Posted on December 23rd, 2025.

Many people feel more at ease getting support in the same place they live, work, and build relationships. Home feels familiar, and that familiarity can make it easier to talk about what you’re going through. Instead of reshaping life around appointments and waiting rooms, it can be comforting when help fits into your existing routines.

For mental health in particular, the setting often matters as much as the service itself. Being able to meet with professionals while staying close to family, work, and community can reduce stress and make follow-through more realistic. Care starts to feel less like a separate event and more like a practical part of everyday life.

Behind the scenes, public programs have gradually adjusted to reflect this reality. Some Medicaid options now focus on support that follows you into your home and community rather than centering care in institutions. One of those options, known as a 1915(i) waiver, plays an important role in making flexible mental health coverage possible for many individuals and families.

Understanding 1915(i) Medicaid Waivers

1915(i) Medicaid waivers, often called 1915(i) home and community-based services, offer an alternative to traditional facility-based care. Instead of focusing on long-term stays in hospitals or nursing homes, these waivers support people in their own homes or community settings. The goal is to make it possible for individuals with mental health needs to remain where they feel most comfortable. This structure can reduce disruptions to work, school, and family life while still providing meaningful support.

A key feature of 1915(i) services is the shift away from requiring an “institutional level of care” just to qualify. In many older Medicaid models, someone had to show that they needed intensive facility-based services before getting certain benefits. With 1915(i), states can design programs that support people earlier in their mental health journey. That means someone can receive community-based services even if they do not currently need inpatient treatment. This early and flexible support can help prevent crises and reduce hospitalizations.

These waivers place strong emphasis on behavioral health services, including care for conditions like major depression, bipolar disorder, schizophrenia, and substance use disorders. The focus is not limited to diagnosis alone; it also considers how symptoms affect daily living. As a result, 1915(i) programs often support people whose functioning is significantly impacted, even if they are not in a hospital. This makes the waivers a valuable tool for expanding Medicaid mental health coverage beyond traditional clinic visits.

The types of services offered through 1915(i) can be broad and tailored. Many states include case management to help coordinate appointments, medications, and community resources. Counseling and therapy services can be provided at home or in community locations, making it easier to keep consistent appointments. Some programs add peer support, where people with lived experience in recovery offer encouragement and practical guidance. Rehabilitation services may also be available to help individuals build skills for independent living.

Because 1915(i) waivers are designed at the state level, no two programs look exactly the same. States decide which services to include, which populations to target, and how to structure eligibility. Some focus heavily on adults with serious mental illness, while others include children and adolescents with complex behavioral health needs. This flexibility allows states to address local gaps in mental health care and respond to community priorities.

For individuals and families, understanding that 1915(i) waivers exist can change the way mental health support is viewed. Instead of assuming that meaningful coverage only comes through hospital or clinic care, you can explore options that bring services into the home. Learning the basic terms, asking providers about 1915(i) programs, and reviewing state Medicaid information are practical steps. 

Eligibility Criteria for Mental Health Services

Eligibility for 1915(i) waivers plays an important role in determining who can receive these Medicaid mental health services. Each state defines its own criteria within federal guidelines, so details vary, but some themes are consistent. Typically, eligibility involves both clinical and financial factors. Clinically, a person must have a qualifying mental health condition or related behavioral health need. Financially, income must fall within limits set by the state, which can be more flexible than those of traditional Medicaid in some areas.

Clinical criteria usually start with a professional assessment. A licensed clinician evaluates the person’s mental health diagnosis, symptoms, and level of functioning. The assessment looks at how conditions like anxiety, depression, or psychotic disorders affect daily life. It might consider how often symptoms appear, how severe they are, and how they influence relationships, work, school, or self-care. This process helps determine whether the person’s needs are serious enough to justify 1915(i) services but not necessarily intensive inpatient care.

