Medicaid Waitlists: When and Where They Exist and How Prioritization Works

Summary
Some Medicaid Long Term Care programs have a limited number of enrollment spots. Once those spots are full, additional applicants are placed on waitlists. How long they have to wait and in what order they are taken off the waitlist and enrolled in a program depends on the state and the Medicaid program. According to a national study, the average waiting period for Medicaid programs targeting seniors is two months, but waitlists as long as two years are not uncommon.

Which Types of Medicaid Programs Have Waitlists

There are three types of Medicaid programs that offer long-term care for seniors of limited financial means – Nursing Home Medicaid, Home and Community Based Service (HCBS) Waivers, and Aged, Blind and Disabled (ABD) Medicaid. Applicants for HCBS Waivers may be placed on a waitlist, but Nursing Home Medicaid and ABD Medicaid applicants will never be placed on a Medicaid waitlist. However, they may face different types of waitlists as they look for long-term care.

HCBS Waivers cover medical care and long-term care benefits for financially limited seniors who require a Nursing Facility Level of Care (NFLOC) but live in the community, which could mean their own home, the home of a loved one, assisted living facilities or other settings outside of a nursing home. HCBS Waivers are not an entitlement. Instead of guaranteed benefits, each HCBS Waiver program has a limited number of enrollment spots, and once those spots are full, a waitlist forms. HCBS Waiver programs vary by state – their name, their benefits, where they can be used, who can use them and how their waitlists operate.

Nursing Home Medicaid covers all healthcare and living expenses in Medicaid-approved nursing homes for financially limited seniors who require a NFLOC. Nursing Home Medicaid is an entitlement, which means eligible applicants are guaranteed by law to receive benefits without wait. This does not mean they are guaranteed a spot in any nursing home they choose because not all nursing homes accept Medicaid. Nursing homes that do accept Medicaid may not have any available space when you or your loved one needs it, and in these cases you may be choose to put your name on the nursing home’s waitlist. Or, you can look for another nursing home in your state that accepts Medicaid and has an open space.

ABD Medicaid is also an entitlement. All financially eligible ABD Medicaid applicants are guaranteed basic healthcare coverage – physician’s visits, prescription medication, emergency room visits and short-term hospital stays – without wait and regardless of their medical condition. To receive long-term care benefits via ABD Medicaid, applicants must show a need for those benefits and those benefits must be available in the area where they live. In some cases, the agency or caregiver that provides these long-term care benefits will have a waitlist.

How Medicaid Waitlists Are Processed

How Medicaid waitlists are organized and processed depends on the state and the program, but not all of them have waitlists. An independent study from KFF (an independent healthcare organization that used data from 2016-21) says that 37 states have HCBS Waivers with waitlists, which means there are 13 states that have no waitlists for their HCBS Waiver programs.

In 28 of the 37 states that had HCBS Waiver waitlists, applicants are screened for financial and functional (medical) Medicaid eligibility before being placed on waitlists. Those states are Alabama, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, North Carolina, North Dakota, South Carolina, Tennessee, Utah, Virginia, West Virginia and Wyoming.

In the other nine states (Alaska, Iowa, New Mexico, Ohio, Oklahoma, Oregon, Pennsylvania, Texas and Wisconsin), applicants are placed on waitlists without being screened for eligibility. So, your loved one could be waiting for long-term care services through an HCBS Waiver only to find out they are ineligible when they get to the top of the list. On the plus side, they could get on the waitlist before they are fully eligible, and then use their time on the waitlist to become eligible. Medicaid planning professionals can work with your family to help you qualify financially. And since medical conditions usually deteriorate over time, there could also be a strategy to coordinate waitlist time with the increasing medical need that will make your loved one functionally eligible.

How Medicaid Waitlists Are Prioritized

According to the study from KFF (formerly the Kaiser Family Foundation), 28 of the 37 states that have HCBS Waiver waitlists prioritize length of time on the waitlist when it comes to taking people off the list and enrolling them in a program. However, most states have more than one priority group. In 23 states, emergency/crisis situations are used to prioritize waitlist status. Twenty-one states prioritize Medicaid beneficiaries moving from institutions and returning to the community. And 17 states prioritize based on risk of institutionalization.

