Texas Medicaid waiver programs for people with IDD

What are the Texas Medicaid waiver programs for people with IDD?

Texas runs four Medicaid waiver programs for people with an intellectual disability or a related condition: 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 Texas Health and Human Services Commission (HHSC) oversees all four.

HHSC explains that these programs serve people who live in their own home, their family's home, or another home-like setting. They are called waivers because certain requirements of the ICF/IID program, the institutional option, are waived.

The federal rules come from section 1915(c) of the Social Security Act. Under a 1915(c) waiver, a state must show that waiver services will not cost more than institutional care, that people are kept healthy and safe, and that services follow a person-centered plan of care.

HHSC notes that, in most situations, anyone eligible for the ICF/IID program is also eligible for one of the waivers. Waiver funding moves with the person to any part of Texas, and a person can change providers within the same city or anywhere in the state.

How do HCS, TxHmL, CLASS, and DBMD compare?

The four waivers differ in who they serve, where people live, and who helps them enroll. HCS is the only one of the four that includes group homes of up to four people and host homes. TxHmL serves people living at home. CLASS and DBMD serve people with related conditions and enroll without the LIDDA.

Here is how HHSC describes each program in its August 2025 overview of IDD services and supports.

• HCS: people with IDD who live with family, in their own home, in a host home/companion care setting, or in a residence with no more than four people receiving services. Service coordination comes from the LIDDA. Yearly cost is capped by level of need, from $169,182 to $392,318.
• TxHmL: people with IDD who live with family or in their own home. Services supplement family and community supports. Service coordination comes from the LIDDA. Services are capped at $17,000 per person per year.
• CLASS: people with a related condition (a disability other than an intellectual disability that began before age 22) who need habilitation. Case management is part of the program. LIDDAs do not handle enrollment.
• DBMD: people who are deaf and blind and also have another disability. Services focus on communication and interacting with their surroundings. LIDDAs do not handle enrollment.

What is the difference between HCS and TxHmL?

HCS covers residential services, and TxHmL does not. Both serve people with IDD, both use the LIDDA for enrollment and service coordination, and both offer day, therapy, nursing, and employment services. TxHmL is for people who stay in their own or their family home.

HHSC lists HCS services as transportation, adaptive aids, minor home modifications, professional therapies, behavioral support, dental, nursing, residential services, individualized skills and socialization (ISS), respite, and employment services. People who live in an HCS residence or a host home/companion care setting pay for their own room and board.

TxHmL covers 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.

The yearly cost limit is the other big difference. HHSC caps TxHmL at $17,000 per person per year. HCS limits are much higher and depend on the level of need (LON).

HHSC Information Letter 2025-21 sets the HCS individual cost limits effective Sept. 1, 2025. Each limit is 210 percent of the annualized ICF/IID cost of care at that level of need.

• HCS Intermittent (LON 1), Limited (LON 5), and Extensive (LON 8): $169,182 per year
• HCS Pervasive (LON 6): $211,822 per year
• HCS Pervasive Plus (LON 9): $392,318 per year
• TxHmL, any level of need: $17,000 per year

Who are the CLASS and DBMD waivers for?

CLASS serves people with a related condition who need habilitation services. DBMD serves people who are deafblind and have at least one more disability. Neither program enrolls through a LIDDA. People are added to the interest list by calling HHSC at 877-438-5658.

HHSC defines a related condition as a qualifying disability, other than an intellectual disability, that began before age 22 and affects how the person functions in daily life. CLASS services include adaptive aids and medical supplies, behavioral support, case management, nursing, respite, specialized therapies, employment services, and support family services.

DBMD services include adaptive aids and medical supplies, assisted living, audiology, behavioral support, case management, minor home modifications, dental, chore services, intervener services, therapies, orientation and mobility, ISS, nursing, respite, and employment services.

How does Community First Choice (CFC) fit with the waivers?

Community First Choice (CFC) is a set of basic attendant and habilitation services for Medicaid recipients who need an institutional level of care. It is not a separate waiver. HHSC makes CFC available to people enrolled in HCS, TxHmL, CLASS, and DBMD, and to some people outside the waivers.

