Texas Medicaid Waiver Programs
What is a Medicaid Waiver?
A Medicaid waiver allows the state to assist individuals and provide some long-term services to those with disabilities or elderly citizens who are eligible for Medicaid. Medicaid waivers override certain rules for how Medicaid funding can be used. If an individual meets eligibility requirements, they can receive services they need in their own homes or other community settings, instead of having to go into a nursing facility or institution. You may apply and/or qualify for both Medicaid benefits, as well as Medicaid Waiver programs.
In Texas, there are several different waiver programs that offer a broad range of home and community-based services to people with disabilities and elderly citizens. There are different rules and funding amounts for each of the different waivers.
About the Interest Lists:
The Department of Aging and Disability Services (DADS) maintains an “Interest List” (previously known as the “Waiting List”) for individuals with disabilities and their families who are requesting Medicaid waiver services.
Due to a variety of reasons, the interest lists move at a different pace for each of the waivers. Some waivers are available immediately, while others have a wait time up to 9 years.
Medicaid Waiver Tips:
- Sign up for all interest lists that you child may be eligible for, or interested in, even if you are not sure you qualify.
- Always get the name & contact information of the person who records your information and keep it with your records. You should receive a letter of confirmation once placed into a waiver program.
- If you receive a letter or phone call from the agency regarding the interest list ALWAYS respond. Your name may be removed from the list if there is no response
- If you change your address or phone number make sure that you call the Texas Department of Aging & Disability Services (DADS) office or the local Mental Retardation Authority (MRA) to give them the correct information.
- It is important to call at least one time a year to verify that your name is still on the list and that your contact information is still correct.
Department Name: Texas Department of Aging & Disability Services (DADS)
Waiver(s) Available: CBA, CLASS, DBMD and MDCP
Phone: (877) 438-5658 or 2-1-1
Department Name: Mental Retardation Authority (MRA)
Waiver(s) Available: HCS and TxHmL
Phone: (877) 283-2121 or 2-1-1
Department Name: Texas Health and Human Services Commission
Waiver(s) Available: Medicaid Application
1. Medicaid Buy-In Program
Medicaid Buy-In for Children can help pay medical bills for children with disabilities. This program helps families who need health insurance, but make too much money to get traditional Medicaid. Families “buy in” to Medicaid by making a monthly payment (premium).
Link: Medicaid Buy-In Program
Phone Number: Call 2-1-1 or 877-541-7905. You can call 8 a.m. to 8 p.m. Central Time.
2. Medically Dependent Children Waiver Program (MDCP)
This waiver program provides services and support to families caring for medically dependent child in their home who are less than 21 years of age. These services may include adaptive aids, adjunct support services (such as those that support independent living, participation in child care and participation in post-secondary education), minor home modifications, respite and transition assistance services.
Phone Number: 877-438-5658 (Be prepared to provide Social Security and Medicaid numbers, type of disability, age of onset of the disability, date of birth, address and phone number of the person to be placed on the interest list)
3. Community Living Assistance and Support Services (CLASS)
CLASS provides home and community-based services such as therapy and personal-attendant care, limited nursing care, job training, daily living skills, adaptive aids, psychological counseling, home medication and respite care for persons with disabilities other than the primary diagnosis of mental retardation.
Phone Number: 1-877-438-5658 (Be prepared to provide Social Security and Medicaid numbers, type of disability, age of onset of the disability, date of birth, address and phone number of the person to be placed on the interest list.)
4. Home and Community-Based Services (HCS)
The HCS program is a Medicaid waiver program that provides services to individuals with mental retardation who either live with their families, in their own home, in a foster/companion care setting, or in a residence with not more than four individuals who receive services. HSC services include residential assistance, day habilitation, respite, nursing, attendant care, adaptive aids, counseling, therapy, minor home modification, and supported employment.
5. Community Based Alternatives (CBA)
Services and supports provided to persons (21 years and older) in their own home, an assisted living facility or in an adult day care setting as an alternative to institutional care in a nursing facility. These services may include adaptive aids and medical supplies, adult foster care, assisted living, residential care services, consumer directed services, emergency response services, home delivered meals, minor home modifications, nursing services, occupational therapy, physical therapy, personal assistance services, respite care, speech and/or language pathology services and prescription drugs (if not covered through Medicare).
MDCP ends when a child reaches age 21. After that, the Community Based Alternative (CBA) continues most services, but the change from MDCP to CBA is not automatic. You must apply for CBA separately, but the eligible child will access CBA services directly without being put on a waiting list. State that the child is reaching 21 and on the MDCP.
Phone Number: 1-877-438-5658.
6. Texas Home Living Waiver (TxHmL)
The TxHmL program is one type of Medicaid waiver that waives a Medicaid requirement so that a list of services such as respite can be delivered by someone other than a licensed practitioner and paid by Medicaid. Therefore, the family's income must meet eligibility for Medicaid to qualify. The TxHmL program provides essential services and support so that Texans with mental retardation can continue to live with their families or in their homes in the community. TxHmL services are intended to supplement.
7. Deaf Blind with Multiple Disabilities Waiver (DB-MD)
Home and community based services for persons who have legal blindness; a chronic, severe hearing impairment; or a condition that leads to deaf-blindness and a third disability that results in impairment to independent functioning. This program is an alternative to institutional care and offers services such as attendant care, orientation and mobility, and assisted living.