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 specific Medicaid program and the state where they live. 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. In short, waitlists are most commonly used with HCBS Waivers, they are sometimes used with ABD Medicaid, and they do not apply to Nursing Home Medicaid.

Nursing Home Medicaid covers all healthcare and living expenses in Medicaid-approved nursing homes for financially limited seniors who require a Nursing Facility Level of Care. Nursing Home Medicaid is an entitlement, which means eligible applicants are guaranteed by law to receive benefits without wait.

HCBS Waivers cover long-term care benefits for financially limited seniors who require a Nursing Facility Level of Care 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.

Receiving healthcare coverage via ABD Medicaid is an entitlement for financially limited seniors who are age 65 and over. To receive long-term care benefits via ABD Medicaid, seniors 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. Sometimes those agencies are the same ones that provide HCBS Waivers benefits.

Nursing Home Medicaid beneficiaries may also encounter similar waitlists – the nursing home in their area that accepts Medicaid may not have any available space and they will need to put their name on a list to wait for a bed. However, in these cases the senior could move into another nursing home in a different part of the state that accepts Medicaid and has space and Nursing Home Medicaid will cover it. But Medicaid won’t pay for a caregiver to travel from a different part of the state to provide long-term care services.

 

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.

 Waitlist Enrollment: A Study of Participants

In Texas in 2022, 18,649 people came to the top of their waitlist. Of those, very few enrolled. What happened to that group breaks downs as follows:
• 9,423 (50.5%) Did not response when their name came to the top of the list
• 3,283 (17.6%) Declined/Denied
• 2,187 (11.7%) Application Withdrawn
• 1,551 (8.3%) Deceased
• 1,256 (6.7%) Enrolled
• 2,500 (13.5%) Other 

 

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

Instead of state-wide waitlists for two of its HCBS Waivers, the Assisted Living Waiver (ALW) and the Home and Community-Based Alternative Waiver, California has multiple waitlists that are area-specific and organized by agencies.

There are 30 Care Coordination Agencies (CCA) for California’s Assisted Living Waiver located across the state, and each one of them operates their own ALW waitlist. This link has a complete list of these CCAs with contact information and counties served. As of February 2023, there were 9,118 people enrolled in the ALW, and 3,316 on the waitlists. Regarding prioritization, “Institutional Transitions” (people on the waitlist who had been residing in an institution such as a nursing home for at least 60 days prior to application) are prioritized over “Community Enrollment” (which is anyone who does not qualify as Institutional). Community Enrollments are then prioritized on a simple first-come, first-served basis.

California’s Home and Community-Based Alternative Waiver has 9 agencies that each have their own waitlist. These waitlists are prioritized on a first-come, first-served basis, but “special circumstances my qualify an applicant for priority enrollment,” according to the California Department of Health Care Services. This webpage has a list of the 9 agencies, including their contact information and areas served.

 

Texas

Texas’s lone HCBS Waiver that provides long term care services for seniors is the STAR+PLUS Waiver. According to an August 2022 report from Texas Health and Human Services, there were 24,049 people enrolled in the STAR+PLUS program during 2022. As of April 30, 2022, there were 11,630 on the STAR+PLUS interest list (“interest lists” are what Texas Medicaid calls a waitlist). These 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.

 

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. 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.

 As research time permits, additional states and waivers will be added to this article.