Most waivers currently in use are 1915(c) HCBS waivers. These are individual federal-state partnerships targeted to specific disability populations that provide both Medicaid coverage and additional services. All provide services beyond regular Medicaid to help people with disabilities live in the community. Since every program is different, it is difficult to generalize.
The typical populations targeted by 1915(c) waivers include the following: Aged, Physical Disabilities, Other (usually medical) Disabilities, Medically Fragile and/or Technology Dependent, Brain/Spinal Cord Injuries, HIV/AIDS, Autism, Developmental Disabilities, Intellectual Disabilities, and Serious Emotional Disturbance or Mental Illness. States often serve these populations in different ways. For example, a child with autism may be served by an autism waiver in one state, a developmental disabilities waiver in another, and an intellectual disabilities waiver in a third. Similarly, a child with cerebral palsy or epilepsy could be served by a physical disabilities waiver, a medically fragile waiver, or a developmental disabilities waiver.
Some of these waivers waive parental income when determining eligibility; others do not. Parental income may be waived in three typical ways: by using institutional deeming rules that typically only count the child's income; by using TEFRA rules for children up to age 19; or by creating a special designated population.
1915(c) waivers can have up to three levels of care: Hospital, Nursing Facility (NF), or Intermediate Care Facility (ICF). Typically, individuals can only receive the amount of services appropriate for their level of care. For example, a child on a ventilator or a child with severe mental illness would have to live in a hospital if he or she did not live at home, so these children are designated as requiring a hospital level of care. Children with physical disabilities typically receive a nursing facility level of care, while children with autism or developmental disabilities receive an intermediate care facility level of care. Typically, individuals cannot receive services that would cost more than their care would in the appropriate type of institution.
The main advantage of 1915(c) waivers is that they provide extra services to help people with disabilities live at home, such as respite, home or vehicle modifications, training, specialized medical equipment, personal support, and behavioral services.
The primary disadvantage of 1915(c) waivers is that they are not entitlements, which means they can have waiting lists. Many programs have waiting lists that are more than three years long before services are granted.