Texas Medicaid Waiver Guide

Texas runs its intellectual and developmental disability services through Texas Health and Human Services (HHSC), with four main Medicaid waivers — Home and Community-based Services (HCS), Texas Home Living (TxHmL), Community Living Assistance and Support Services (CLASS), and Deaf Blind with Multiple Disabilities (DBMD). The single most important thing to understand about Texas is the interest list. Demand far outpaces the slots the Legislature funds, so most people join a waiver “interest list” and wait — often well over a decade. Because of that, the most useful step a family can take is to sign up as early as possible. Your local IDD authority (LIDDA) is the front door for HCS and TxHmL, and it can also connect you to services you may be able to get while you wait.

Eligibility depends on the waiver. HCS and TxHmL require an intellectual disability (generally a full-scale IQ of about 70 or below) confirmed through a Determination of Intellectual Disability (DID), or a qualifying related condition, plus an ICF/IID level of care and Medicaid. CLASS serves people with a related condition — a disability other than intellectual disability that began before age 22. DBMD serves people who are deaf-blind with additional disabilities. Meeting the criteria does not mean immediate services, because each waiver enrolls people from its interest list as funding allows.

Texas serves most IDD waiver services through “interest lists” rather than open enrollment, and the lists are among the longest in the country. Six programs use them: HCS, TxHmL, CLASS, DBMD, MDCP, and STAR+PLUS HCBS. Places are first-come, first-served — the people who have been waiting longest are enrolled first — so the date you sign up matters more than anything else. Being on a list does not by itself provide services, but it also does not stop you from receiving Medicaid or other community services in the meantime, and taking those does not affect your place.

Type

Interest lists (one per waiver, ordered by sign-up date)

Typical timeline

Waits for HCS commonly run 10–15+ years, and releases depend entirely on what the Legislature funds each biennium. As of a May 19, 2026 HHSC notice, no HCS interest list reduction slots are being released from May 2026 through the end of FY 2026 — biennial appropriations were not sufficient to support more. 315 slots had been released between September 2025 and April 2026. HHSC says it is monitoring affordability and will post updates. Separately, “attrition slots” continue to be used for people in crisis and people moving out of nursing facilities or state supported living centers, so those paths are not frozen.

How to check status

For HCS and TxHmL, contact your LIDDA. For CLASS, DBMD, MDCP, and STAR+PLUS HCBS, call the CSIL hotline at 1-877-438-5658. You must sign up for each waiver separately. HHSC publishes monthly interest list counts and release figures on its Interest List Reduction page.

1. Find your local LIDDA

   Your Local Intellectual and Developmental Disability Authority is the front door for HCS and TxHmL. Find yours in the HHS directory or by calling 2-1-1.

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2. Get on the interest list(s) — as early as possible

   Ask your LIDDA to add the person to the HCS and TxHmL interest lists. For CLASS, DBMD, MDCP, or STAR+PLUS HCBS, call the CSIL hotline at 1-877-438-5658. Sign up for each waiver you may want.

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3. Ask about help available now

   While you wait, your LIDDA can explain services you may get sooner — Community First Choice, Medicaid state-plan services, ICF/IID, and general-revenue supports.

4. Complete eligibility when your name comes up

   When a slot opens, the LIDDA completes the Determination of Intellectual Disability and ID/RC assessment, and HHSC confirms Medicaid financial eligibility.

5. Enroll and choose how services are delivered

   Pick a program provider, or choose the Consumer Directed Services (CDS) option to hire and manage your own staff with a Financial Management Services Agency.

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• The person's age, diagnosis, and county of residence.
• Medicaid status or whether you still need to apply.
• Current supports, urgent needs, and living situation.
• School, medical, evaluation, or eligibility documents.
• Questions about waitlists, timelines, and next steps.

Exact covered services depend on the waiver, assessed need, Medicaid rules, funding, and state program requirements. Confirm services, availability, and payment acceptance with the state, support coordinator, and provider.

Texas offers the Consumer Directed Services (CDS) option across HCS, TxHmL, CLASS, and DBMD, letting you recruit, hire, train, and manage your own workers with help from a Financial Management Services Agency (FMSA) that handles payroll and paperwork. A lighter Service Responsibility Option (SRO) lets you direct your workers' day-to-day schedules without becoming the legal employer.

1. Early Childhood Intervention (birth–3)

   Texas's ECI program serves infants and toddlers with developmental delays or disabilities. This is also a good time to join waiver interest lists, since the wait is so long.

2. School age (3–21)

   Public schools provide special education through an IEP. Keep interest-list sign-ups current — many families add a young child to HCS so a slot may open near adulthood.

3. Transition to adulthood (14–22)

   IEP transition planning and the Texas Workforce Commission (vocational rehabilitation) prepare students for work and independent living while they wait for waiver services.

4. Adult services

   When a waiver slot opens, the LIDDA coordinates adult supports — supported home living, residential, day and employment services, and the CDS self-direction option.

5. Decision-making at 18

   Texas families weigh guardianship, alternatives like a Supported Decision-Making Agreement (authorized by Texas law), and powers of attorney as the person reaches adulthood.

If a waiver service is denied, reduced, or ended, you can request a Medicaid fair hearing — generally within 90 days of the notice. The HHS IDD Ombudsman (1-800-252-8154) can help you resolve problems, and Disability Rights Texas provides free legal advocacy.

HHSC

The Texas Health and Human Services Commission, the state agency that runs the IDD Medicaid waivers.

LIDDA

Local Intellectual and Developmental Disability Authority — the local agency that handles interest lists, eligibility, and service coordination for HCS and TxHmL.

Interest list

Texas's term for its waiver waiting lists. People are added by date and offered services as funding allows; you sign up for each waiver separately.

HCS

Home and Community-based Services — the main, more comprehensive IDD waiver, which can include residential support.

TxHmL

Texas Home Living — a waiver with more limited supports for people who live in their own or their family's home.

CLASS

Community Living Assistance and Support Services — a waiver for people with a related condition (other than intellectual disability) that began before age 22.

DID

Determination of Intellectual Disability — the formal finding, completed by the LIDDA, used to establish eligibility for HCS and TxHmL.

ID/RC assessment

The Intellectual Disability/Related Conditions assessment (Form 8578) used to confirm an ICF/IID level of care.

CDS

Consumer Directed Services — the option to hire and manage your own workers with help from a Financial Management Services Agency.

CFC

Community First Choice — Medicaid state-plan attendant and habilitation services that may be available while you wait for a waiver.