A Medicaid waiver lets a state set aside some ordinary Medicaid rules so it can offer home and community-based services to a defined group of people. The rule most people feel is the one about institutions. To enroll in the usual intellectual and developmental disability waiver, a person has to meet an institutional level of care, generally the level that would qualify them for an ICF/IID, and then receive services in the community instead.
The main authority for that deal is section 1915(c) of the Social Security Act. States also use other authorities, including state-plan home and community-based options and broader demonstrations. Those are not trivia. They change whether enrollment can be capped. A 1915(c) waiver can have a limited number of slots. A slot is why a person can be eligible and still waiting.
Each waiver has a name the state chose, a list of services, a geographic reach, and a fee schedule. Families know the local name. Providers know the service codes. A legislature often knows only the line in the budget. "The waiver" in a news story should mean a specific program. If the story does not name it, the cut or the raise may apply to one waiver and not the one a reader is on.
Waivers are also where self-direction is written in or left out, and where the state says whether a relative can be paid. The document that puts a person on the waiver is the plan. The document that says what the state will pay is the fee schedule. The waiver application is the rulebook both of those have to fit.
Renewal is a calendar, not a slogan. Waivers are approved for a period of years and then renegotiated with the federal government. A renewal year is when services, caps, and rates move.