Unlike Medicare – which is run entirely by the federal government to cover people aged 65 or older and some people under age 65 who may qualify due to a disability or another special situation – Medicaid is a state and federal partnership that is needs-based and managed by each state. Because both the state and federal government put in money for the Medicaid program, services available in Medicaid vary from state to state as well as eligibility requirements to receive them.

Medicaid offers two types of care coverage for people with disabilities: acute care services and long-term services and supports.

Acute care services are health services provided over a short-term for the prevention, diagnosis, or treatment of a medical condition. Acute care covers the type of things normally covered by private insurance such as doctor’s visits, prescriptions, inpatient care, and emergency services. Traditional Medicaid includes acute care services.

Long-term services and supports involves a broad range of health and health-related assistance provided over an extended period of time. Long-term services and supports are not intended to treat or cure a medical condition and help in maintaining or improving an optimal level of functioning and quality of life. Long-term services and supports are almost NEVER included in private insurance policies and includes things like a personal care attendant to help with dressing, employment supports, and/or an adult day program to provide social and other related support services. Because intellectual and developmental disabilities are by definition severe, chronic disabilities that are likely to continue indefinitely, resulting in substantial functional limitations in major life activities, long-term services and supports are almost always essential.

Medicaid can pay for long-term services and supports provision either in an institutional setting (e.g., nursing facility, intermediate care facility, state supported living center) or in a community setting. Long-term services and supports provided in the community are available through Community First Choice (CFC) and/or a home and community-based services (HCBS) waiver.

In Texas, long-term services and supports provided in the community are offered through Community First Choice (CFC) and/or a home and community-based services (HCBS) waiver.

Community First Choice (CFC) provides home and community-based attendant services and supports to Medicaid recipients with disabilities. CFC enables Texas Medicaid to provide the most cost-effective approach to basic attendant and habilitation service delivery. To be eligible for CFC, an individual must be eligible for Medicaid, need help with activities of daily living, such as dressing, bathing and eating, and need an institutional level of care. This option allows Texans with Medicaid who need basic long-term services to remain in their community, to receive them without a wait.

The Arc of Texas advocated during the 83rd Legislative session to provide this critical option to Texans.

Texas has 7 HCBS waivers, 6 of which are specific to serving people with disabilities. They were developed to provide alternatives to institutionalization. They “waive off” Medicaid requirements for institutional settings, as required by the federal government. Since funding from the Texas Legislature determines the availability of waiver services, there are waiting lists or “interest lists” for these critical services.

Even if you are eligible, you may not be able to get services right away. Texas does not rank high for services compared to most other states, and some Medicaid waivers have long waiting lists (as much as 16 years for some waivers). The waiting lists are called Interest Lists here, and it is often a good idea to get on all of the lists. Many people will accept whatever waiver becomes available first, while waiting for a waiver that better meets their needs. You do not have to prove eligibility to be added to the waiver interest lists. You will go through this process and review once at the top of the list. Only then is your eligibility information reviewed and used to decide if you can enroll. Current Interest List Counts across all six Interest Lists are typically over 170,000 people.

HCBS Waivers

• • Community Living Assistance and Support Services (CLASS): gives home and community-based supports to children and adults with related conditions. There are over 200 related conditions, like cerebral palsy and spina bifida. The related condition must have occurred before the child was age 22.
• • Deaf Blind with Multiple Disabilities (DBMD): gives services for children and adults who are deaf-blind or have a related condition that leads to deaf-blindness, and who have another disability.
• • Home and Community-based Services (HCS): gives services and supports to children and adults with an intellectual disability (ID) or a related condition who live with their families, in their own homes, or in small group homes with no more than 4 people.
• • Medically Dependent Children Program (MDCP): gives services to children and adults who are 20 and younger who are medically fragile as an alternative to receiving services in a nursing facility.
• • STAR+PLUS Home and Community-based Services (HCBS): gives services to adults over the age of 21 to keep them in their community and not in a nursing home facility.
• • Texas Home Living (TxHmL): gives services to children and adults with an intellectual disability (ID) or a related condition who live in their own home or their family’s home.
• • Youth Empowerment Services (YES): gives home and community-based services to children under the age of 19 who otherwise would need psychiatric inpatient care, or whose parents would turn to state custody for care.