Waitlists can be state-wide, and most are state-wide in states with low populations. However, in bigger states they can be organized into smaller regions, like counties. In California, waitlists are broken down by the agencies that provide the long-term care services.

A surprisingly few number of people actually enroll in the HCBS Waiver for which they were waitlisted. In an analysis in Texas, it was found that just under 7% of the people waitlisted ended up enrolled in the program.

Medicaid Waitlists By State

Below are waitlist details for specific HCBS Waiver programs, organized by state. If you don’t see your state in this version of the article, check with your local Medicaid officials or a Medicaid planning professional to find out about specific HCBS Waiver waitlist details in your state.

California

There are four Medicaid programs in California that could have waitlists, and two currently have them – the Medi-Cal Assisted Living Waiver and the Home and Community-Based Alternatives Waiver.

California’s Assisted Living Waiver (ALW) covers long-term care services and supports for assisted living residents who need a Nursing Facility Level of Care (NFLOC), and it’s approved for 16,344 program participants. The ALW has a statewide waitlist that dates back to 2019, and there were 11,973 people on that waitlist as of April 2025. ALW waitlist priority is given to nursing home residents who are going to use the ALW to transition back into the community, as well as individuals who have a referral from Adult Protective Services. To find out the current average waiting period, contact an ALW Care Coordination Agency.

Assisted Living Waiver applicants should complete a Waitlist Request Form, which they can get from an ALW Care Coordination Agency, in order to be put on the waitlist. California’s Department of Health Care Services (DHCS) will contact the agency when a slot becomes available, then the agency will contact the applicant, who will have 60 days to submit a completed application to DHCS. ALW applicants who are already enrolled in Medicaid but don’t meet the functional requirement of needing a NFLOC may be placed on the waitlist with the assumption they will need a NFLOC by the time a slot opens.

The Home and Community-Based Alternatives (HCBA) Waiver covers long-term care for persons who are “technology dependent” and/or “medically fragile” and live in their own home, the home of a loved one or a congregate health facility. According to the waiver’s enrollment dashboard, there were 9,503 enrolled in the waiver as of April, 2025, and there were 5,641 on the waitlist. To apply for the HCBA Waiver and get on the waitlist, contact the HCBA Waiver Agency serving your county and request an application. Anyone in Los Angeles and Orange Counties should use the Waiver Agency serving their zip code.

There are nine HCBA Waiver Agencies, and each of them have their own waitlist. Persons who meet “Reserve Capacity” are given priority on these HCBA Waiver waitlists, which includes:

• Applicants who have been in a healthcare facility for 60 or more days at the time their HCBA Waiver application was submitted.
• Applicants transitioning to the HCBA Waiver from a similar Medicaid program that is not meeting their needs.
• Applicants who are 21 years old or younger.

The two Medi-Cal programs that could have waitlists but do not currently are the Multipurpose Senior Services Waiver, which covers long-term care for beneficiaries who live in their own home or the home of a loved one, and Community Based Adult Services, which covers adult day care.

Florida

Florida’s Medicaid Waiver program is called the Statewide Medicaid Managed Care (SMMC) Long-Term Care program. The SMMC waitlist is based on need.

Florida’s Department of Elder Affairs works with the state’s Aging and Disability Centers to screen each SMMC applicant and assign them a priority score based on their medical condition. There are eight levels, or “Ranks” of priority scores, with Rank 1 being the lowest and Rank 8 being the highest and given top priority to come off the waitlist. Florida uses this method to ensure “the most fragile Floridians are offered Long-term Care Program enrollment when it becomes available,” according to the Florida Agency for Health Care Administration, which also has a webpage with SMMC waitlist details.

Georgia

The HCBS Waiver relevant to seniors in Georgia is the Elderly and Disabled Waiver, which has approximately 50,000 enrollment spots per year. During the application process for this Waiver, Georgia seniors will be interviewed over the phone by their local Area Agency on Aging to determine their potential eligibility and their urgency of need, which will impact their place on the waitlist if all the enrollment spots are full. When the applicant reaches the top of the waitlist, the state will conduct an in-person evaluation to confirm their level of care need and urgency, and to help create their care plan moving forward.

