In a nutshell:

Medicaid waivers let home care agencies bill Medicaid for non-medical services under state-run HCBS programs, but each waiver requires separate enrollment, service authorization, and adherence to unique billing rules before claims can be submitted.

The (slightly) longer version:

Medicaid waivers allow home care providers to bill for non-medical services—like personal care, homemaking, and respite—under state-run programs designed to keep people out of institutional care. Each waiver has its own rules, services, and enrollment process, and providers must be approved for each waiver they want to bill.

How Medicaid Waivers Work for Home Care Agencies

1. They fund in-home services not covered by standard Medicaid.

2. Waivers cover services like bathing, dressing, meal prep, and caregiver respite under Home and Community-Based Services (HCBS) programs.

3. You must apply to participate in each waiver program. This is a separate process from general Medicaid enrollment and may include submitting staff qualifications and service descriptions, showing licensure and insurance, and/or passing a site visit or readiness review.

4. Authorizations are required before billing.

5. You cannot bill for waiver services until a care plan and service authorization are in place.

6. Waiver programs have their own billing rules.

7. Reimbursement rates, service units, documentation standards, and billing portals may differ by waiver, even within the same state.

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Pro Tip: Many agencies think they’re “Medicaid-approved” but forget to enroll in specific waivers. Without waiver approval, you can’t bill for HCBS, even if the client is eligible.

For agencies working with Paradigm, we identify the right waivers in your state, guide you through credentialing, and manage the billing so your claims get paid on time and in full.

Reminder: This information is not legal advice, not a guarantee, and not a substitute for checking in with your state’s Medicaid authorities and plans directly. Read our full disclaimer here.