Medicaid Waiver Programs

Medicaid is a jointly funded state-federal program signed into law along with Medicare in 1965 by President Lyndon B. Johnson. Medicaid began as an assistance program to help individuals with low income but it has grown to provide health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities.

Since the early 1980s, programs known as Medicaid waivers have given states the flexibility to waive certain Medicaid requirements to provide care for people who otherwise might not qualify for Medicaid. This is why they are called "waivers". For example, Medicaid eligibility is based solely on family income; however, all but one waiver is based on only the child’s income rather than family income. Your child’s income means any money that they personally have earned or are paid.

Before the creation of waiver programs, people had to live in hospitals, nursing homes, or other institutions like state-supported living centers or residential treatment centers so Medicaid would pay for long-term services. Through waiver programs, Medicaid now pays for a comprehensive range of services in the home and community rather than in an institutional setting.

Some of the services you can get with a waiver are:
Personal care for help with things like bathing or dressing
Nursing care
Home modifications like ramps
Car modifications
Respite care
Certain therapies

Besides getting these additional services, people also get full Medicaid health-care benefits. This is a huge help for children and adults who have complicated medical needs and no other health insurance.

There are 7 different Medicaid Waiver programs in Texas and each has its own rules, qualifications, and funding amounts. Waivers are managed by the Health and Human Services Commission (HHSC).

The 7 programs are:

Community Living Assistance and Support Services (CLASS):

• Provides home and community-based services to people with an intellectual disability or a related condition as a cost-effective alternative to placement in an intermediate care facility. A related condition is a disability, other than an intellectual disability, that originated before age 22 and that affects a person's ability to function in daily life. Related conditions are found in the list of Approved Diagnostic Codes for Persons with Related Conditions.
• To be eligible for the CLASS waiver, individuals also must have substantial functional limitation in at least three of the following fields:
  • Learning
  • Mobility
  • Self-care
  • Language
  • Self-direction (age 10 and older)
  • Independent living (age 10 and older)
• Individuals must live in their own home or their family's home.
• Services offered include adaptive aids, auditory enhancement/auditory integration training, behavior support, case management, cognitive rehabilitation therapy, dental services, dietary services, employment services, minor home modifications, nursing, occupational and physical therapy, personal assistance services, respite, speech and language therapy, transition assistance services and transportation.
• Visit the CLASS website.
• Informational documents: What is CLASS in English and What is CLASS in Spanish.

Deaf Blind with Multiple Disabilities (DBMD):

• The program provides home and community-based services to people who are deaf-blind or function as a person with deafblindness with an additional disability as a cost-effective alternative to institutional placement. The program focuses on increasing opportunities for consumers to communicate and interact with their environment.
• Deafblind individuals must have another diagnosis to qualify—including but not limited to an intellectual disability—that originated when the individual was 22 years of age or younger. The disability must affect the individual's ability to function in daily life. The waiver refers to these disabilities as “related conditions.” Related conditions are found in the list of Approved Diagnostic Codes for Persons with Related Conditions.
• To be eligible for the DBMD waiver, individuals also must have substantial functional limitation in at least three of the following fields:
  • Learning
  • Mobility
  • Self-care
  • Language
  • Self-direction (age 10 years and older)
  • Independent living (age 10 years and older)
• Services include adaptive aids and medical supplies, assisted living, audiology, behavioral support services, case management, day habilitation, dental services, dietary services, employment services, minor home modifications, nursing, occupational and physical therapy, respite, and speech, hearing and language therapy services. Chore services, orientation and mobility services and intervener services, which are unique to DBMD, also may be provided.
• Visit the DBMD website.
• Informational documents: What is DBMD in English and What is DBMD in Spanish.