The Elderly and Disabled Waiver funds two programs that provide long-term care services to Georgia residents who live in their own home, the home of a loved one or an assisted living personal care home – the Community Cares Services Program (CCSP) and the Service Options Using Resources in a Community Environment (SOURCE). The programs are similar and described more here, but the main difference is that SOURCE is for individuals who also qualify for Supplemental Security Income (SSI).

Illinois

There are two HCBS Waivers programs in Illinois for seniors that have waitlists – the Supportive Living Program (SLP) and the Waiver for the Elderly.

SLP provides long-term care services and support for seniors who are at risk of nursing home placement but live in “supportive living facilities,” which are like assisted living residences. Benefits include housekeeping help, intermittent nursing care and personal care assistance. SLP is approved for 15,246 beneficiaries per year. If all of those spots are taken, additional applicants will be placed on a waitlist. It’s believed the SLP waitlist is prioritized by application date, which means it’s first-come, first-served. To learn more about SLP and its waitlist, go to this Illinois Department of Healthcare and Family Services (HFS) page, or call HFS at 844-528-8444 or 217-782-0545. To find SLP providers by county, click here.

The Waiver for the Elderly, also known as the Persons who are Elderly Waiver, covers long-term care services and supports for seniors who live at home. Benefits include adult day care, housekeeping assistance, automatic medication dispensers and medical alert services. This waiver is approved for 141,029 participants per year. If all those spots are full, it’s believed the waitlist will be prioritized by application date, which means it’s first-come, first-served. To learn more about the Waiver for Elderly, go to this HFS page, contact a local Area Agency on Aging or call the senior helpline at 1-800-252-8966.

New York

New York’s Medicaid program that could have a waitlist is the Assisted Living Program (ALP), which provides long-term care benefits to New York Medicaid beneficiaries who need a NFLOC but live in an Adult Care Facility that is licensed as an “assisted living program,” which is different that being a private assisted living residence. ALP is approved for 10,000 applicants per year, and if all those spots are full a waitlist will form. The ALP waitlist is prioritized based on the individual’s need for care. So, those who need care the most will be moved to the top of the list. To learn more about ALP, go this New York State Department of Health webpage, or contact your local Department of Social Services (DSS).

Ohio

The HCBS Waivers waitlists in Ohio are managed by county boards, which assess individual’s needs using the state’s Waiting List Assessment Tool. The list is then prioritized according to the assessments and the four possible results:

• Immediate need – the individual has an unmet health care needs that is creating a substantial health risk
• Current need – the individual has an unmet need, or will have an unmet need within 12 months, that should be met by Medicaid
• No unmet needs – the individual has no current unmet need and is not expected to have any within 12 months
• Not eligible – the individual is not eligible for an HCBS Waiver in Ohio, or not eligible to placed on the waitlist

Pennsylvania

Seniors in Pennsylvania can receive HCBS Waiver benefits via the Community HealthChoices (CHC) Program. The program is funded for more than 167,000 beneficiaries per year, but there is still a substantial waitlist. It’s prioritized according to need. The individuals with the highest level of need on the waitlist are in the “emergency” category, which means they need services immediately or no later than six months, and there are typically thousands of people in the emergency category on this waitlist.

Texas

Texas’s lone HCBS Waiver that provides long term care services for seniors is the STAR+PLUS Waiver. This waiver has about 24,000 enrollment spots, and there were roughly 6,000 people on the interest list (Texas Medicaid’s term for a waitlist) as of April 30, 2025, according to this report from Texas Health and Human Services. Texas Medicaid interest lists are prioritized on a first-come, first-served basis.

Texas is one of the states that does not screen applicants before placing them on the interest list, so some of the people on the list will be denied when they get to the top of the list rather than be enrolled in the program. While others on the list will use the time to become financially, or medically, eligible, as discussed above.