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State Medicaid programs operating under a waiver that permits them to utilize Medicaid funds, normally available only to pay for care in a skilled nursing, intermediate care or other long-term care facility, to provide case management and home care services for eligible individuals as a means of avoiding premature institutionalization. Individuals must be Medicaid eligible, must be certified or certifiable for long-term care, and must meet other criteria as specified in the state waiver, e.g., age and disability requirements. States are allowed to make waiver services available to people at risk of institutionalization, without being required to make waiver services available to the Medicaid population at large. States use this authority to target services to particular groups, such as elderly individuals, technology-dependent children, seriously emotionally disturbed children, or persons with intellectual disabilities or developmental disabilities; or on the basis of disease or condition, such as AIDS. Covered services depend on the population(s) covered in the waiver. Those for older adults and adults with disabilities, for example, include but are not limited to case/care management, homemaker services, home health aides, personal care, adult day health care, habilitation and respite care. Services for children may also include wraparound facilitation/community support, independent living/skill building services and parent support and training. Every state has its own set of waiver programs that are unique.

Medicaid programs offered by states that have been authorized by the Secretary of the U.S. Department of Health and Human Services (HHS) to waive certain Medicaid statutory requirements giving them more flexibility in Medicaid program operation. Included are home and community care based (HCBC) waiver programs operated under Section 1915(c) of the Social Security Act that allow long-term care services to be delivered in community settings; managed care/freedom of choice waiver programs operated under Section 1915(b) of the Social Security Act which allow states to implement managed care delivery systems or otherwise limit individuals' choice of provider under Medicaid; and research and demonstration project waiver programs operated under Section 1115 of the Social Security Act to projects that test policy innovations likely to further the objectives of the Medicaid program. Each of the states has developed waivers to meet their needs; and while every state's waiver programs have their own unique characteristics, there may also be common threads.