Getting into a group home typically involves a multi-step application process that starts with contacting your state’s disability or aging services agency, establishing eligibility, securing funding (usually through Medicaid), completing a needs assessment, and then matching with an available home. The process can take anywhere from a few weeks to several years depending on your state, the type of group home, and whether there is a waiting list. While the broad steps are similar across the United States, the details vary considerably from state to state, and understanding the system before you start can save months of confusion.
Who Group Homes Serve
Group homes are shared residential settings where a small number of people live together with staff support. They serve several distinct populations, and the application pathway depends heavily on which population you or your family member belongs to. The most common categories include people with intellectual and developmental disabilities (IDD), older adults who need daily assistance but not the intensive medical care of a nursing home, people with serious mental illness, and individuals recovering from substance use disorders. Some group homes serve youth aging out of foster care or people transitioning out of institutional settings.
The type of group home matters because it determines which agency handles intake, which funding streams apply, and what kind of assessment you will need. A group home for adults with IDD is typically overseen by a state developmental disabilities agency, while one for older adults may fall under the state’s aging services division. Mental health group homes often have their own referral pathway through community mental health centers. Before anything else, identify which category fits your situation, because that determines every step that follows.
Starting the Process With Your State Agency
The first concrete step is contacting the correct state agency. Every state has a designated agency that manages services for people with developmental disabilities, and a separate one (sometimes overlapping) for aging and long-term care. These agencies go by different names in different states, but you can usually find the right one through your state’s department of health and human services website or by calling 211, which is a national helpline that connects callers to local social services.
When you reach the agency, you will typically be assigned a case manager, service coordinator, or intake worker. This person becomes your guide through the system. They will explain what documentation you need, walk you through the eligibility determination process, and help you understand which programs are available in your area. If you are applying on behalf of a family member, the agency will ask for authorization to share information with you, so it helps to have a power of attorney or legal guardianship established before you begin.
For people with IDD, the initial contact often involves providing proof of the disability diagnosis, which usually must have originated before adulthood. For older adults, the process may begin with a referral from a physician or hospital discharge planner. For mental health group homes, the referral often comes through a psychiatrist or community mental health provider. Each pathway has its own paperwork, but they all funnel into the same basic question: does this person meet the criteria for the level of care the group home provides?
Eligibility Determination
Eligibility has two sides: clinical eligibility and financial eligibility. Clinical eligibility means demonstrating that you have a condition that warrants the level of support a group home provides. Financial eligibility usually means qualifying for Medicaid, because Medicaid is by far the largest funder of group home placements in the United States.
Clinical eligibility typically involves submitting medical records, psychological evaluations, and sometimes school records or prior service history. For people with intellectual disabilities, states generally require documentation that the disability was present before age 18 (or 22 in some states) and that it substantially limits functioning in areas like self-care, communication, or independent living. For older adults, the key question is whether the person needs a level of care that would otherwise require a nursing facility.
Financial eligibility is where Medicaid enters the picture. Most group home residents receive services funded through Medicaid’s Home and Community-Based Services (HCBS) waiver programs. In fiscal year 2009, Medicaid funded over 75% of all publicly funded long-term supports and services for individuals with IDD, with federal and state HCBS waiver spending alone exceeding $25.1 billion that year.1PubMed Central. Home and Community Based Services (HCBS) waivers: a nationwide study of the states Those numbers have grown substantially since then. To qualify for Medicaid, applicants must meet income and asset limits, which vary by state. Some states have higher thresholds for people receiving HCBS waiver services than for standard Medicaid. Your case manager can help you understand whether you qualify and, if not, what spend-down options exist.
Understanding HCBS Waivers
The HCBS waiver is the funding mechanism that makes most group home placements possible. These waivers allow states to use Medicaid dollars to pay for community-based services instead of institutional care. The name “waiver” comes from the fact that states are waiving certain Medicaid rules to provide services in home and community settings rather than only in institutions like nursing facilities or large state-run residential centers.
Each state designs its own HCBS waiver programs, and most states operate multiple waivers targeting different populations. A state might have one waiver for people with IDD, another for elderly and physically disabled individuals, and a third for people with traumatic brain injuries. The services covered under each waiver differ. A nationwide analysis of 88 HCBS Section 1915(c) waiver applications across 41 states and the District of Columbia found that while waivers commonly covered services like respite care and transportation, the specific menu of services and the populations served varied widely.1PubMed Central. Home and Community Based Services (HCBS) waivers: a nationwide study of the states
Applying for an HCBS waiver is usually part of the broader application process your case manager helps you navigate. You do not typically apply for the waiver separately from applying for services. However, being approved for a waiver does not mean services start right away. Most states have waiting lists for their HCBS waiver programs, and the wait can be long.
The Needs Assessment
Once eligibility is established, the next step is a formal assessment of what level of support the person needs. This assessment serves two purposes: it determines what services the person qualifies for, and it helps match them to the right type of group home.