The following eligibility criteria is specific to HCBS waivers and not general Medicaid. In order to qualify for a HCBS waiver, you must meet both financial and functional eligibility. It is important to note that eligibility is not determined until an individual is offered a HCBS waiver (e.g., their name comes to the top of the interest/waiting list).

All 6 HCBS waivers specific to people with disabilities listed above – except MDCP and STAR PLUS – provide long-term services and supports for Texans of all ages. MDCP is for Texans aged 0-20 and STAR PLUS is for Texans 21 and older.

Financial eligibility

For all waivers — except TxHmL:

• • Income must be within 300% of Social Security Income (SSI)
• • Does not look at parental income

For TxHmL waiver:

• • Income must be within 100% of SSI
• • Does look at parental income

Functional Eligibility

Individuals must meet the functional eligibility criteria for the specific waiver. Refer to page 3 of the Texas Long-Term Services and Supports Waiver Programs document for functional eligibility criteria specifics.

Depending on you or your loved one with IDD’s situation, you should start by contacting your Local IDD Authority or LIDDA. They can help you understand your options based on your individual circumstances and needs. Income, age, disability, and urgency may all impact options. You may go to Your Texas Benefits to apply for benefits of all kinds and determine what you may be eligible for (the LIDDA can assist you in filling out the form), including CFC.

Please note that there is no one number to call or place to be added to all the lists. Since eligibility is not determined until your name comes up on the list, we recommend adding your name to all lists since you do not know the circumstances and support needs that will exist when your name comes up on a particular list. In addition, you may receive waiver services from one program while waiting for another.

• • For MDCP, CLASS, and DBMD interest lists call 1-877-438-5658
• • For HCS and TxHmL interest lists, contact your local intellectual and developmental disability authority (LIDDA)
• • For STAR+PLUS HCBS interest list call 1- 877-782-6440

Watch this video by The Arc of Texas and The Texas Council for Community Centers about how to access a crisis diversion waiver.

About Crisis Diversion

Crisis Diversion waivers are HCS waivers, historically funded separately from the first come, first serve waitlist (currently they are funding these waivers with attrition) to prevent Texans with disabilities from being institutionalized due to a lack of supports and services. The phrase many people know in relation to qualifying for a crisis diversion waiver is “imminent risk of institutionalization.” This term means different things to each person or family and is not a black and white definition.

Contact your LIDDA and tell them you or your loved one needs an HCS crisis diversion waiver. The LIDDA should help you through the process. It is very important for you and/or your loved to be involved in the process and ensure the LIDDA paints an adequate picture of the situation – the support needed to prevent institutionalization.

The LIDDA, with you or your loved one’s input, will fill out form 1058 and the LIDDA will submit a copy of the Determination of Intellectual Disability (DID), the person’s Inventory for Client and Agency Planning (ICAP) booklet/scoring sheet, and other needed documentation to HHSC. You can learn more about the full process here.

Do I need to enter an Intermediate Care Facility (ICF) to receive a diversion waiver?

No! If an ICF or other services are not “adequate and appropriate” for you or your loved one’s needs, which can be true for many reasons, including location or the institutional model (for example, living with lots of other people or not with parents), then you meet the requirements for “imminent risk” of institutionalization and can request a diversion waiver.

Yes. Check out the Health and Human Services Commission’s comprehensive information on each waiver, including a comparison of each waiver chart, and explanation of all services offered.

Yes. Check out Navigate Life Texas’ explanation on Texas Medicaid Waiver Programs for Children with Disabilities.

Learn more on our Waiting on a Waiver page, and the Texas Medicaid Waivers webpage.