Medicaid Waiver Guide – Texas

Understanding the Texas Medicaid

Texas currently has six Medicaid waivers that can serve children, and all of them are home and community based 1915(c) waivers. Five of these six waivers are based only on child income without regard to parent income. See this information on Long Term Care or this page comparing the various programs. An independent site, Texas Medicaid Waivers Explained, also gives general information about the waiver process in Texas. Texas also has a Medicaid Buy-In Program for children.

Texas has shifted children in most waiver programs into managed care through an 1115 demonstration program called STAR Kids. In addition, Texas began implementing the Community First Choice Option in 2015, which means it can no longer have waiting lists for attendant care for individuals who qualify for Medicaid. It appears that Texas is allowing some individuals on waiting lists for waivers to access this benefit.

Types of Waiver Programs

Medically Dependent Children Program (MDCP) Waiver

• Description from medicaid.gov: Provides respite, supported employment, financial management services, adaptive aids, employment assistance, flexible family support services, minor home modifications, and transition assistance services to individuals who are medically fragile ages 0-20 years who meet a hospital or nursing facility level of care.  This waiver operates with a concurrent 1915(a)(1)(a) and 1115 authority.
• Online State Information: Medically Dependent Children Program
• Official Federal Information
• How to Apply: Call 1-877-438-5658 to be placed on the waiting list.

Deaf Blind with Multiple Disabilities

• Description from medicaid.gov: Provides case management, day habilitation, residential habilitation, respite, supported employment, prescribed drugs, financial management services, support consultation, adaptive aids and medical supplies, assisted living, audiology services, behavioral support services, chore service, dental treatment, dietary services, employment assistance, intervener, minor home modifications, nursing, occupational therapy services, orientation and mobility, physical therapy services, speech, hearing, and language therapy services, transition assistance services for individuals with DD, ages 0 – no max age.
• Online State Information: Deaf Blind with Multiple Disabilities Program
• Official Federal Information
• How to Apply: Call 877-438-5658 or contact your local office.

Community Living Assistance & Support Services (CLASS) Waiver

• Description from medicaid.gov: Provides case management, prevocational services, residential habilitation, respite (in-home and out-of-home), supported employment, adaptive aids, dental treatment, dietary, nursing, occupational therapy, physical therapy, prescribed drugs, speech and language pathology, financial management services, support consultation, auditory integration training/auditory enhancement training, behavioral support, cognitive rehabilitation therapy, continued family services, employment assistance, minor home modifications, specialized therapies, support family services, transition assistance services to individuals with DD, ages 0 – no max age.
• Online State Information: CLASS Program
• Official Federal Information
• How to Apply: Call 877-438-5658 or contact your local office.

Home Living Program (TXHML) Waiver

• Description from medicaid.gov: Provides day habilitation, respite, supported employment, prescription medications, financial management services, support consultation, adaptive aids, audiology services, behavioral support, community support, dental treatment, dietary services, employment assistance, minor home modifications, nursing, occupational therapy services, physical therapy services, and speech-language pathology services for individuals with intellectual disabilities and developmental disabilities ages 0 to no max age.
• Online State Information: Home Living Program
• Official Federal Information
• How to Apply: Call 877-438-5658 or contact your local office.

Home and Community-Based Services (HCS) Program Waiver

• Description from medicaid.gov: Provides day habilitation, respite, supported employment, adaptive aids, audiology, occupational therapy, physical therapy, prescribed drugs, speech and language pathology, financial management services, support consultation, behavioral support, cognitive rehabilitation therapy, dental treatment, dietary services, employment assistance, minor home modifications, nursing, residential assistance (host home/companion care, supervised living, residential support services), social work, supported home living, transition assistance services for individuals with ID/DD, ages 0 – no max age.
• Online State Information: Home and Community Based Services
• Official Federal Information
• How to Apply: Contact your local office.

Youth Empowerment Services

• Description from medicaid.gov: Provides respite, supported employment, adaptive aids and supports, community living supports, employment assistance, family supports, minor home modifications, non-medical transportation, paraprofessional services, specialized therapies, supportive family-based alternatives, and transitional services to individuals with serious emotional disturbance ages 3-18 years who meet a hospital level of care.
• Online State Information: Youth Empowerment Services
• Official Federal Information
• How to Apply: Contact your County Local Mental Health Authority.

Other online resources for Texas:

• Texas Medicaid Waivers is a website that helps parents navigate through Texas’ difficult and frustrating process. The website looks outdated but has some good materials.
• Early Childhood Intervention Services may be able to help you if your child is younger than 3.
• Texas Parent to Parent connects parents for the purpose of sharing information, advice, and emotional support.
• This Children’s Health page provides some extra information and advice on the Texas Medicaid Process
• The ARC of Texas can help you with all things related to disability including advocacy.

Telephone Resources

• Call 1-877-438-5658 for information about putting your child on an interest list for long-term services.
• Local HHS Offices can be found here
• 1.800.866.4726 this Partner Resource Network number can connect you with their Texas state office and help you find and obtain services.

Ordering Goally with a Medicaid Waiver

Talk with your case manager to see if the waiver program you have will cover Goally. If so, have your case manager email us at: [email protected] to place an order on your behalf.