct an in-home assessment to determine what services are needed and create a care plan.

Ohio PASSPORT: The State's Flagship Home Care Waiver

Ohio's PASSPORT program is one of the longest-running and most well-known Medicaid home care waivers in the country. The program has been operating since the mid-1990s and serves tens of thousands of seniors annually. PASSPORT is administered locally through Ohio's network of Area Agencies on Aging (AAAs), which gives the program a community-based feel that larger managed care programs sometimes lack.

What PASSPORT Covers

PASSPORT covers a comprehensive suite of home-based services designed to substitute for nursing home care. These services include personal care aide assistance with bathing, dressing, and daily routines, homemaker services for cooking, cleaning, and laundry, home-delivered meals, adult day services providing structured daytime activities and supervision, emergency response systems, home modifications for accessibility and safety, transportation to medical appointments and essential errands, respite care to relieve family caregivers, and supplemental adaptive and assistive devices. One distinctive feature of Ohio PASSPORT is its emphasis on care management, where each enrollee is assigned a care manager through their local Area Agency on Aging who regularly visits the home, reassesses needs, and adjusts the care plan.

Eligibility Requirements for Ohio PASSPORT

Ohio uses the same basic financial thresholds as Texas: income at or below 300% of the SSI rate and countable assets at or below $2,000. The functional eligibility requirement is that the individual must be determined to need an "intermediate" or "skilled" level of nursing facility care based on an assessment using Ohio's standardized tool. The individual must also be age 60 or older and must be able to live safely in the community with the waiver services in place.

Applying for PASSPORT

Families should contact their county's Area Agency on Aging as the first step. Ohio has a statewide aging information line at 1-866-243-5678 that can connect you with the correct local AAA. The AAA will conduct a pre-screening over the phone, then schedule an in-home assessment if the individual appears to meet basic criteria. Simultaneously, you will need to file a Medicaid application through the county Department of Job and Family Services. Both the Medicaid financial approval and the PASSPORT functional assessment must be completed before services can begin.

South Carolina Community Choices: Flexibility for Families

South Carolina's Community Choices waiver program replaced the state's older Elderly and Disabled waiver in 2016 and introduced several features that give families more control over their care arrangements. The program is administered by the South Carolina Department of Health and Human Services (SCDHHS) in partnership with local care coordination agencies throughout the state.

Community Choices Service Menu

The Community Choices waiver covers personal care services, adult day health care, home-delivered meals, private duty nursing, respite care for family caregivers, environmental modifications to improve home safety and accessibility, assistive technology devices, companion services, consultation from behavioral health professionals, employment support services, pest control when medically necessary, specialized medical equipment and supplies, and support for participant direction (allowing the enrollee to hire and manage their own caregivers).

The participant direction option is particularly noteworthy in South Carolina. Under this model, Medicaid funds are allocated directly to the enrollee, who can then hire caregivers of their choosing, including family members in some circumstances. A financial management service handles payroll, taxes, and billing so the enrollee does not have to manage those administrative responsibilities alone.

South Carolina Eligibility

Income must be at or below 300% of SSI (approximately $2,901 per month), and countable assets must not exceed $2,000 for an individual. The applicant must require a nursing facility level of care as determined by an independent assessment, must be age 18 or older (though the program primarily serves seniors), and must be able to reside safely in the community with services in place. South Carolina also requires that the estimated cost of community-based services not exceed the cost of nursing facility care for the individual.

Getting Started in South Carolina

The entry point for Community Choices is through the South Carolina Healthy Connections Medicaid program. Families can call 1-888-549-0820 to reach the Medicaid eligibility office or visit their local Department of Social Services office to file a Medicaid application. Once Medicaid eligibility is confirmed, the state will arrange for a Level of Care assessment. If the individual is found to need nursing facility care, they can be enrolled in Community Choices and will be connected with a care coordination agency to develop a person-centered care plan.

West Virginia Aged and Disabled Waiver: Rural-Focused Support

West Virginia's Aged and Disabled Waiver (ADW) is designed with the state's heavily rural geography in mind. With many seniors living in remote areas far from nursing facilities, the ADW program plays a critical role in ensuring that elderly West Virginians can access care without leaving their homes and communities. The program is administered by the West Virginia Bureau for Medical Services in coordination with local ADW agencies that provide case management throughout the state.

ADW Covered Services

The West Virginia ADW covers personal attendant services for assistance with daily living activities, homemaker services, adult day care, transportation to medical and non-medical appointments, emergency response systems, home accessibility modifications, respite care for family caregivers, nutritional counseling and home-delivered meals, specialized medical equipment, and skilled nursing services in the home. West Virginia also offers a Consumer Directed option similar to South Carolina's participant direction model, allowing enrollees to recruit, hire, train, and supervise their own personal attendants.

West Virginia Eligibility Criteria

Financial eligibility in West Virginia follows the same federal framework: income at or below 300% of SSI and countable assets at or below $2,000. Functional eligibility requires that the applicant be determined to need a nursing facility level of care based on a comprehensive assessment. The individual must be at least 18 years old, though the vast majority of ADW enrollees are 65 and older. Like other states, West Virginia requires that the projected cost of waiver services not exceed the cost of nursing home placement.

