Federal, exists in every state
Medicaid home-care programs (waivers)
Home-care programs that can pay for approved nursing, personal care and other services when a child’s assessed needs fit.
What it is
Home-care programs that can pay for approved nursing, personal care and other services when a child’s assessed needs fit.
HCBA may help your child receive care at home using their own finances rather than parents’ income. The waiver agency must find a nursing-facility or subacute level of care. Ordinary chemotherapy alone does not meet that requirement. These questions cannot assess that level of need.
Eligibility rules
- HCBA requires nursing-facility or subacute care needs. The agency looks at your child’s actual daily tasks and a safe care plan.
- A rule called institutional deeming uses your child’s own income and assets. Applicants under 21 have waiting-list priority.
What you get
- Approved home services for children who meet a program’s criteria.
Services
- Approved HCBA services can include care management, private-duty nursing, respite, equipment and home changes.
- Applying for the waiver, getting services approved and finding staff are separate steps.
If you decide to apply
- Ask the discharge or home-care team about assessing your child’s daily tasks, their frequency and any skilled-care needs. These questions cannot establish the care level.
Discharge planner or care manager
After you apply
- Ask the regional HCBA agency about the care assessment and its current queue. The county checks finances separately.
Good to know
A note of the tasks you do and how long they take can help the assessment. Keeping one is optional.
Other details
- A waiting list reflects agency capacity. It does not establish that the federal enrollment limit is full.
- You can ask Medi-Cal to review medically necessary nursing separately from HCBA.
Related California cards: HCBA, nursing at home through Medi-Cal, IHSS and WPCS.
Official sources
“Could HCBA or ordinary Medi-Cal home nursing fit our child’s care? What would each offer, what would we need to arrange, and could you help us seek the right assessment?”
Why I’m asking: I want to understand what home support could be available if our child’s care needs change.
More background and detailed requirements
Additional program information and published rules
Who does what
The three parts, side by side. The agency decides; nobody on this page does.
You
Register the child on the list, keep the task log, and answer the assessment call when it comes.
Your social worker
Names the waiver that takes medically fragile children in this state and helps with the registration form.
The care team
Documents the nursing-level tasks and the risk if care stops.
- Who decides
- The state waiver agency after a level-of-care assessment
- Ask your social worker
- “Which home-care program fits my child, and can we register today? Can Medicaid start home-nursing hours while we wait?”
How to apply
First step: Ask the discharge team which state home-care service or waiver fits your child's assessed needs, and how to apply.
- Register on the list this week.
- Ask the Medicaid plan for EPSDT nursing hours while you wait.
- Keep a two-week task log for the assessment.
Where it starts: State application or interest list. Assessment when a slot opens
What to gather
- A two-week log of daily tasks: what, how often, how long
- Doctor's letter naming nursing, equipment or safety needs
- Medicaid ID if the child has one
How long: Application steps, assessment timing and waiting-list availability depend on the specific state program. Ask for its current process.
What a yes looks like
A service plan with approved hours and a case manager's name.
What a no looks like, and the next move
“Does not meet level of care” or “no slot”: ask for Medicaid's rule that a child under 21 gets what is medically needed nursing through the Medicaid plan instead, and stay on the list.
Watch out
- If a suitable waiver has a waiting list, ask how and when to register and how priority is determined.
- For a child already on Medicaid, Medicaid's rule that a child under 21 gets what is medically needed home nursing can start long before a waiver slot opens. Ask for both.
- The assessment considers the child's actual care needs under the specific program's rules. No diagnosis or item of equipment guarantees approval.
The numbers and the rules
The arcane layer, kept on purpose. Checked September 7, 2026.
What it is worth
Nursing hours, respite, personal care, equipment, home changes and a case manager. The value is the approved hours.
Covers: Case management · Respite · Personal care · Nursing (some waivers) · Adaptive equipment · Home and vehicle modifications · Caregiver training
What it costs the family: Medicaid-delivered. Patient liability depends on the state.
The eligibility facts, as published
- State specific
- yes
- Institutional level of care
- yes
- Target population
- medically fragile or technology-dependent children in most states
Decisions this site cannot make: Level of care · Service-plan necessity · Financial eligibility (child-only in institutional-deeming waivers)
Expect friction on: Interest lists · Provider shortages · Reassessment
The trap: Ask which waiver, if any, serves your child's needs and whether it has a waiting list. Request covered Medicaid services separately while any waiver application is reviewed.
What changes by state: Which waiver takes medically fragile children, the list length (Texas runs years), and whether parents' income is ignored.
Where I read this
- Home and Community-Based Services 1915(c) — Centers for Medicare & Medicaid Services, read August 27, 2026
- Full List of Medicaid Waivers and Programs — Kids’ Waivers, read August 27, 2026
- Early and Periodic Screening, Diagnostic, and Treatment — Centers for Medicare & Medicaid Services, read August 27, 2026