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HCBS Waivers
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Home and community based services (HCBS) waivers permit states to offer an array of services to persons with Alzheimer's who are Medicaid eligible and otherwise would require institutional care. These services may include:

  • Adult Day Health

  • Case Management

  • Habilitation

  • Home Health Aide Services

  • Homemaker Services

  • Personal Care Services

  • Respite Care

More than two-thirds of Medicaid long-term care dollars are spent on institutional care (including nursing homes). States are increasingly recognizing the significant cost of long-term care services and are exploring ways to stretch their dollars to expand health programs for those whose needs are not best met by a nursing home.

Over the past two decades, Medicaid has worked to slowly shift the delivery of services to more cost effective home and community settings. In 1981, the first home and community based waiver program was established.

To receive approval to implement a HCBS waiver program, state Medicaid agencies must ensure that the cost of providing home and community based services will not exceed the cost of care for the identical population in an institution.

These home and community based services are very important to the care of individuals with Alzheimer's disease. For instance, respite is designed to give an unpaid primary caregiver (usually a family member) a temporary break from caregiving.

Our position

Medicaid HCBS Waivers may help prevent or postpone institutionalization of individuals who could be served just as effectively within the community, and seem to satisfy both states and recipients. States may save Medicaid dollars they do not spend on nursing home stays and seniors are generally happier being cared for in their homes.

What we are doing

Alzheimer's Association advocates throughout the country have been instrumental in the development of HCBS waivers that provide services to individuals with Alzheimer's disease and dementia who qualify for the program.

In the development process, Alzheimer advocates work in collaboration with state agencies, HCBS service providers, state lawmakers and other consumer organizations.

This work and collaboration has resulted in 75 approved home and community based waivers that are targeted to aged and disabled populations, making this the second largest category of individuals served by the program.

Almost all states have at least one waiver to serve this population. The waivers serve a total number of recipients per year ranging from seven in Delaware to 27,978 in Texas.



  • For more information and tools for advocates, see Resources.


Alzheimer's Association

Our vision: A world without Alzheimer's disease®.
Formed in 1980, the Alzheimer's Association is the leading voluntary health organization in Alzheimer's care, support and research.