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 158,000 people.

See the top of this page for a description of each waiver.