What is the difference between HCS and TxHmL in Texas?

What are HCS and TxHmL?

Home and Community-based Services (HCS) and Texas Home Living (TxHmL) are two of the four Texas Medicaid 1915(c) waivers for people with an intellectual disability or a related condition. The Texas Health and Human Services Commission (HHSC) oversees both, and the local intellectual and developmental disability authority (LIDDA) handles enrollment and service coordination for both.

Both programs pay for services in the community instead of an institution, so both are built on the same level of care as the ICF/IID program. HHSC's Medicaid for the Elderly and People with Disabilities Handbook lists the same core criteria for each: the person lives in the community, meets ICF/IID Level of Care VIII, and has an approved plan of care.

For the full list of Texas IDD waivers, including CLASS and DBMD, see our guide to Texas Medicaid waiver programs.

What is the biggest difference between HCS and TxHmL?

Residential services. HCS can pay for a person to live in a provider-run residence with no more than four people receiving services, or in a host home/companion care setting. TxHmL has no residential services. It supplements family and natural supports for a person who lives in their own home or their family's home.

That one difference shapes everything else. A person who needs round-the-clock support away from family usually needs HCS. A person who lives safely with family and needs targeted help, such as respite, therapies, or a day program, may be served by TxHmL.

HHSC notes that people who live in an HCS residence or a host home/companion care setting pay for their own room and board. HCS pays for the services, not the rent or groceries.

What services does each program cover?

The two lists overlap heavily. Both cover nursing, adaptive aids, minor home modifications, therapies, behavioral support, dental, individualized skills and socialization (ISS), respite, employment services, and transportation. HCS adds residential services.

HHSC lists HCS services as transportation, adaptive aids, minor home modifications, professional therapies, behavioral support, dental, nursing, residential services, ISS, respite, and employment services.

HHSC lists TxHmL services as transportation, nursing, adaptive aids, minor home modifications, specialized therapies, behavioral support, dental, ISS, respite, and employment services. HHSC says TxHmL services supplement, but do not replace, other programs such as Texas Health Steps and natural supports such as family and neighbors.

Community First Choice (CFC) attendant and habilitation services are available to people in both programs. That is why the HCS plan of care is titled "Individual Plan of Care (IPC) HCS and CFC" and the TxHmL plan is titled "TxHmL-CFC Individual Plan of Care."

How do the cost limits compare?

TxHmL has a flat cap of $17,000 per person per year. HCS caps are much higher and depend on the person's level of need (LON): $169,182 for LON 1, 5, and 8, $211,822 for LON 6, and $392,318 for LON 9, effective Sept. 1, 2025.

HHSC Information Letter 2025-21 sets each HCS limit at 210 percent of the annualized ICF/IID cost of care at that level of need. The LON comes from the ICAP and parts of the ID/RC Assessment, which our ICAP and level of need guide explains.

For scale: HCS residential support at LON 1 pays $164.46 per day on the current HCS rate table, about $60,000 over a full year. That is more than three times the whole TxHmL cap.

How is Medicaid eligibility different?

HCS can make a person Medicaid eligible through the special income limit for waiver applicants. TxHmL cannot. HHSC's handbook says a TxHmL applicant must already be a Medicaid recipient, and TxHmL eligibility is not determined with the special income limit.

In HHSC's Medicaid for the Elderly and People with Disabilities Handbook, Section A-3330 says an HCS applicant is eligible for Medicaid using the special income limit. Section A-3370 says a TxHmL applicant must be "currently a Medicaid recipient" and that "eligibility is not determined using the special income limit."

In practice, a person who would only qualify for Medicaid through the waiver itself can be served by HCS but not by TxHmL. Families should confirm eligibility with their LIDDA and HHSC, because each case depends on the person's income, resources, and Medicaid category.

How do the interest lists compare?

Both programs keep separate interest lists managed by the LIDDA, and both waits run for years. HHSC told the Texas House in May 2026 that people still on the list had waited 8.4 years on average for HCS and 7.6 years for TxHmL.

To join either list, the person, their legally authorized representative (LAR), or someone actively involved calls the HHSC interest list hotline at 877-438-5658. Families register separately for each program.

HHSC paused HCS interest list slot releases starting in May 2026, citing insufficient appropriations. Our HCS slot pause guide covers what that means for providers.

What does the difference mean for providers?

HCS and TxHmL are separate HHSC contracts, with separate plan of care forms and separate billing rules, though HHSC surveys both through Long-Term Care Regulation. An agency that runs group homes or host homes needs an HCS contract. TxHmL work is non-residential: day programs, respite, nursing, and in-home supports.

The paperwork follows the program. An HCS provider works from the IPC on Form 3608 and documents residential support on the Form 4119 service delivery log or host home/companion care on the Form 4122 log. A TxHmL provider works from the IPC on Form 8582. ISS is shared: HHSC Form 8615 is the on-site and off-site ISS service delivery log for both HCS and TxHmL.

Our guide on how to become an HCS provider walks through the contract application, training, and the initial certification survey.

Which programs does Sereniq support?

Sereniq is built for HCS: Residential Support, HCBS Supervised Living, and Host Home/Companion Care, plus ISS day programs. Sereniq records TxHmL as a waiver type on the individual record, but it does not ship TxHmL-specific workflows or print Form 8582.

For HCS homes, DSPs write notes, medication passes, and incidents on their phones, and Sereniq prints the Form 4119 and Form 4122 service logs, the Form 3092 MAR, and the Form 3608 IPC. For ISS, Sereniq prints the Form 8615 log from attendance.

Sereniq was born in Texas on HHSC forms and adapts forms, terms, and time zones for other states. Texas is live today. This guide is not legal or eligibility advice; confirm every requirement with HHSC and your LIDDA.