Residential Support Waiver

The Residential Support Waiver (RSW) is Washington's 1915(c) HCBS waiver for clients who need nursing-facility-level care and require enhanced residential services such as Expanded Community Services (ECS), Adult Family Home Specialized Behavior Support Services, Community Stability Supports, and Enhanced Residential Services. A waiver amendment effective July 1, 2025 clarifies that when an LTSS participant is eligible for a service under the Medicaid State Plan (including 1915(i)), they must receive that service through the State Plan rather than through the 1915(c) waiver, services under the waiver supplement, not replace, State Plan services. The amendment also clarifies that recreational opportunities offered by residential providers may be identified in behavioral support plans.