I/DD Waivers in Texas

All states: Medicaid disability services map

Texas I/DD services at a glance

Last verified against state sources: 2026-10-23.

Who runs I/DD services in Texas?

Texas does not have a separate developmental disabilities department. The Texas Health and Human Services Commission (HHSC), which is also the state Medicaid agency, runs all four I/DD waivers directly. Local intellectual and developmental disability authorities (LIDDAs) are the front door for most I/DD services, and who does case management depends on the waiver.

• HHSC: operates the Home and Community-based Services (HCS), Texas Home Living (TxHmL), Community Living Assistance and Support Services (CLASS) and Deaf Blind with Multiple Disabilities (DBMD) waivers. It contracts with providers, sets rates and keeps the statewide interest lists (Texas's name for waiting lists).
• LIDDAs: there are 39 local IDD authorities, each covering a set of counties. The LIDDA is the point of entry for HCS, TxHmL, intermediate care facilities (ICF/IID) and non-waiver Community First Choice. It also decides whether a person has an intellectual disability through a Determination of Intellectual Disability (DID).
• Case management: in HCS and TxHmL, LIDDA service coordinators plan and monitor services (paid as targeted case management, outside the waiver). In CLASS, a contracted case management agency does case management, and a separate direct services agency delivers the other services. In DBMD, the contracted DBMD provider agency does case management. For non-waiver Community First Choice, the health plan's service coordinator leads, with LIDDA service coordination for adults 21 and older.

What Medicaid waivers and programs serve people with I/DD in Texas?

Texas has four 1915(c) waivers for people with I/DD. A 1915(c) waiver is a federal Medicaid option that lets a state pay for home and community services instead of institutional care. All four serve people of any age who meet an ICF/IID level of care and are Medicaid eligible. Community First Choice, a state plan benefit, adds personal assistance and habilitation.

• Home and Community-based Services (HCS) (1915(c), control number TX.0110): the largest program, first authorized in 1985. It serves people with an intellectual disability (IQ 69 or below) or an approved related condition (IQ 75 or below) with adaptive behavior deficits. Services include residential services in 3- and 4-person group homes, host home/companion care, supported home living, individualized skills and socialization (the day service), employment readiness, employment assistance, supported employment, respite, nursing, behavioral support, therapies, dental, adaptive aids, minor home modifications and transition assistance. The individual cost limit depends on level of need (for example $169,182 a year for levels 1, 5 and 8 as of Sept. 1, 2025).
• Texas Home Living (TxHmL) (1915(c), control number TX.0403): started in 2004 for people with an intellectual or developmental disability who live in their own or family home. It has no residential services. It covers community support, individualized skills and socialization, employment services, respite, nursing, behavioral support, therapies, dental, adaptive aids and minor home modifications. The individual cost limit is $31,684 a year as of Sept. 1, 2025.
• Community Living Assistance and Support Services (CLASS) (1915(c), control number TX.0221): first authorized in 1991 for people with a related condition, meaning a disability other than intellectual disability that began before age 22 and causes substantial functional limits. Services include residential habilitation, prevocational services, employment assistance, supported employment, in-home and out-of-home respite, support family services, nursing, therapies, behavioral support, cognitive rehabilitation therapy, adaptive aids, minor home modifications and case management. The current waiver took effect Sept. 1, 2024 and was amended effective Sept. 1, 2025. The individual cost limit is $149,774 a year.
• Deaf Blind with Multiple Disabilities (DBMD) (1915(c), control number TX.0281): started in 1995 for people who are deafblind and have another disability. Services include residential habilitation, intervener services, chore services, employment assistance, supported employment, respite, nursing, therapies and minor home modifications, with case management by the DBMD provider agency. The individual cost limit is $149,774 a year.
• Community First Choice (CFC) (1915(k) state plan benefit): covers personal assistance services, habilitation, emergency response services and support management. People in one of the four waivers get CFC from their waiver provider. People with I/DD who are not in a waiver can get non-waiver CFC through their Medicaid health plan (STAR+PLUS, STAR Kids or STAR Health) or, for people with STAR or traditional Medicaid, through the Department of State Health Services (DSHS).

The cost limits above come from HHSC's waiver comparison chart. Texas also has intermediate care facilities for individuals with an intellectual disability or related conditions (ICF/IID), including state supported living centers, as the institutional option that the waivers are an alternative to.

Does Texas pay for I/DD services through managed care?

Not for the waivers today. HCS, TxHmL, CLASS and DBMD are paid fee-for-service, with claims going through the Texas Medicaid and Healthcare Partnership (TMHP), the state's Medicaid claims administrator. Some I/DD supports outside the waivers are already run by health plans.

• Waivers: HHSC contracts with providers and pays claims through TMHP. Service planning is done by LIDDA service coordinators (HCS and TxHmL) or by contracted case management agencies (CLASS and DBMD).
• Non-waiver Community First Choice: delivered through the STAR+PLUS, STAR Kids and STAR Health managed care plans, which authorize services, according to HHSC's LIDDA handbook. The LIDDA still does the eligibility assessment.
• Planned move to managed care: state law schedules the waivers to begin moving into managed care in phases, starting with TxHmL. The timeline depends on a pilot and its evaluation, and is covered in the last section below.

