Massachusetts Home Care Medicaid

Massachusetts runs ten separate Home and Community-Based Services waivers, with MassHealth sharing the work alongside the Executive Office of Aging and Independence, the Department of Developmental Services, and MassAbility — each waiver built around its own defined target population.

The state frames these HCBS waivers as alternative, state-specific programs that let eligible people get long-term services and supports while staying in their own homes and communities. But capacity is baked into the design: each waiver has a maximum number of people it can serve in a given year, and the state has to demonstrate cost neutrality to keep that approval — so even though someone can typically apply at any time, a program-wide cap on enrollment is still a real feature to plan around.

The Frail Elder Waiver is the one most families run into first. It's built for adults age 60 and older who meet a nursing-facility level of care but can still remain safely in the community with the right supports in place.