Texas Medicaid Waiver Programs for Children with Disabilities

Community Living Assistance and Support Services (CLASS) Waiver

• Provides home and community-based services to individuals who have a disability—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.”
• More than 200 related conditions are listed on the Texas Approved Diagnostic Codes for Persons with Related Conditions, including cerebral palsy, spina bifida, muscular dystrophy, epilepsy and head injuries.
• 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)
• Services include adaptive aids, auditory enhancement/auditory integration training, behavior support, case management, cognitive rehabilitation therapy, continued family service, dental services, dietary services, employment services, minor home modifications, nursing, occupational and physical therapy, personal assistance services respite, speech and language therapy, support family services, transition assistance services, transportation, and specialized therapies which are unique to the CLASS waiver.
• Individuals must live in their own home or their family’s home.
• Eligibility is based on the child’s income.
• Individuals receiving CLASS waiver services can remain on other waiver interest lists but cannot be enrolled in another Medicaid waiver unless they give up their CLASS waiver.
• Request to be added to the CLASS waiver interest list by calling 877-438-5658 toll-free and asking for the CLASS waiver program.

Deaf Blind with Multiple Disabilities (DBMD) Waiver

• Provides home and community-based services to individuals who are deafblind or function as a person with deafblindness with an additional disability as a cost-effective alternative to placement in an institution such as a nursing home or hospital. Deafblindness also includes those who have a related condition that leads to deafblindness.
• 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.”
• More than 200 related conditions are listed on the Texas Approved Diagnostic Codes for Persons with Related Conditions, including cerebral palsy, spina bifida, muscular dystrophy, epilepsy and head injuries.
• 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; chore service; day habilitation; dental services; dietary services; employment services;minor home modifications; nursing; occupational and physical therapy; respite; speech, hearing and language therapy services; and orientation and mobility services and intervener which are unique to DBMD.
• Eligibility is based on the child’s income.
• Individuals receiving DBMD waiver services can remain on other waiver interest lists but cannot be enrolled in another Medicaid waiver unless they give up DBMD waiver services.
• Request to be added to the DBMD waiver interest list by calling 877-438-5658 toll-free and asking for the DBMD waiver program.

Home and Community-based Services (HCS) Program

• HCS may be available to any Texas resident not living in an institutional setting who has an IQ of 69 or below or has an approved related condition with an IQ of 75 or below; has mild to severe deficits in adaptive behavior; is eligible for Medicaid benefits; and is not enrolled in any other Medicaid waiver program.
• Provides services and supports to individuals age birth or older who qualify for ICF/IID LOC I or an ICF/IID LOC VIII if transitioning or diverting from a nursing facility and who live with their families, in their own homes, or in three-person or four-person residences or host home/companion care settings.
• Services include professional therapies (audiology, dietary services, occupational therapy, physical therapy, behavioral support, social work, speech and language pathology, cognitive rehabilitation therapy); day habilitation; in-home day habilitation; registered nursing and specialized registered nursing; licensed vocational nursing and specialized registered nursing; residential assistance (host home/companion care, residential support, supervised living, supported home living [transportation]); respite; in-home respite; supported employment; employment assistance; adaptive aids; minor home modifications; dental treatment; and transition assistance services.
• If at least one HCS Program service is delivered through the consumer directed services (CDS) option, financial management services (FMS) and support consultation is required.
• Individuals receiving HCS services can remain on other waiver interest lists but cannot be enrolled in another Medicaid waiver.
• Families can call 2-1-1 for information about eligibility or contact the Local Intellectual and Developmental Disability Authority (LIDDA). See the Appendix for LIDDA contact information.

Medically Dependent Children Program (MDCP) Waiver

• Provides services to support families caring for children and young adults ages 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.
• Eligibility is based on the child’s income.
• Individuals receiving MDCP waiver services can remain on other waiver interest lists but cannot be enrolled in another Medicaid waiver.
• Request to be added to the MDCP waiver interest list by calling 877-438-5658 toll-free and asking for the MDCP waiver program.

STAR+PLUS Home and Community-based Services (HCBS) Waiver

• 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 (STP).
• 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.
• Individuals receiving HCBS waiver services can remain on other waiver interest lists but cannot be enrolled in another Medicaid waiver.
• Call 877-782-6440 toll-free for information about eligibility. 

Texas Home Living (TxHmL) Program

• HCS may be available to any Texas resident not living in an institutional setting who has an IQ of 69 or below or has an approved related condition with an IQ of 75 or below; has mild to severe deficits in adaptive behavior; is eligible for Medicaid benefits; and is not enrolled in any other Medicaid waiver program.
• Provides selected essential services and supports for individual who qualify for an ICF/IID LOC I or an ICF/IID LOC VIII if transitioning or diverting from a nursing facility and who live in their family homes or their own homes.
• Services include professional therapies (audiology, dietary services, occupational therapy, physical therapy, behavioral support, social work, speech and language pathology); day habilitation; in-home day habilitation; registered nursing and specialized registered nursing; licensed vocational nursing and specialized licensed vocational nursing; community support [transportation]); respite; in-home respite; supported employment; employment assistance; adaptive aids; minor home modifications; and dental treatment.
• If at least one TxHmL Program service is delivered through the CDS option, financial management (FMS) and support consultation are required.
• Individuals receiving TxHmL Program services can remain on other waiver interest lists but cannot be enrolled in another Medicaid waiver.
• Families can 2-1-1 for information about eligibility or contact the Local Intellectual and Developmental Disability Authority (LIDDA). See the Appendix for LIDDA contact information.

Youth Empowerment Services (YES) Waiver

• 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 (CLS), 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.
• Average length of time in the YES waiver is 11 to 18 months. A child’s needs determine program duration.
• YES Waiver does not have a statewide interest list at this time. Slots are allocated based on data indicating need for each geographic area.
• Eligibility is based on the child’s income.
• For eligibility information, call the YES waiver inquiry line at your Local Mental Health Authority (LMHA) or Local Behavioral Health Authority (LBHA). Each LMHA and LBHA has a designated phone number for inquiries about YES enrollment. See link in the Appendix.