Medicaid waivers and wait lists, explained
Most long-term services for adults with IDD are paid for by Medicaid waivers. Here is what they are, why there are wait lists, and how to get in line.
What a waiver is
Medicaid pays for care in institutions by default. A home and community-based services (HCBS) waiver lets a state "waive" that rule and pay for help at home and in the community instead. Most states have one or more waivers for people with IDD. Each has its own name, like Innovations in North Carolina or HCS in Texas.
What waivers pay for
- Help at home with daily living (personal care, in-home support)
- Respite for families
- Day programs and community activities
- Supported employment and job coaching
- Supported living, host homes, and group homes
- Therapies, behavior support, and assistive technology
- In many states, pay for family members who provide care
Why there are wait lists
Unlike regular Medicaid, states can cap how many people a waiver serves. When the slots are full, new people go on a waiting list. In some states the wait is many years. Our State of Support report cards grade every state on its wait list.
How to get in line
- Find your state's programs and the agency that runs them. See every named waiver, state by state.
- Apply as early as you can, even for a young child. Some states place people by the date they applied.
- Ask for the wait list rules in writing, including how they decide who gets the next opening.
- Keep your contact details current and answer every letter. People lose their place by missing a letter.
- Ask about other help while you wait, such as state-funded family support, Medicaid state plan services, and respite grants.
If you move to another state
Waivers do not transfer between states. A family that moves usually starts over at the end of the new state's wait list. Compare states before you move.
The Funding Atlas shows how every state funds services and how long its lists are.
Last reviewed: October 2026. Laws, dollar amounts, and program rules change. Check with the agency named on this page before you make a decision.