Get the free Application for a §1915(c) Home and Community-Based Services Waiver - hfs illinois

This document serves as an application for the Medicaid Home and Community-Based Services waiver program, outlining the purpose, service information, participant access, and financial accountability

How to fill out application for a 1915c

How to fill out Application for a §1915(c) Home and Community-Based Services Waiver

1. Obtain the Application for the §1915(c) Home and Community-Based Services Waiver form from your state Medicaid agency or their website.
2. Read the instructions carefully to understand the eligibility requirements for the waiver.
3. Fill out personal information: Provide your full name, address, phone number, and date of birth.
4. Indicate your diagnosis or condition that necessitates the waiver services.
5. Detail your functional limitations and care needs that require home and community-based services.
6. List any other services you are currently receiving or have received in the past.
7. Include financial information, such as income and asset details, as required by the application.
8. Review all provided information for accuracy and completeness.
9. Sign and date the application to certify that the information is true.
10. Submit the application to the designated Medicaid office address.

Who needs Application for a §1915(c) Home and Community-Based Services Waiver?

1. Individuals with disabilities or chronic illnesses who require services that support living in the community and avoiding institutional care.
2. Caregivers or family members of individuals who need support and services that promote independence in a home setting.
3. Those seeking financial assistance for long-term care services, including help with daily activities.

People Also Ask about

How many HCBS Waivers are there?

States can operate as many HCBS Waivers as they want — currently, about 257 HCBS Waiver programs are active nationwide.

What is HCBS Waiver NY?

A family of two seeking to qualify for government subsidies under the 2025 Obamacare health insurance must have an income between $20,440 and $81,760.

What is 1915 I HCBS state plan option?

1915(i) State Plan HCBS Overview 1915(i) provides states with the option to cover HCBS through their Medicaid state plans rather than through a 1915(c) waiver. 1915(i) requires participants to meet a state-defined needs-based criteria, not an institutional level of care as required under a 1915(c) waiver.

What is Section 1915 C of the Social Security Act?

The Medicaid Home- and Community-Based Services (HCBS) waiver program was authorized under Section 1915(c) of the Social Security Act. Through this program, states can help provide different services that allow those who need care to receive services in their homes or communities.

Is there an income limit for HCBS waiver?

There are two financial eligibility requirements for Home and Community Based Services (HCBS) Waivers – an asset limit and an income limit. In most states in 2025, the individual asset limit for HCBS Waivers is $2,000 and the individual income limit is $2,901/month.

What is the income limit for HCBS waiver?

There are two financial eligibility requirements for Home and Community Based Services (HCBS) Waivers – an asset limit and an income limit. In most states in 2025, the individual asset limit for HCBS Waivers is $2,000 and the individual income limit is $2,901/month.

What is the maximum income to qualify for NYS health insurance?

The OPWDD Home and Community-Based Services (HCBS) Waiver operated by the Office for People With Developmental Disabilities (OPWDD) is a program of supports and services that enables adults and children with developmental disabilities to live in the community as an alternative to Intermediate Care Facilities (ICFs).

For pdfFiller’s FAQs

What is Application for a §1915(c) Home and Community-Based Services Waiver?

The Application for a §1915(c) Home and Community-Based Services Waiver is a request submitted to the state government to obtain federal funding that allows states to provide home and community-based services to individuals with disabilities or long-term care needs, enabling them to receive care in their homes or communities rather than in institutional settings.

Who is required to file Application for a §1915(c) Home and Community-Based Services Waiver?

States are required to file the Application for a §1915(c) Home and Community-Based Services Waiver. The application is typically submitted by state Medicaid agencies to seek approval from the Centers for Medicare & Medicaid Services (CMS) for the waiver program.

How to fill out Application for a §1915(c) Home and Community-Based Services Waiver?

To fill out the Application for a §1915(c) Home and Community-Based Services Waiver, a state must follow specific guidelines provided by CMS. This includes gathering data on the population to be served, specifying the services to be offered, detailing the state's budget for the program, and addressing how services will be administered and monitored.

What is the purpose of Application for a §1915(c) Home and Community-Based Services Waiver?

The purpose of the Application for a §1915(c) Home and Community-Based Services Waiver is to allow states to offer Medicaid-funded services and supports that help individuals with disabilities remain in their homes or communities, thus promoting independent living and reducing reliance on institutional care.

What information must be reported on Application for a §1915(c) Home and Community-Based Services Waiver?

The information that must be reported in the Application for a §1915(c) Home and Community-Based Services Waiver includes details on the target population, the specific services to be provided, eligibility criteria, the budget and funding sources, service delivery methods, quality assurance measures, and a description of how the program will be evaluated and monitored.