Functioning in daily activities is another important piece of the eligibility picture. Evaluators often focus on how well someone can manage personal care, household responsibilities, medication routines, and community participation. For example, they may ask whether the person can safely cook meals, manage bills, or attend appointments without support. When mental health symptoms make these tasks difficult or unsafe, that information can support eligibility for home and community-based services. The goal is to understand the full impact of the condition, not just the diagnosis code.

States may also look at social and environmental factors that influence mental health. Housing stability, family support, transportation access, and financial stress can all affect whether someone can maintain wellness without additional services. Some assessments ask about isolation, safety concerns, or recent crises. By including these elements, 1915(i) programs recognize that mental health is shaped by more than symptoms alone. A person’s surroundings and support network matter when deciding the right level of care.

Financial criteria are also part of the eligibility framework. Many states using 1915(i) waivers have the option to set income limits higher than standard Medicaid, which can open the door for people who might have been excluded before. This is especially helpful for adults who work part-time or live on fixed incomes that slightly exceed traditional thresholds. In some cases, assets and resources are reviewed to ensure the program targets those who truly need assistance. 

Once a person is found eligible, services are typically organized through a person-centered plan. This plan outlines goals, needed supports, and the types of services that will be provided, such as counseling, skills training, or peer support. Plans are reviewed regularly to confirm that services still match the person’s needs and progress. If conditions change, the plan can be updated. Knowing that eligibility is not a one-time decision but an ongoing process can be reassuring, because it means supports can adjust as life circumstances evolve.

Home Care Support for Severe Mental Health Conditions

Home care for adults with mental illness, supported through 1915(i) waivers, can look very different from traditional facility-based treatment. Instead of traveling frequently to clinics or hospitals, individuals receive many services where they live. For someone experiencing severe anxiety or depression, the home setting can feel safer and less overwhelming than a busy medical environment. This familiar backdrop reduces some of the stress that often comes with seeking help. 

Services delivered at home often focus on both symptom management and practical daily support. A therapist might visit to provide counseling focused on coping strategies, emotional regulation, and problem-solving. Skill-building sessions can help with routines such as getting out of bed on time, preparing meals, keeping track of medications, or organizing a calendar. Over time, this type of hands-on support can strengthen confidence. Building small, consistent habits in the home environment often translates into improved stability and independence.

For individuals with severe anxiety, leaving the house can sometimes feel nearly impossible. Home-based care allows treatment to start where the person currently feels able to engage. A clinician can slowly introduce exposure strategies, relaxation techniques, or planning for short trips outside the home. Similarly, for those living with major depression, in-home support can encourage gradual activity, social contact, and involvement in meaningful tasks. 

Family involvement is another key advantage of home care support for serious mental health conditions. When services happen in the home, family members or trusted supporters can be present for part of the sessions if the individual agrees. They can learn more about the condition, understand triggers, and practice communication strategies that reduce conflict. Education about warning signs, crisis planning, and available resources can also be included. 

Home- and community-based programs often coordinate multiple types of support to create a comprehensive care network. Alongside therapy, there may be case management to link individuals with housing resources, employment programs, or social groups.

Peer support workers can share their own recovery experiences and model hope. Some services may use technology, such as secure video visits, to supplement in-person care and provide more flexible scheduling. When these elements work together, they create a safety net that extends beyond any single provider visit.

Related: Empathy and Understanding: Building Blocks of Recovery

Moving Forward With 1915(i) Support

When you understand how 1915(i) waivers work, it becomes easier to see how home and community-based mental health services might fit your situation. These programs are designed to support real lives, with all their routines, challenges, and responsibilities. If you or a loved one is considering this option, it can help to speak with professionals who know the details and can answer specific questions.

At TruCare Health Services, we work with families to explore whether 1915(i) services align with their mental health needs and daily life. We listen carefully, explain eligibility in clear language, and help you understand what home-based support might look like.

Contact us today to see how we can build a support plan that works for your family.

Let’s begin this journey together, fostering peace, strength, and well-rounded wellness.