Texas’ Medicaid Waivers Overview

The purpose of a Medicaid Waiver is to prevent institutionalization by providing community-based care options.

Texas has 7 Waivers created through the Social Security Act section 1915(c):

• CLASS (Community Living Assistance and Support Services) Waiver
• HCS (Home and Community Based Services) Waiver
• TxHmL (Texas Home Living) Waiver
• MDCP (Medically Dependent Childrens Program) Waiver
• SPW (Star+Plus HCBS (Home and Community Based Services) Waiver)
• DMBD (Deaf-Blind Multiple Disabilities) Waiver
• YES (Youth Empowerment Services) Waiver

Each of these Medicaid Waivers was designed to address a different category of disabilities, and the way the services are managed is different.

• CLASS is the most flexible of the Medicaid Waivers.
  • The service array includes accommodates for both physical and intellectual disabilities, including lots of adaptive aid categories, specialized therapies with mental and physical benefits (music therapy, massage therapy, aquatic therapy, recreational therapy, therapeutic horseback, and hippotherapy), along with both PAS/Hab (Personal Assistance Services) and Respite (relief for natural supports).
  • The providers are all non-governmental, so you have many choices for both Case Management Agencies and Direct Service Providers (home health agencies).
  • There are no age limits for CLASS
• HCS is the most well known of the Medicaid Waivers.
  • The service array is designed around individuals with IDD (Intellectual and Developmental Disabilities). The most unique feature of HCS is the 3 options available for daily support: 1. Group Home living with daily or hourly care; 2. Host Home care with a daily rate; 3. PAS/Hab (Personal Assistance Services) that can only be provided by someone who does not live in the same home.
  • The 3 biggest drawbacks to HCS are:
    1. People who live with the individual can only receive a daily rate for Host Home; they cannot provide any paid support as part of the PAS/Hab team.
    2. Host Home rate is determined by a Level of Need tool vs a PAS/Hab assessment.
    3. The HCS Providers are non-governmental with lots of choices; but the HCS Service Coordination was assigned to the LIDDA (local IDD authority) based on your county and there is no alternative when they are not helpful.
  • There are no age limits for HCS
• TxHmL is a mini-HCS, with lower funding limits and no Medicaid-access provision.
  • The service array is designed around individuals with IDD (Intellectual and Developmental Disabilities). TxHmL provides selected essential services and supports to people with intellectual and developmental disabilities who live in their family homes or their own homes. TxHML has 2 options available for daily support: 1. Host Home care with a daily rate; 2. PAS/Hab (Personal Assistance Services) that can only be provided by someone who does not live in the same home.
  • The 3 biggest drawbacks to TxHmL are:
    1. People who live with the individual can only receive a daily rate for Host Home; they cannot provide any paid support as part of the PAS/Hab team.
    2. Host Home rate is determined by a Level of Need tool vs a PAS/Hab assessment.
    3. The TxHmL Providers are non-governmental with lots of choices; but the TxHmL Service Coordination was assigned to the LIDDA (local IDD authority) based on your county and there is no alternative when they are not helpful.
  • There are no age limits for TxHmL, but you must already have Medicaid to accept the spot.
• MDCP is an amazing short-term options.
  • The service array is designed to support a family caring for a child with high medical needs. It includes an option for respite to be provide by an unskilled person or a nurse.
  • It ends at age 21. If the nursing needs remain, the individual should be transitioned to the Star+Plus HCBS Waiver.
  • MDCP is managed completely by the StarKids Managed Care Organization you select. You can select from subcontracted home health or Financial Management Service Agencies they have contracts with.
  • MDCP age limits are 0-20
• SPW (Star+Plus HCBS Waiver) is an alternative for adults who need Nursing Home care.
  • The service array is designed to accommodate medical needs.
  • It starts at age 21 and does not have a waiting list for individuals who are on Star+Plus Medicaid.
  • MDCP is managed completely by the StarKids Managed Care Organization you select. You can select from subcontracted home health or Financial Management Service Agencies they have contracts with.
  • SPW age limit is 21+ years old
• DBMD focuses on increasing opportunities for consumers to communicate and interact with their environment.
  • There are no age limits for DBMD
• YES is the newest waiver and the only one focused mental illness.
  • YES services are family-centered, coordinated and effective at preventing out-of-home placement and promoting lifelong independence and self-defined success.
  • YES Service Coordination is proved by the local mental health authority.
  • YES age limits are 3-18 years old