The specific assessment tools vary by state. Some states use standardized instruments like the Supports Intensity Scale (SIS), which measures the frequency, duration, and type of support a person needs across areas such as home living, community participation, health and safety, and social activities. Research has found that the SIS demonstrates adequate reliability and validity for this purpose and correlates well with measures of daily living skills.2PubMed Central. Evaluating the supports intensity scale as a potential assessment instrument for resource allocation for persons with intellectual disability Other states use their own assessment tools or a combination of instruments.
The assessment is usually conducted by a trained evaluator, often a social worker or psychologist, who interviews the individual and their family members or caregivers. It is not a test you pass or fail. Rather, it generates a profile of needs that guides the kind of placement and the amount of funding allocated. If you feel the assessment does not accurately reflect the person’s needs, you generally have the right to request a reassessment or to appeal the determination. Being specific and honest during the assessment matters, because underreporting needs can lead to placement in a setting with too little support.
Person-Centered Planning and the Individual Program Plan
Before or shortly after placement, you will go through a person-centered planning process. This is not optional paperwork. The Centers for Medicare and Medicaid Services (CMS) requires that HCBS-funded services be guided by a person-centered plan, a requirement reinforced by the CMS Home and Community-Based Services Settings Rule.3Research and Practice for Persons with Severe Disabilities. Person-Centered Planning for Group Home Residents with Intellectual and Developmental Disabilities The resulting document, often called an Individual Program Plan (IPP) or Individual Service Plan (ISP), lays out the person’s goals, preferences, and the specific services they will receive.
Person-centered planning is supposed to put the individual at the center of decision-making. In practice, this means the planning meeting should include the person themselves (with whatever communication supports they need), their chosen family members or advocates, and the service providers who will be carrying out the plan. The plan should reflect what the person wants for their life, not just what services the system happens to offer. If someone wants to live near a particular family member, or has a strong preference about housemates, or needs access to a specific kind of day program, those preferences are supposed to be documented and, where possible, honored.
The plan is not a one-time document. It gets reviewed at least annually, and you can request a revision if the person’s needs or preferences change. Understanding that you have the right to participate meaningfully in this process is important, because it directly affects the quality of the placement.
Navigating the Waiting List
For many families, the waiting list is the most frustrating part of the entire process. In many states, the wait for HCBS waiver services can stretch for years. Some states have reported waiting lists of tens of thousands of people. The length depends on the state’s budget allocation, the number of waiver slots available, and the population being served.
While waiting, there are a few things you can do. First, make sure you are actually on the list. It sounds obvious, but some families complete part of the eligibility process and assume they have been added to a waiting list when they have not. Ask your case manager to confirm your position and provide it in writing if possible. Second, stay in contact. Some states require periodic check-ins to keep your spot on the list, and failure to respond to a letter or phone call can result in being removed. Third, explore interim services. Many states offer some level of support even before a waiver slot opens, such as family support services, respite care, or crisis intervention.
If the person’s situation is urgent, such as when a primary caregiver becomes seriously ill or dies, states typically have mechanisms for emergency or crisis placements that can bypass the standard waiting list. These placements are temporary at first, but they can sometimes transition into permanent arrangements.
Why the Process Looks So Different From State to State
One of the most confusing aspects of the group home application process is that it varies so much depending on where you live. Medicaid is a joint federal-state program, and while the federal government sets minimum standards, states have enormous flexibility in how they design their waiver programs, what services they cover, who qualifies, and how much they pay providers. Research examining state-level Medicaid HCBS waivers has identified wide variability in caregiver support across states.4PubMed. State-level Medicaid 1915(c) home and community-based services waiver support for caregivers
This variability extends to the specific services available. A comprehensive documentation effort tracking Medicaid HCBS waivers over time found that while certain services like respite and transportation were commonly offered, the percentages changed only modestly between 2010 and 2019. Respite services were included in roughly two-thirds to just under 70% of waivers, transportation in about half, and meal or dietary services in around two-thirds.5Innovation in Aging. Systematic Documentation of State Variation in Medicaid Home- and Community-based Services: The Medicaid Home and Community-based Services Dataset Initiative The share of waivers allowing payments to family caregivers rose from about two-thirds to roughly three-quarters over that same period, while caregiver training availability actually declined slightly.5Innovation in Aging. Systematic Documentation of State Variation in Medicaid Home- and Community-based Services: The Medicaid Home and Community-based Services Dataset Initiative
The practical implication is that advice from someone in a different state may not apply to your situation. A family in one state might have access to a robust array of community-based options and relatively short wait times, while a family in a neighboring state faces a years-long backlog and fewer service options. Always get your information from your own state’s agency rather than relying on general guides or another family’s experience in a different state.
Preadmission Screening for Certain Populations
If the person you are seeking placement for has a serious mental illness and is being considered for a nursing facility rather than a traditional group home, there is an additional federal requirement called Preadmission Screening and Resident Review, or PASRR. This program was established under the Omnibus Budget Reconciliation Act of 1987 and requires states to assess people with serious mental illness who are seeking nursing home care to determine whether a nursing facility is the most appropriate setting or whether community-based alternatives would be better.6Innovation in Aging. Meaningful Assessment or Minimum Compliance: PASRR for Nursing Home Residents with Mental Illness
PASRR exists in part to prevent people from being placed in nursing homes when a group home or other community setting could meet their needs. If PASRR screening determines that a nursing facility is not the right level of care, the person should be referred to community-based options, which may include a group home. The quality and thoroughness of PASRR screening varies by state, but being aware of the process matters because it can either open up community options or, if done poorly, lead to an institutional placement that was not necessary.
