How do Medicaid waivers work for home care providers?

Short answer
Medicaid waivers let agencies bill Medicaid for non-medical, in-home services through state HCBS programs. Each waiver is its own lane, with separate enrollment, service authorizations, and billing rules that must be followed before you can submit a claim.

What this means in practice

1. They fund non-medical care at home. Think personal care, homemaking, respite, and similar supports that help people avoid facility placement.
2. Each waiver has its own rulebook. Services covered, rates, units, documentation, and portals can differ by waiver even inside the same state.
3. You must enroll in each waiver. This is separate from general Medicaid enrollment and can include credentials, insurance, staff qualifications, and sometimes a site visit.
4. Authorizations come first. A care plan and service authorization must be active before you bill.
5. Claims must match the auth. Dates, codes, units, and visit notes need to line up with the approved plan.

Common pitfalls to avoid

• Assuming “Medicaid enrolled” means “waiver enrolled.” It does not.
• Billing before an authorization is in place or after it expires.
• Using the wrong HCPCS code or missing a required modifier.
• Skipping EVV or submitting notes that do not support the units billed.

Pro tip
Treat each waiver like a separate payer. Learn its enrollment steps, codes, rates, documentation rules, and timelines.

If you want this handled for you, Paradigm identifies the right waivers in your state, completes credentialing, tracks authorizations, and manages billing so your claims get paid correctly and on time.

‍