HHSC lists four CFC services: personal assistance services (help with activities like eating, bathing, and dressing), habilitation (teaching those skills), support management (how to select, manage, and dismiss attendants), and emergency response services for people who are often alone.

People with IDD who are not in a waiver can still get CFC through their managed care plan or traditional Medicaid. HHSC calls this non-waiver CFC. For them, the LIDDA completes the eligibility assessment on Form 8578-CFC and provides service coordination to adults 21 and older in managed care.

In HCS, CFC services appear on the same plan of care. HHSC Form 3608 is titled Individual Plan of Care (IPC) HCS and CFC.

How is the ICF/IID program different from a waiver?

An ICF/IID is a 24-hour residential setting, not a waiver. Texas has two kinds: state supported living centers (SSLCs) on campuses, and community-based ICF/IID homes. The waivers were built as a community alternative to this level of care, so eligibility for the two often overlaps.

HHSC runs 13 SSLCs, each serving between 70 and 400 people with significant medical or behavioral health needs. State law limits SSLC admission to people with an intellectual disability.

Community-based ICF/IID homes serve people in a six-bed home or larger settings. Each operator can set extra admission criteria and keep its own waiting list. A person can choose a home, but the home must have a vacancy and the provider must approve the admission.

How do people get on an interest list and enroll?

Waiver slots are not always open right away, so HHSC keeps interest lists. To join the HCS or TxHmL list, the person, their legally authorized representative (LAR), or someone actively involved calls the HHSC interest list hotline at 877-438-5658. The local LIDDA manages the list for its area.

HHSC's LIDDA handbook says the person who has been on the interest list longest is served first. When funding opens, HHSC releases the next person and authorizes the LIDDA to make an enrollment offer.

After an HCS or TxHmL offer, the LIDDA walks the person through eligibility and enrollment. For HCS, the LIDDA service coordinator leads the person-directed plan (PDP) and completes the initial Individual Plan of Care (IPC) before enrollment. In most areas there is a choice of providers, and the LIDDA can share a list of providers nearby.

How long is the wait for Texas IDD waivers?

The wait is measured in years. HHSC told the Texas House in May 2026 that people still on the HCS interest list had waited 8.4 years on average, and people removed from it in fiscal year 2025 had waited 16.7 years. HCS had 128,111 people on its list and 30,516 served.

HHSC gave these figures for August 2025, based on January 2026 reports. The first average counts people still on the list as of Aug. 31, 2025. The second counts people removed from the list in fiscal year 2025, for any reason.

Some individuals are on more than one interest list, so the lists overlap. Anyone can be on an interest list, and HHSC contacts people on the list at least once every biennium.

HCS slot releases are paused. HHSC announced on May 19, 2026, that it "will not release interest list reduction slots for the HCS program starting in May 2026," because biennial appropriations for HCS are insufficient to support more slot releases, based on data as of March 2026. HHSC says it will provide updates and has not given a date to resume.

• HCS: 30,516 served; 128,111 on the interest list; 8.4 years average wait for people still on the list; 16.7 years for people removed in fiscal year 2025
• TxHmL: 2,497 served; 116,551 on the list; 7.6 years still waiting; 14.6 years for people removed
• CLASS: 5,988 served; 96,211 on the list; 8.5 years still waiting; 16.3 years for people removed
• DBMD: 347 served; 2,324 on the list; 2.0 years still waiting; 5.7 years for people removed

Where do providers fit, and how does Sereniq help?

Providers deliver the services. HHSC says public or private entities may provide waiver services, and all waiver providers are certified or licensed by HHSC. The provider runs the homes and day programs, documents every service, and keeps the records surveyors and billing reviews check.

Sereniq is documentation software for HCS providers. It supports HCS residential support, supervised living, and host home/companion care, plus ISS day programs. DSPs write notes, medication passes, and incidents on their phones, and Sereniq prints the HHSC forms those records feed.

Sereniq records TxHmL as a waiver type on the individual record, but it does not ship TxHmL-specific workflows. It does not support CLASS, DBMD, or ICF/IID documentation. Sereniq was born in Texas on HHSC forms and adapts forms, terms, and time zones for other states. Texas is live today.