Visiting and Choosing a Group Home
Once funding is in place and a waiver slot has opened, you will typically be presented with one or more group home options. This is the point where you get to evaluate specific homes, and it is worth taking your time. Visit in person if at all possible, and try to visit at different times of day. A home that seems calm and organized during a scheduled tour might feel different on a weekday evening when all residents are home.
Things to pay attention to during a visit include the physical condition of the house, how staff interact with current residents, the ratio of staff to residents, whether residents seem engaged or mostly sitting idle, the cleanliness of common areas and bathrooms, and the overall atmosphere. Ask about staff turnover, because high turnover is a red flag for management problems. Ask how the home handles medical emergencies, behavioral situations, and communication with families. Ask whether residents participate in choosing meals, activities, and their daily schedules, because CMS rules require that HCBS settings promote individual choice and community integration.
You can also check the home’s licensing and inspection history. Most states maintain a database of licensed residential care facilities with any violations or complaints on record. Your state’s licensing agency can tell you where to find this information. If a home has repeated citations for the same issue, that pattern matters more than a single minor violation.
What to Bring to the Application
While the exact documentation requirements vary by state and provider, having the following items ready will speed up almost any group home application:
- Medical records: Recent physician notes, medication lists, hospital discharge summaries if applicable, and any specialist evaluations.
- Disability documentation: Psychological evaluations, IQ testing results, educational records showing special education services, or documentation from the Social Security Administration.
- Financial documents: Proof of income (Social Security benefits statements, pay stubs), bank statements, and Medicaid card or pending Medicaid application status.
- Legal documents: Guardianship or conservatorship papers, power of attorney, representative payee designation, or advance directives.
- Behavioral or support plans: Any existing behavioral support plans, prior residential placement records, or crisis plans from previous providers.
Gathering these documents before you need them prevents delays later. Requesting medical records and psychological evaluations can take weeks, so start early.
Private-Pay and Non-Medicaid Options
Not everyone who needs a group home qualifies for Medicaid, and not every group home is Medicaid-funded. Some homes operate on a private-pay model, where the resident or their family pays the cost directly. These homes may accept residents more quickly because they do not require waiver approval, but costs can be substantial, often ranging from several thousand dollars per month to well over $10,000 depending on the level of care and geographic location.
Other funding sources to explore include state-funded programs that operate independently of Medicaid, Veterans Affairs benefits for eligible veterans, Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits that can be directed toward residential costs, and in some cases, special needs trusts or ABLE accounts that families have established to supplement public funding without jeopardizing Medicaid eligibility. A benefits counselor or disability rights organization in your state can help you sort out which combination of funding sources makes sense for your situation.
When the Application Is Denied
Denials happen, and they are not always the end of the road. Common reasons for denial include not meeting the clinical criteria for the level of care, exceeding the financial limits for Medicaid, incomplete documentation, or the specific home determining that they cannot meet the individual’s needs. Each of these has a different remedy.
If the denial is based on clinical criteria, you can request a fair hearing through your state’s Medicaid office. This is an administrative appeal process where you can present additional documentation or argue that the assessment did not accurately capture the person’s needs. If the denial is financial, a benefits specialist can sometimes help restructure assets or identify exemptions that bring the person within eligibility limits. If a specific home turns down the application, ask for the reason in writing. Sometimes the issue is solvable, such as needing additional behavioral supports that the home can arrange. Other times it means that particular home is not the right fit, and you should look at other options.
Disability rights organizations, legal aid societies, and Protection and Advocacy agencies (every state has one, federally mandated) can provide free assistance with appeals. These organizations deal with denials regularly and know the specific rules and precedents in your state. They are an underused resource that can make a real difference when the system is not working the way it should.
Planning Ahead for Transition
Moving into a group home is a major life change, and how the transition is handled affects how well the person adjusts. If possible, arrange for one or more visits to the home before the move-in date. Some providers offer trial overnight stays so the person can experience what daily life in the home feels like before committing. Meeting future housemates and staff in advance reduces the shock of a sudden change in environment.
Prepare a detailed profile of the person’s routines, preferences, and communication style for the staff. What time do they usually wake up? Do they have food preferences or sensitivities? How do they express distress? What activities do they enjoy? Staff who know these details from day one can provide better support during the adjustment period. Also identify a point of contact at the home who will communicate with you regularly during the first few weeks, so you can flag concerns early and feel confident that the person is settling in.
The transition period typically lasts a few months. Some regression in behavior or mood is normal during this time, and it does not necessarily mean the placement is wrong. Maintaining familiar routines, keeping favorite personal items in the new space, and scheduling regular visits or calls from family can help smooth the adjustment. If serious problems persist beyond the initial adjustment period, request a team meeting to revisit the person-centered plan and discuss whether modifications to the environment, staffing, or services could help.