Home and Community-Based Services (HCS):

• The program provides individualized services and supports to persons with intellectual disabilities who are living with their family, in their own home or in other community settings, such as small group homes.
• Services include transition assistance services, PT, OT, speech and language pathology, audiology, social work, behavioral support, dietary services, cognitive rehabilitation therapy, nursing care, host home/companion care, supervised living, residential support, supported home living, respite, day habilitation, employment assistance, supported employment, adaptive aids, minor home modifications, and dental treatment.
• Visit the HCS website.
• Informational documents: What is HCS in English and What is HCS in Spanish.

Medically Dependent Children Program (MDCP):

• The program provides services to support families caring for children and young adults age 20 and younger who are medically dependent and to encourage de-institutionalization of children and young adults who reside in nursing facilities.
• Services include adaptive aids, employment assistance, financial management services, flexible family support services, minor home modifications, respite, supported employment and transition assistance services through a STAR Kids or STAR Health managed care organization.
• Visit the MDCP website.

STAR+PLUS Home and Community Based Services (HCBS):

• A managed care model that provides services for adults 21 and older who are medically eligible for nursing home care but who want to live in their community. It is sometimes called the STAR+PLUS waiver.
• Services include personal assistance services, respite care, home nursing services, home-delivered meals, minor home modifications, adaptive aids, medical equipment and supplies, adult foster care, assisted living, cognitive rehabilitation, and occupational, physical and speech-language therapy.
• Visit the HCBS website.

Texas Home Living (TxHml):

• The program provides selected essential services and supports to people with intellectual and developmental disabilities who live in their family homes or their own homes.
• Services include day habilitation, respite, supported employment, adaptive aids, behavioral support, community support, employment assistance, minor home modifications, nursing, dental treatment, OT, PT, speech/language pathology services, audiology services, and dietary services.
• Visit the TxHml website.
• Informational documents: What is TxHml in English or What is TxHml in Spanish.

Youth Empowerment Services (YES):

• Provides home and community services to children ages 3 through 18 years who otherwise would need psychiatric inpatient care or whose parents would turn to state custody for care.
• Services include adaptive aids and supports, community living supports, employment assistance, family supports, respite, supported employment, non-medical transportation, paraprofessional services, and specialized therapies.
• Nontraditional services provide alternative and creative forms of therapy to help improve the youth’s health, welfare and functioning in their community:
  • Animal-assisted therapy
  • Art therapy
  • Music therapy
  • Recreational therapy
  • Nutritional counseling
• Services are provided within a team planning process called wraparound. Wraparound builds on family and community support and uses YES services to help build the family’s natural support network and connection with their community.
• YES is not a first stop for meeting serious mental, emotional and behavioral health needs. Eligibility requires that children have tried less intensive mental health services.
• Visit the YES website.

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 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.

Be sure to ask for an email confirmation or a mailed letter when you add your child to the Medicaid waiver interest lists. Keep all correspondence in a safe place.

For CLASS, DBMD, and MDCP: Call toll-free 1-877-438-5658.

HCS and Texas Home Living Waiver: Call your Local Intellectual and Developmental Disability Authority (LIDDA) which is based on the county in which you live.

For YES: Call the YES waiver inquiry line at the local mental or behavioral health authority in your area which is based on the county in which you live.

• 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 along with all other correspondence.
• It is very important to keep your address and contact phone numbers updated. 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. They might also call you or send you a letter to see if your child still needs services. If they can’t reach you, they might take your child off the list.
• At least once a year, call to find out where your child is on the interest list and update your contact information, if needed. Most parents remember by calling around their child’s birthday. Write the number down in a safe place, like a care notebook, so you can keep track of how far your child moves up the list each year.
• 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 services.
• Your child can remain on other waiver interest lists while receiving waiver services. They just can’t receive services from more than one waiver program at the same time. For example, your child is receiving MDCP services. If they move to the top of the CLASS interest list and are approved for CLASS services, you will have to pick between the two programs. You might want to connect with other parents who have done this before.
• 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.

This document provides a comparison of the 7 Medicaid Waiver programs.