Is there a waiting list for I/DD services in Texas?

Yes, and it is long. HHSC keeps a statewide interest list for each waiver. On Aug. 31, 2026, 135,497 people were on the HCS interest list, the largest of the I/DD lists. People are generally offered a slot in order of the date they asked to be added.

• Latest counts: HHSC's interest list data for Aug. 31, 2026 show 135,497 people waiting for HCS, 117,404 for TxHmL, 99,475 for CLASS and 2,708 for DBMD. Across all six of its waiver interest lists, including two that are not for I/DD, HHSC counted 199,471 different people. HHSC publishes updated data each month.
• The lists are growing: between Sept. 1, 2025 and Aug. 31, 2026, the HCS list grew from 128,110 to 135,497 and the CLASS list from 96,191 to 99,475.
• Order of service: LIDDAs keep the HCS and TxHmL lists in HHSC's Community Services Interest List (CSIL) system, and the person who has waited longest is served first, according to the LIDDA handbook.
• Reserved slots: CLASS reserves capacity for Promoting Independence and Money Follows the Person, programs that help people leave institutions, so those people do not wait on the interest list.

Families should ask to be added as early as possible. For HCS and TxHmL, contact the LIDDA for the county where the person lives. For CLASS and DBMD, call HHSC Interest List Management at 877-438-5658.

How do people apply for I/DD services in Texas, and how are budgets set?

A person joins an interest list first. HHSC checks eligibility only when a slot is offered. Each waiver has an individual cost limit, and the ICAP assessment sets the person's level of need, which drives HCS rates and limits.

• Applying: for HCS, TxHmL, ICF/IID and non-waiver Community First Choice, start with the LIDDA for the person's county. For CLASS and DBMD, call HHSC Interest List Management at 877-438-5658.
• Eligibility: all four waivers require Medicaid eligibility and an ICF/IID level of care. Level of care I is for an intellectual disability. Level of care VIII is for a related condition that began before age 22. Most waivers allow income up to 300 percent of the Supplemental Security Income (SSI) limit. For HCS and TxHmL, an applicant who qualifies under level of care VIII must be moving out of, or avoiding entry to, a nursing facility.
• Assessment: Texas uses the Inventory for Client and Agency Planning (ICAP). In HCS it sets the person's level of need (LON 1, 5, 8, 6 or 9), and in CLASS, DBMD and non-waiver Community First Choice it sets the adaptive behavior level. In April 2026 HHSC told providers that the University of Minnesota's Institute on Community Integration acquired the ICAP and plans to update it over three to four years, and that its temporary revised protocol may not be used for these decisions (IL 2026-10).
• Budgets: each waiver has an individual cost limit (listed in the waivers section above). HCS residential and host home rates are tiered by level of need.
• Self-direction: the Consumer Directed Services (CDS) option is available in all four waivers. The person or their representative acts as the employer, and a financial management services agency handles payroll. In HCS, CDS is open only to people living in their own or family home. Nearly all TxHmL services can be self-directed.

What day and residential services can I/DD providers offer in Texas?

HCS and TxHmL providers offer individualized skills and socialization as the day service, plus employment services. CLASS adds prevocational services. Residential options are HCS group homes and host homes, CLASS support families and DBMD residential habilitation, each with its own license or certification.

Day and employment services

• Individualized skills and socialization (ISS) (HCS and TxHmL): delivered on site at a licensed center, off site in the community, or in the person's home. ISS sites are licensed as Day Activity and Health Services (DAHS) facilities under 26 TAC Chapter 559, Subchapter H, without a nurse requirement. HHSC directories listed 745 ISS-only licensed sites on Oct. 20, 2026. Off-site staffing ratios are set by level of need under 26 TAC 263.2017: 1:8 for LON 1 or 5, 1:2 for LON 6 or 8, and 1:1 for LON 9, with tighter ratios for enhanced staffing. On site, the rule requires sufficient staff but no numeric ratio. We did not find the ISS billing unit or rate in a primary source.
• Employment readiness, employment assistance and supported employment: employment readiness (HCS and TxHmL) prepares a person for work, employment assistance helps a person find a job, and supported employment supports a person on the job. CLASS and DBMD offer employment assistance and supported employment. In HCS these are billed by the hour. We did not find a published staff ratio.
• Prevocational services (CLASS): for a person whose planning team does not expect them to work within a year, even with supported employment. Delivered by the CLASS direct services agency. We did not find a published staff ratio or billing unit.

