What Texas Health Steps Providers Need to Know

When Medicaid was first enacted, payment for long-term services was made solely to institutions such as nursing homes. . . Medicaid (through waivers) now pays for a comprehensive range of home and community services that provide alternatives to unnecessary institutional care.

U.S. Department of Health and Human Services

In Texas, nearly 1.3 million children ages birth through 17 years have special health-care needs. That number represents 17.4 percent of Texas children in that age group, according to the 2019-2020 National Survey of Children’s Health (HHS, 2022), the most recent data available.

Texas Health Steps providers are encouraged to be familiar with the Texas Medicaid waiver programs and to provide resources and recommendations to families whose children may be eligible for the programs. Primary care providers serve as medical homes for many children with special health-care needs, even when children also are under the care of specialists or subspecialists. As medical home providers, Texas Health Steps providers and their staff members work with a range of specialists, therapists, case managers and other service providers to ensure children with disabilities receive appropriate medical care.

Key facts about Medicaid waivers for children in Texas

• Each waiver program has its own criteria.
• Parents should be encouraged to contact the waiver program that would best fit their child’s qualifying medical condition and request to have their child added to the interest list, which effectively serves as a waiting list.
• It can take years for a child to reach the top of an interest list. Once services are available, the parent can decide whether to accept services.
• A child can be added to multiple waiver lists based on current or anticipated diagnoses and needs but can be enrolled in only one waiver program at a time.
• Parents should be advised that most waiver programs are based on the child’s income rather than family income. Medicaid eligibility is based on the family’s income.
• Individuals who receive waiver services also receive full Medicaid coverage.