In the beginning
When Medicaid was first enacted, it would only pay for long term care when a person was in an institution such as a nursing home. Over the years, however, disabled people and their caregivers have asked for an alternative to institution based care. This desire was seconded by some state governments, for they knew that caring for someone in their home was less expensive than a nursing home or hospital.
The Waiver programs became official when the Supreme Court ruled on a case that made this policy change possible. Waivers are treated as exceptions to the normal regulations that govern Medicaid, and are used to test new approaches to providing health care. They are sometimes called "demonstrations". There are currently four sections of waivers, but we are only concerning here with one.
Home and Community-Based Services Waivers:
These programs were created to increase the role of home based care. The focus is to provide long term care in a home or community setting.
Unlike Medicare's provisions for home health care, the Medicaid Waiver programs are not focused on nursing and medical care alone. Personal care assistance and homemaking aides - help with the activities of daily living (ADL's)-- are included in many state plans.