Nearly 650,000 People Are Waiting for Medicaid Home Care. Her Daughter May Be Paying for Help Another Medicaid Benefit Could Cover
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Picture a daughter who stops at her mother’s house every morning before work. Mom can’t safely get in and out of the tub anymore, and some days she forgets to eat. So the daughter pays a private aide to wash and feed her, one check every month, because a social worker told her Mom is on a Medicaid home-care waiting list. She took that to mean Medicaid can’t help yet.
She may be paying for help Medicaid already covers. Most home-care waiting lists apply to one type of program, called a home and community-based services (HCBS) waiver. Medicaid also offers state-plan services, which can include personal care such as help with bathing, dressing and eating. States may cap waiver enrollment, while eligible state-plan services such as personal care cannot be limited through the same kind of waiting list.
649,900 People Are on the Lists, and the Average Wait Reached 34 Months
KFF counted 649,900 people on Medicaid home-care waiting or interest lists in 2026, spread across 40 states. That’s about 7% more than in 2025. People who moved from the lists into services had waited an average of 34 months, up from 32 in 2025. That’s a lot of private checks.
The lists exist because waivers let states cover a broad menu of services and choose, and limit, the number of people who receive them. When applicants outnumber slots, a line forms. KFF estimates more than 5 million Medicaid enrollees use home care, and roughly half receive services through the regular Medicaid state plan.
Being on one of those lists doesn’t necessarily mean a person has been found eligible for that waiver. Eight states (Alaska, Florida, Iowa, New Mexico, Oklahoma, Oregon, South Carolina and Texas) add people to lists without screening anyone for eligibility first, and those states hold 56% of everyone waiting. Some families sign children up years early, expecting to need services by the time their names come up. And 72% of people waiting want waivers for people with intellectual or developmental disabilities, so an older adult’s line can move very differently from the national average.
Why Medicaid Personal Care Escapes the Waiver Cap
Medicaid splits home care into two categories. Waivers come with a cap: the state sets a number of slots and stops there. State-plan benefits run more like an entitlement once a state chooses to offer them. Anyone who meets the eligibility rules gets the service, with no slot count holding them back.
Personal care is the classic state-plan home-care benefit. Community First Choice, another state-plan option, pays for attendants who help with daily tasks. Both are optional state plan benefits, so the menu changes at every state line. A mother in one state may qualify for a state-plan aide right away. In a state that runs nearly all home care through waivers, her daughter may have fewer options.
More Than 80% on the Lists Qualify for Help Now
Here’s the number that should stop the daughter mid-check. KFF found that more than 80% of people on home-care waiting lists qualify for personal care or other state-plan services while they wait. Where living arrangements are known, 95% of people waiting live in the community.
There’s a trade-off. State-plan benefits may deliver fewer hours or a different set of services than the waiver someone is waiting for. People on the lists generally can’t get waiver-only services, such as supported employment or adult day care, until a slot opens up. A state-plan aide might handle Mom’s morning bath and breakfast, while the waiver package might add adult day care.
Even partial coverage changes the family budget. Every hour Medicaid pays for is an hour the daughter doesn’t.
Approval Doesn’t Guarantee an Aide Shows Up
Coverage and an actual caregiver at the door are separate problems. KFF notes that its counts can miss people who have already been approved for services but can’t find an available provider. Worker shortages hit both waiver and state-plan services.
More transparency is coming. Starting in July 2027, states must report their waiver waiting lists to CMS every year, including how many people are waiting and how long newly enrolled people waited. For certain home-care services, states must also report what share of authorized hours actually got delivered.
The questions that matter for this family are simple.
- Which Medicaid benefit is Mom actually waiting for?
- Has anyone screened her for financial and functional eligibility?
- And which state-plan services, such as personal care, could start now?
A spot on one program’s waiting list doesn’t determine whether Medicaid can help today. Getting those answers before writing more checks could keep hundreds of dollars a month in the daughter’s account.
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Gerelyn Terzo is the author of dividend investing handbook "Dividend Investing Strategies: How to Have Your Cake & Eat It Too." A veteran financial journalist, she covers agri-finance for outlets like Global AgInvesting and the broader stock market and personal finance for 24/7 Wall Street. She began at CNBC and later helped launch Fox Business in New York. Gerelyn currently resides in Woodland Park, Colorado and dabbles in nature photography as a hobby.
