Texas Medicaid HCBS Waiver Programs Guide

Who it serves: Individuals of any age with intellectual or developmental disabilities (IDD) — including intellectual disability, related conditions with onset before age 18, and qualifying autism — who need home- and community-based services as an alternative to institutional care. IDD eligibility is determined by the LIDDA through Form 2060. HHSC does not accept direct family applications — all HCS enrollment goes through the LIDDA. Confirm your specific diagnosis and current eligibility criteria with your local LIDDA.

How to apply: Contact your local LIDDA — find the directory at hhs.texas.gov or call HHSC at 2-1-1 to locate the LIDDA in your area. The LIDDA completes a Form 2060 (Determination of Intellectual Disability) to establish eligibility. Once found eligible, you are placed on the HCS interest list by the date HHSC receives the completed eligibility packet. The LIDDA manages your interest list placement and contacts you when a slot opens. Confirm current interest list timelines and what pre-waiver supports may be available while you wait.

Note: Texas operates an interest list (not a numbered waitlist) for HCS — placement order is based on the date HHSC receives your completed eligibility documentation. Wait times in many Texas regions exceed several years. Request written confirmation of your interest list date from your LIDDA and keep it as proof of your position. Some limited pre-waiver supports may be available through HHSC interim programs — ask your LIDDA.

Who it serves: Individuals with intellectual or developmental disabilities who need HCBS supports but at a less intensive level than the HCS Waiver. TxHmL may provide faster access to services for individuals with less complex support needs. Eligibility determination is also conducted through the LIDDA via Form 2060. Confirm your eligibility and the difference in service arrays between HCS and TxHmL with your LIDDA.

How to apply: The intake process is the same as HCS — contact your local LIDDA, complete the Form 2060 IDD eligibility determination, and be placed on the TxHmL interest list by your eligibility date. Individuals can be on both the HCS and TxHmL interest lists simultaneously. Your LIDDA can explain the service differences and help you determine which waiver better fits current and anticipated support needs.

Note: TxHmL provides a different service array than HCS — generally less intensive day and residential supports. Individuals placed on TxHmL may accept that slot while remaining on the HCS interest list if they anticipate needing more intensive services in the future. Confirm service availability and current wait times in your region with your LIDDA.

Who it serves: Individuals with a related condition — including traumatic brain injury (TBI), autism without qualifying IDD, physical disabilities with onset before age 22, and other neurological conditions — who do not qualify for HCS or TxHmL. CLASS provides HCBS supports such as adaptive aids, behavioral support, employment assistance, and habilitation. Eligibility requires that the condition originated before age 22, is expected to continue indefinitely, and results in substantial functional limitations in three or more major life areas. HHSC and authorized CLASS providers determine eligibility — confirm your diagnosis and current criteria with an HHSC-authorized CLASS provider.

How to apply: Contact an HHSC-authorized CLASS program provider directly — find a directory at hhs.texas.gov or call 2-1-1. Unlike HCS/TxHmL, CLASS intake is initiated through an HHSC-authorized provider rather than through a LIDDA. The provider submits the eligibility documentation to HHSC for determination. CLASS also has an interest list — placement is based on the date HHSC determines your eligibility. Active Texas Medicaid enrollment is required before waiver services can begin.

Note: CLASS is the primary HCBS pathway for Texans with related conditions who are not IDD-eligible. Key differences from HCS: intake goes through an authorized CLASS provider rather than a LIDDA, and the service array emphasizes habilitation and community integration rather than residential supports. Confirm current eligibility criteria, interest list timelines, and authorized providers in your area with HHSC.

Who it serves: Adults aged 21 and older with physical disabilities or aged adults (65+) who need a nursing-facility level of care and are enrolled in Texas Medicaid managed care. STAR+PLUS LTSS is the primary HCBS pathway for Texans who are not IDD-eligible and do not qualify for CLASS. LTSS services include personal attendant services, adult day care, home health aide services, and care coordination through the managed care plan. Eligibility for LTSS services is assessed by the MCO — confirm with your plan.

How to apply: Enroll in Texas Medicaid through HHSC at hhs.texas.gov or by calling 2-1-1. Once enrolled, contact your assigned STAR+PLUS managed care plan to request LTSS enrollment and a level-of-care assessment. The MCO conducts a needs assessment to determine whether you qualify for HCBS LTSS services under the STAR+PLUS program. Plans and service arrays vary by region — confirm which plans serve your county and how to request an LTSS assessment from your current plan.

Note: STAR+PLUS operates through multiple managed care organizations under contract with HHSC. If you are already enrolled in a managed care plan for standard Medicaid benefits, LTSS services are a separate enrollment process — contact your plan's care coordinator to initiate the LTSS assessment. Confirm which MCO serves your county at hhs.texas.gov/managed-care.

Who it serves: Children and young adults aged 0 through 20 with complex medical needs who require a nursing-facility level of care and are living at home. MDCP provides HCBS supports including personal attendant services, respite, adaptive aids, and transition assistance. Active Texas Medicaid enrollment is required. MDCP eligibility requires a nursing-facility level-of-care assessment — confirm current age limits, eligibility requirements, and slot availability with HHSC or your managed care plan.

How to apply: Contact your child's STAR+PLUS or STAR Kids managed care plan to request an MDCP referral and nursing-facility level-of-care assessment. MDCP is administered through the managed care system — intake goes through the MCO rather than directly through HHSC. The MCO care coordinator can guide the MDCP assessment and enrollment process. Confirm current MDCP slot availability and intake procedures with your plan.

Note: MDCP is a separate waiver from STAR+PLUS LTSS and is specifically targeted at children and young adults with complex medical needs. Age-out transitions (at 21) require planning — contact your MCO care coordinator well in advance of the child's 21st birthday to understand transition options. Confirm current program structure and any recent changes with HHSC or your MCO.