Medicaid Home Care Waiting Lists Near 650,000: What Agencies Should Watch

KFF released its annual survey of Medicaid home and community-based services on October 5, and the headline number is hard to ignore. Almost 650,000 people are on Medicaid home care waiting lists or interest lists in 2026, up about 7% from last year, across 40 states. Thirty-two states reported growth and only seven reported declines. The average wait before services start rose to 34 months, from 32 months in 2025. For agencies that deliver personal care, waiver services, or home health, these numbers show where demand is building and where states are under pressure to respond.

Who is waiting matters as much as how many. KFF found that 72% of people on lists have intellectual or developmental disabilities, and about a quarter are adults 65 and older or people with physical disabilities. More than 80% are eligible for personal care or other Medicaid state plan services while they wait, so many already rely on some in-home support, just not the fuller waiver package. KFF also cautions that the eight states that do not screen for eligibility before adding someone account for 56% of everyone on a list, so the total is an incomplete measure of need. The report notes that federal Medicaid funding changes could push some states toward tighter caps, while other states keep expanding.

How states are responding to Medicaid home care waiting lists

Some of that expansion is already live. Kansas launched its new Community Supports Waiver on October 1, a 1915(c) waiver for people ages 5 and older with I/DD who do not need 24-hour paid support, with 500 projected enrollees in its first year and invitations going first to people who have waited longest. Arkansas announced a plan in September to let people on its Community and Employment Support Waiver waitlist receive supportive living services without a full waiver slot, with access expected by January 2027 and a planned rate increase that same month. New waivers and carve-outs like these bring new provider enrollment, training, and authorization rules that agencies benefit from learning early.

A reporting change is coming too. Starting in 2027, under the federal rule on access to Medicaid services, states must report waiting list counts, how long newly enrolled people waited, the time between approval and service start, and the percent of authorized hours of care that were actually provided. That last measure puts a spotlight on delivery. Agencies that can clearly show authorized versus delivered care will be in a stronger position when states and plans start asking. CareSync® gives teams planned-versus-completed visit visibility on one board, which is the kind of plain record those conversations usually begin with.

A few things worth doing this quarter: check whether your state keeps a waiting list or interest list for the populations you serve, watch your state Medicaid agency for new waivers or slot releases, and review how your team tracks authorized hours against completed visits. One more note for the people doing this work every day: we are quietly building an invite-only space where home health professionals can compare notes on changes like these, and we hope it will be genuinely useful to the field. More on that when it is ready.