Texas Medicaid Waiver Programs for Children with Disabilities

Waivers

Video: Waivers and Wait Lists

Texas Medicaid waivers are a gateway to getting services for your child. We don’t want to tell you what to do, but we strongly suggest that you consider adding your child to the waiver interest list(s), which many parents call “waiting lists,” if you haven’t already done so. Even if you hope your child will never need those services, it is very important that they be added to the interest list for any program(s) that might meet their needs. You can always decline the services once your child moves to the top of the list.

Medicaid Waiver Programs for Children with Disabilities

Many parents say they wish they had signed up for the waiver interest lists when their child was born or first diagnosed with a disability or special health-care needs. Some of the interest lists have more than a 10-year wait time for services.

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What Are Waivers and How Do They Work?

• Waivers let states use Medicaid funds for long-term home and community-based services for people with disabilities or special health-care needs and the elderly in order to help them live in the community.
• Before the creation of waiver programs, people had to live in hospitals, nursing homes, or other institutions such as Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID), so that Medicaid would pay for long-term services.

They are named “waivers” because certain Medicaid requirements are waived (meaning they don’t apply). For example, family income. All but 1 waiver is based on just the child’s income and certain licensing requirements for service providers. Your child’s income means any money that they personally have in assets, earn, or are paid – not your whole family’s income.

• Besides getting these additional services, people who receive waiver long-term services and supports also get full Medicaid health-care benefits. This is a huge help for children who have complicated medical needs and no other health insurance.
• Texas has 7 waivers, and each one has its own interest list. Consider adding your child to all the interest lists based on their identified diagnosis and current needs. You don’t know what future needs your child might have, so you might want to place them on as many of the lists as possible. One of the Medicaid waivers, known as the Youth Empowerment Services (YES) program, will eventually be statewide but is currently only available in several counties, including Bexar, Tarrant, Harris, and Travis.
• Waivers are managed by the Department of State Health Services (DSHS), the Health and Human Services Commission (HHSC), or the Texas Department of Aging and Disability Services (DADS).
• When there is room for your child on one of the waiver programs, they will come off of the interest list. This is when DSHS, HHSC, or DADS (as applicable) will review diagnostic and other information to decide if your child meets the waiver requirements. Depending on the waiver, you might be asked for information about their medical, psychological, and developmental history, as well as financial and income eligibility. The eligibility information that is needed changes based on the waiver. The comparison of Texas Medicaid waiver programs chart gives you more details about what is needed for each of the waivers.

How to Add Your Child to Interest Lists

You do not have to prove your child is eligible before adding them to the waiver interest lists. Your child will go through this process and review once they move to the top of the list. Only then is the eligibility information reviewed and used to decide if your child can enroll.

• Call 1-855-937-2372 for information about DADS long-term services. A trained professional will guide you to the right option, including the waivers, if appropriate.
• Call your Local Mental Health Authority about the Youth Empowerment Services (YES) waiver program. Go to the DSHS website to find the Local Mental Health Authority in your area.

The Texas Medicaid Waivers

All of the waivers are listed below with a description and link leading to more information about each one:

• Community Living Assistance and Support Services (CLASS): gives home and community-based supports to people with related conditions.
• Deaf Blind with Multiple Disabilities (DBMD): gives services for people 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 people 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 beds.
• Medically Dependent Children Program (MDCP): gives services to families caring for children and young adults as an alternative to receiving services in a nursing facility.
• STAR+PLUS Home and Community-based Services (HCBS): a managed care model so that people who qualify for nursing facility care can get acute care and long-term services and supports (LTSS) in order to live in the community.
• Texas Home Living (TxHmL): gives services to people 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 who otherwise would need psychiatric inpatient care or whose parents would turn to state custody for care.

Important Tips About Interest (Waiting) Lists

• Consider adding your child to as many waiver interest lists as possible when your child is first diagnosed with a disability or special health-care needs. You should also think about adding your child to the lists even if they aren’t diagnosed but have reason to believe that you child will have a long-term disability or special health-care needs.
• Ask for an email confirmation or a mailed letter when you add your child to the Medicaid waiver interest lists. Keep this in a safe place.
• It is very important to keep your address and contact phone numbers updated because if your child moves to the top of the interest list and they can’t reach you, your child will be dropped from the list.
• At least 1 time a year, call to update your contact information so they know how to reach you. Most parents remember by calling around their child’s birthday. During these calls, you can also find out where your child is on the list. Write it down in a safe place, like your care notebook, so you can keep track of how far your child moves up the list each year. See our Organizing Medical Records page for more information about care notebooks.
• Once your child moves to the top of an interest list, a service coordinator, case manager, or nurse will schedule a home visit. This will start the process of determining if your child is able to enroll in one of the waiver programs. You can also research the waiver program beforehand to learn what it takes for your child to get its services.
• Your child can remain on other waiver interest lists while receiving waiver services. They just can’t receive services from more than 1 waiver program at the same time. For example, if your child is receiving MDCP services, and they move to the top of the CLASS interest list and are approved for CLASS services, you will have to pick between the 2 programs. In this example, it might be better to give up MDCP and enroll your child in the CLASS program, since your child will age out of MDCP at 21 years old, and CLASS has no age limit. You can also connect with other parents whose children receive waiver services to help you decide which one is best for your child.
• If you have other health insurance through an employer, and your child is enrolled in a waiver program, you might be reimbursed for health insurance premiums through the Health Insurance Premium Payment (HIPP) program. Once your child starts receiving waiver services, call your local utility company about possible discounts on electricity, water, and wastewater bills if your child lives in your home. Depending on income, your family might also be able to receive food stamps (SNAP benefits).
• Most of the waivers offer the Consumer Directed Services (CDS) choice for at least some, if not all, of the program’s services. Also known as “self-directed services,” this gives you more personal control over how your child’s services are delivered, and many parents prefer it. For example, parents who pick the CDS choice serve as the employer for their child’s attendants. They are able to interview, hire/fire, and train them.
• If your child has an intellectual disability or a condition related to an ID in addition to high medical needs, call 1-855-937-2372 to ask about diversion slots. These slots are for extreme cases only, such as a critical health crisis that puts the family at risk of placing the child in a state supported living center. If approved, your child moves to the top of the HCS interest list.

Suggested Links to Additional Resources

• Comparison of Texas Medicaid waiver programs
• DADS’ Access and Intake Services Community Booklet
• Texas Department of Aging and Disability Services (DADS) interest lists
• Medicaid.gov web page about Medicaid waiver programs
• Texas Health and Human Services Commission, “Home and Community- based Services in Texas: Which Programs Do What?” in English and “Servicios en el Hogar y en la Comunidad en Texas: ¿Qué servicios ofrecenlos programas?” in Spanish
• Texas Council for Developmental Disabilities: “A Roadmap to Understanding Texas Medicaid Waivers”
• More about the YES waiver
• More about the HCBS waiver