Applying in West Virginia

Families should begin by contacting the West Virginia Department of Health and Human Resources (DHHR) at their local office or by calling the state's information line at 1-877-716-1212. The DHHR handles the Medicaid financial eligibility determination. Once Medicaid is approved, the Bureau for Medical Services will arrange a Level of Care evaluation. If approved for the waiver, the enrollee will be assigned a case manager from a local ADW agency who will visit the home, assess needs, and create a service plan. In rural counties, the ADW agency may be the only provider of case management services in the area, so response times can be longer than in more populated regions.

Side-by-Side Waiver Comparison Across All Four States

What to Do While Waiting for Waiver Approval

The period between filing an application and receiving approved waiver services can stretch from weeks to months, and in some cases longer if there is a waiting list. During this gap, families are often left scrambling. Here are practical steps you can take to bridge the gap while your loved one's waiver application is pending.

First, explore whether your loved one qualifies for any Medicaid State Plan personal care services. Most states offer some limited personal care assistance through their standard Medicaid benefit even before a waiver is approved. These services are less comprehensive than full waiver benefits, but they can provide a lifeline during the waiting period. Contact your local Medicaid office and specifically ask about "State Plan Personal Care Services" or "Personal Care Attendant Services" outside of the waiver program.

Second, contact your local Area Agency on Aging regardless of which state you are in. AAAs often administer Older Americans Act programs that provide free or low-cost services like home-delivered meals (Meals on Wheels), in-home respite, light housekeeping assistance, and transportation to medical appointments. These programs are not income-based and do not require Medicaid enrollment, though they may have their own waiting lists.

Third, investigate whether your loved one is a veteran or the surviving spouse of a veteran. The VA Aid and Attendance pension benefit can provide additional monthly income ranging from approximately $1,200 to $2,300 depending on the claimant's category, and this benefit can be used to pay for home care while waiting for Medicaid waiver services. See our guide to paying for elderly care for more details on VA benefits and other funding sources.

Fourth, look into local charitable organizations and faith-based groups in your community. Many areas have volunteer caregiver programs, senior companion programs, or nonprofit home care providers that offer sliding-scale fees. Your local 2-1-1 information line can connect you with these resources.

Common Mistakes That Delay or Derail Waiver Applications

After working with hundreds of families navigating the Medicaid home care waiver process, several patterns emerge in what causes applications to stall or get denied. Avoiding these mistakes can shave weeks or even months off your timeline.

The most frequent mistake is failing to submit the Medicaid financial application simultaneously with the waiver request. These are two separate processes that must both be completed, and families often focus on one while neglecting the other. Start both applications at the same time. The financial eligibility determination and the functional Level of Care assessment can run in parallel, and having both completed is required before services can begin.

Another common error is underreporting the severity of your loved one's care needs during the functional assessment. This is not about exaggerating; it is about accuracy. Many seniors minimize their difficulties when speaking with assessors because they are embarrassed or want to appear independent. If your mother insists she is fine while you know she has fallen three times this month and cannot manage her medications, make sure the assessor hears from family members as well. Provide written documentation of incidents, hospitalizations, and specific daily struggles.

Asset and income miscalculations also cause delays. Many families do not realize that certain income and assets are exempt. For example, the home your loved one lives in is generally exempt, as is one vehicle, burial plots, term life insurance policies, and household goods. On the income side, medical expenses that your loved one pays out of pocket can sometimes be deducted from countable income. Working with an elder law attorney or a benefits counselor at your local Area Agency on Aging can help ensure the financial picture presented to Medicaid is both accurate and favorable.

Finally, missing deadlines for requested documentation is a silent killer of applications. Medicaid offices will send requests for verification documents with specific deadlines, and if those deadlines pass without a response, the application is often denied or closed. Set up a system to track every document request and respond promptly, even if you need to send partial information with a note that the remainder is forthcoming.

Planning Ahead: When to Start the Waiver Process

One of the most important pieces of advice for families considering Medicaid home care coverage is to start the process earlier than you think you need to. The ideal time to begin exploring waiver eligibility is when your loved one first starts showing signs of needing regular assistance, not when a crisis forces the issue. Application processes, assessments, potential waiting lists, and provider matching all take time, and starting early gives you a buffer that emergency situations do not.

If your loved one is currently in a hospital or rehabilitation facility and expected to need ongoing home care after discharge, the facility's discharge planner or social worker should be able to initiate the waiver referral process before discharge. This is a federally required function of hospitals and skilled nursing facilities under the Preadmission Screening and Resident Review (PASRR) requirements. Do not leave the facility without asking the discharge planner specifically about Medicaid waiver referral.

For families who have not yet reached a crisis point, start by calling your state's information line (listed in the comparison table above) and requesting a general eligibility screening. This phone call is free, takes about 20 minutes, and will give you a preliminary sense of whether your loved one is likely to qualify. Even if they do not meet the criteria today, understanding the thresholds helps you plan for the future and make financial decisions that preserve eligibility down the road.