Yeah! So most/all US state Medicaid programs have an additional system in place for those who qualify, called Long-Term Care Medicaid Home and Community-Based Services (HCBS).

Qualification requirements are generally the same as most other government programs; you have to have a low enough monthly income; be above age 65 OR blind, OR disabled; and have a "functional need" for program services. In this context, "functional need" is defined as needing supports with at least some activities of daily living (bathing, dressing, feeding, transferring, etc.)

There are different waivers that offer different types of supports. Before I got on the DD waiver, I was on the supported living services (SLS) waiver. SLS offers things like support with being in the community, a caregiver to visit your home a few times a week to help with ADLs, access to day programs, etc. It doesn't offer supported residential programs though; those are only accessible through the DD waiver.

Types of residential programs can look like group homes, where several disabled adults live in a large home together and have either live-in or drop-in caregivers that support everyone in the home.

It can also look like nursing homes or similar state-run hospital facilities.

The type of residential support I'm receiving is called host home. Community members can apply to be host home providers, and are employed by a residential services agency to be full-time caregivers to disabled waiver-holders who will move into the providers' home.

The majority of HH providers are family members of a disabled adult who are paid by the program to provide care. This means they can continue supporting their disabled family member who may need 24/7 support, meaning the caregivers cannot hold another job.

There are strict rules that a HH provider must follow, to ensure that the person in care is not being abused, neglected, or exploited. Even family carers must follow these rules. They are things like not being allowed to manage the resident's money (this can be done by a third party called a representative payee, if the resident needs financial support); they are not allowed to use medicines in a manner that is not prescribed, which prevents the risk of unethical chemical restraint; the resident must have their own room or space within the home, and a lot more rules besides.

In terms of the kinds of people who would benefit, essentially it's a good choice if you can't or don't want to live with family, and need more support than a drop-in caregiver can provide.

I'll get help with transport to my therapy, skills, and social group appointments; reminders to take my meds and help refilling them on time; a rep payee to manage my money so my bills get paid and I don't accidentally over-spend; support at my medical appointments; help keeping track of my weekly appointments so I don't forget or miss them; in-home help with cooking, cleaning and laundry; reminders for bathing; safety care when I have meltdowns; and overnight support for anything that might come up.

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