Residential services

• Supervised living and residential support services (HCS): staffed services in 3-person (supervised living) and 4-person (residential support services) homes, paid at daily rates by level of need, for example $164.46 to $341.83 a day for supervised living as of Sept. 1, 2025. HCS providers are certified by HHSC.
• Host home/companion care (HCS): the person lives in a host home or with a companion caregiver, paid $72.56 to $147.84 a day by level of need as of Sept. 1, 2025.
• Support family services and continued family services (CLASS): family-based residential options where the person lives with a support family. The provider is licensed by HHSC as a child placing agency.
• Residential habilitation (DBMD): in 1 to 3 person group homes or 4 to 6 person assisted living facilities. The provider is licensed as an assisted living facility or a home and community support services agency.

How are I/DD provider rates set and how do agencies enroll in Texas?

HHSC sets uniform statewide rates each two-year budget cycle under 1 TAC Chapter 355. Most rates are built from audited provider cost reports, and some use a modeled approach. The current waiver rates took effect Sept. 1, 2025. Agencies contract with HHSC to provide waiver services.

• Rate method: for most services, HHSC uses projected costs per unit from provider cost reports (the weighted median, times 1.044). Some services use a modeled pro forma approach, and CDS rates are the agency rate minus indirect costs. Proposed rates go to a public hearing with notice in the Texas Register, and rates are rebased when the Legislature funds an increase.
• Latest change: new HCS, CLASS and other waiver rates took effect Sept. 1, 2025, when the 2026-27 state budget (Rider 23) funded higher personal attendant wages and ended the Attendant Compensation Rate Enhancement program. CMS approved the related waiver amendments. HHSC posts the HCS rate schedule, with daily residential and host home rates and hourly rates for therapies, nursing, respite and employment services.
• Enrolling: HCS and TxHmL providers contract with HHSC and must subscribe to HHSC GovDelivery updates. HHSC's waiver contracting team is at IDDWaiverContractEnrollment@hhsc.state.tx.us or 512-438-3234. A CLASS direct services agency must be licensed as a home and community support services agency, and CLASS case management agencies contract separately. We did not find step-by-step enrollment instructions for CLASS or DBMD; ask HHSC waiver contracting.
• EVV: electronic visit verification (EVV) applies to in-home CFC personal assistance and habilitation, respite, nursing and therapies in all four waivers, and to in-home ISS in HCS and TxHmL. Providers use HHAeXchange, the free state system, or an approved proprietary system. HCS and TxHmL EVV claims must carry the Texas EVV Service Provider ID and may not be billed before or on the day of service, and claims without a matching visit are denied, per HHSC's EVV policy handbook.

What is changing next for I/DD services in Texas?

State law schedules TxHmL to begin moving into Medicaid managed care on Sept. 1, 2027, then CLASS in 2029 and HCS and DBMD in 2031. Each step depends on a STAR+PLUS pilot and its evaluation, and we did not find an HHSC notice confirming the pilot results or an implementation plan, so these dates are not certain.

• Managed care transition: Government Code 542.0201 (recodified by H.B. 4611, effective April 1, 2025) sets the phased dates. For HCS and DBMD, only nonresidential services are scheduled; residential services have no date. The same law set the pilot to run from Sept. 1, 2023 to Sept. 1, 2025 unless continued, with an evaluation report to the Legislature due by Sept. 1, 2026. Providers and families can ask HHSC about the status.
• EVV alternative devices: on Sept. 1, 2027, the share of EVV visits that may use an alternative device drops from 50 percent to 25 percent.
• ICAP update: the new owner of the ICAP plans to update it over three to four years. HHSC has said the temporary revised version may not be used for level of need decisions.

Recent changes already in place: CMS told HHSC on March 31, 2026 that Texas completed its home and community-based settings corrective action plan for all four waivers, and new waiver rates took effect Sept. 1, 2025. HHSC's provider letters page also lists a July 2026 letter on a new Critical Incident Management System for waiver providers and a September 2026 letter on extra fees for ISS.

Texas I/DD sources

• Texas HHS: Home and Community-based Services (HCS)
• Texas HHS: Texas Home Living (TxHmL)
• Texas HHS: Community Living Assistance and Support Services (CLASS)
• Texas HHS: Deaf Blind with Multiple Disabilities (DBMD)
• Texas HHS: Long-term services and supports waiver comparison chart
• Texas HHS: Interest list reduction and monthly interest list data
• Texas HHS LIDDA Handbook: 7000, HCS and TxHmL interest lists
• Texas HHS: HCS payment rates effective Sept. 1, 2025
• Texas Legislature: H.B. 4611 (Government Code 542.0201, managed care transition)
• Texas HHS EVV Policy Handbook: 13000, EVV claims

Related reading

• Disability Services and Independent Living Guide
• Essential Acronyms in Disability Services: A Quick Reference Guide
• Disability Services DayHab has a dilemma - how to solve it
• Outcome Measures in Disability Services: Measuring what matters
• I/DD services in every state (map)
• Texas EVV requirements

Page history

• October 23, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for I/DD provider agencies, including EVV, service documentation, goal tracking and billing. If you would like to talk through your program, contact Ankota or read more about Ankota's I/DD software.