on a Waiver

Medicaid Home and Community-Based Services (HCBS) waivers help people with disabilities live and work in their community. Unfortunately, there are over 158,000 Texans on the interest list (also called a “waitlist”).

See below for an overview of the six types of waivers for people with disabilities, as well as step-by-step instructions to look up your place in line or join waitlists.

What are HCBS Waivers?

Medicaid Home and Community-Based Services (HCBS) waivers help people with disabilities live and work in their community. Texas offers seven different waivers, six of which are specific to individuals with disabilities.

Waivers provide opportunities for people to receive cost-effective, long-term services and supports in their own home, rather than in an institutional setting, allowing them to live and work in their community. A waiver can cover things that are almost NEVER covered by private insurance, like an attendant that helps someone get out of bed and get dressed, supports to help someone get or keep a job, or specialized interventions to help with someone’s behaviors in particular situations.

HCBS waiver services can include, but are not limited to:

  • personal assistance services
  • in-home or out-of-home respite care
  • home nursing services
  • medical equipment and supplies
  • assisted living
  • employment supports
  • cognitive rehabilitation
  • occupational, physical and speech therapies

Six Waivers for Texans with Disabilities

  1. Community Living Assistance and Support Services (CLASS)
  2. 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.

  3. Deaf Blind with Multiple Disabilities (DBMD)
  4. 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.

  5. Home and Community-based Services (HCS)
  6. 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.

  7. Medically Dependent Children Program (MDCP)
  8. 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.

  10. STAR+PLUS gives services to adults over the age of 21 to keep them in their community and not in a nursing home facility.

  11. Texas Home Living (TxHmL)
  12. 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.

Learn more about waiver waitlists/interest lists.

The Problem

Because the demand for waivers far outweighs the resources made available by the Texas Legislature, Texans with intellectual and developmental disabilities (IDD) are placed on often decades-long interest lists. We must use our voices to advocate for additional funding for waivers to ensure that people with IDD receive the services they require and deserve.

You can now find your place on waitlists by taking the following steps online. We encourage you to do so and check back often.

Find Your Place on Waiver Interest List(s)

1. Create an account at www.YourTexasBenefits.com and log in

2. Click “Interest List Manager” under “Quick Links” on the right side panel

3. Click “Find my Interest List ID”

4. Choose a way to identify yourself by entering your interest list ID, your Social Security Number, or your Medicaid ID

5. You will then be able to see each list you are on and your place in line on each.

6. Ensure that your contact information is correct and log in periodically to check your status.

Join Waiver Interest Lists

If you or your loved one would like to receive services and supports via Medicaid Waiver programs, follow the instructions below.

If you have questions about services available to you, or if you have trouble with the online sign-up process, call your Local Intellectual and Developmental Disability Authority (LIDDA). They can help you understand your options based on your individual circumstances and needs. Income, age, disability and urgency may all impact options.

How To Sign Up for Waivers in 30 Minutes

1. Create an account at www.YourTexasBenefits.com and log in

2. Click “Interest List Manager” under “Quick Links” on the right side panel

3. Select “Create an Interest List ID” on right hand side in blue box

4. Choose “Interest Lists” to join, fill out interest list ID information, and fill out the interest list questionnaire.

Note: You can only join waitlists for the following waivers online: Community Living Assistance and Support Services (CLASS), Deaf Blind with Multiple Disabilities (DBMD), Medically Dependent Children Program (MDCP), and STAR+PLUS HCBS program (STAR+PLUS HCBS).

To join the waitlists for Texas Home Living (TxHmL) or Home and Community-based Services (HCS), call your LIDDA.

Note: You must sign up individually for each waiver you are interested in.

Questions? See FAQs at the bottom of this page.

Disability Services in Texas

Frequently Asked Questions

What is Medicaid?

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.

What does Medicaid cover for people with disabilities?

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.

How do I get long-term services and supports through Medicaid in the community?

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.

What is Community First Choice?

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.

What are HCBS Waivers?

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.

What are the eligibility criteria for HCBS waivers?

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.

Who do I contact to get on the interest/waiting list for HCBS waivers?

Scroll up to see “How to Join Waiver Interest Lists” above.

I need services NOW and can’t wait for a waiver. What can I do?

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.

Are there different types of waivers? How are they different?

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

Are there waivers for children with intellection and developmental disabilities?

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

Where can I learn more about waivers?

Learn more on the Texas Medicaid Waivers webpage.