Massachusetts DDS HCBS Waivers: Adult Supports, Community Living, and Intensive Supports Explained

Three Waivers, Three Levels of Support

Massachusetts DDS operates three Home and Community-Based Services waivers for adults with intellectual and developmental disabilities. Each waiver targets a different intensity of need, and the services available under each one differ accordingly. Understanding which waiver fits your family member's situation determines what supports they can access — and how long they might wait.

All three waivers require DDS clinical eligibility (a documented intellectual or developmental disability under 115 CMR 6.00), enrollment in MassHealth Standard, an Intermediate Care Facility level of care determination, and age 22 or older.

Adult Supports Waiver

This waiver serves individuals who live with family, in adult foster care, or independently and do not require 24-hour supervised care. It is the least intensive of the three and covers:

• Service coordination
• Community-based day supports
• Respite care (giving family caregivers scheduled breaks)
• Individualized home supports
• Assistive technology
• Transportation to day programs

The Adult Supports Waiver is designed for people whose primary support comes from family or natural networks, with the waiver filling specific gaps. It does not provide 24-hour care.

Community Living Waiver

The Community Living Waiver covers a moderate level of support — more than what family can provide alone, but less than around-the-clock supervision. Services include:

• Group supported employment
• Individualized home supports with a live-in caregiver option
• Day habilitation programming
• Residential habilitation in staffed settings (less than 24-hour coverage)
• Shared living arrangements

Financial eligibility requires income below 300% of the SSI Federal Benefit Rate ($2,982 per month in 2026) and countable assets under $2,000. This waiver bridges the gap for individuals who need structured daily programming and some residential support but can function with intermittent rather than continuous supervision.

Intensive Supports Waiver

Reserved for individuals with the most significant behavioral, medical, or physical needs, the Intensive Supports Waiver authorizes:

• 24-hour residential habilitation
• Shared living with continuous support
• Self-directed home sharing with 24/7 coverage
• Intensive behavioral supports
• Clinical and nursing services

This waiver is typically associated with group home placements or specialized residential programs where staff are present at all times. Eligibility reflects the highest clinical acuity — individuals who would otherwise require institutional care.

How the Waitlist Works

Here is the part that catches families off guard: clinical eligibility for DDS services does not guarantee a waiver slot. Adult developmental services in Massachusetts are funded through legislative appropriations, not individual entitlements. There are a finite number of waiver slots, and when they are full, eligible individuals go on a waitlist.

DDS prioritizes the waitlist using three tiers:

• Priority 1 (Emergency/Crisis): The individual faces immediate danger — homelessness, active abuse or neglect, or the sudden incapacitation or death of their primary caregiver. Priority 1 cases are funded with reasonable promptness.
• Priority 2 (Substantial Need): The individual has significant support needs but their current living situation is stable, typically living with aging parents. Priority 2 applicants may wait years for a funded slot, depending on regional budget availability.
• No Priority: The individual is eligible but does not meet the criteria for either priority tier. These cases are funded only when surplus capacity becomes available.

The gap between eligibility and funded services is the source of most family frustration. A young adult can be determined eligible for the Community Living Waiver at age 22 and spend years living at home under Priority 2 before a slot opens.

What Families Can Do While Waiting

While waiting for a waiver slot, families can access DDS-funded "Family Support" services that operate outside the waiver system. These include limited respite, family training, and some assistive technology. The scope is narrower than waiver services, but it provides a baseline of support during the wait.

Documenting changes in the individual's needs or the caregiver's capacity is critical. If a parent's health declines or the individual's behavior escalates, requesting a priority reassessment from your DDS service coordinator can move the case from Priority 2 to Priority 1.

The Massachusetts SSI at 18 & Adult Disability Benefits Guide includes a benefit calculation worksheet that maps DDS waiver services against SSI income, MassHealth coverage, and ABLE account savings — helping families see the full financial picture while navigating the waitlist.

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