Texas Medicaid Waivers for Children, Compared: Eligibility, 2026 Waitlists, and How to Apply

Texas has six Medicaid waivers that can serve children: MDCP, CLASS, HCS, TxHmL, DBMD, and YES. All six are home and community-based 1915(c) waivers, meaning they fund services that keep children at home rather than in institutional settings.

Five of the six are based on the child's income only, with no consideration of parent income. Some interest lists run 15 years or longer. Every month a family delays applying is a month lost on a wait that may already be measured in decades. This guide explains which waiver fits which child, what each one covers, the 2026 slot counts, how to apply, and what to do while you wait. Families just starting on early ABA therapy for young autistic children can run that track in parallel with waiver planning.

Key Takeaways

• Apply to every waiver your child qualifies for on the same day: Interest lists are long and independent of each other. Joining multiple lists at once maximizes your child's chances of receiving services sooner.
• Interest lists are not the same as waitlists: Being on an interest list means your family is tracked for future availability. It does not guarantee a slot. When a slot opens, HHSC contacts you and you must respond quickly or lose your place.
• ABA therapy is covered separately: ABA for children under 21 is available through Texas Medicaid's State Plan EPSDT benefit, not through waiver line items. Waivers add services like respite, habilitation, and adaptive aids on top of that base coverage.
• 2026 brought two significant changes: The MDCP nursing facility diversion rule (March 2026) and the One Big Beautiful Bill Act (OBBBA), which introduces Medicaid redetermination changes for expansion adults beginning with renewals on or after December 31, 2026.
• Start ABA while your waiver application moves through: Alpaca Health, an in-network ABA therapy provider with Texas Medicaid, matches families with a BCBA in under 24 hours. Begin your intake to start care now.

Which Texas Medicaid Waiver Should I Apply For?

A Medicaid waiver is a federal authorization that allows Texas to offer home and community-based services to people who would otherwise qualify for institutional care. The waiver funds services Medicaid's standard State Plan doesn't cover, things like respite care, supported employment, and specialized habilitation, delivered at home or in the community.

Each waiver targets a different population. Here's a quick decision tree based on your child's primary need:

• Child under 21 with complex medical needs requiring nursing-level care at home: MDCP
• Child with a related condition diagnosis established before age 22, requiring ICF/IID level of care: CLASS
• Child with an intellectual or developmental disability (IDD) of any age: HCS (call your Local Intellectual and Developmental Disability Authority, or LIDDA)
• Child with IDD whose needs don't require the full HCS level of support: TxHmL (also through your LIDDA)
• Child with both deafblindness and another disability: DBMD
• Child ages 3 to 18 with a serious emotional disturbance (SED): YES (call your Local Mental Health Authority, or LMHA)

You can and should join every list your child qualifies for on the same day. The lists are independent. Joining one does not affect your position on another.

Interest list vs. waitlist: Texas uses the term "interest list" for most of these programs. Being on an interest list means HHSC is tracking your family for future availability. It does not mean you have a guaranteed spot. When a slot opens and HHSC contacts you, you must respond quickly. Families who don't respond in time lose their place and must rejoin the list. Keep your contact information current with HHSC at all times.

The 6 Texas Medicaid Waivers for Children

Each waiver below targets a different child population, has its own eligibility criteria, and runs its own interest list. Apply to every one your child qualifies for on the same day.

MDCP: Medically Dependent Children Program

MDCP provides home and community-based health services to children under 21 with medically complex needs who would otherwise require nursing facility placement. Services include respite care, flexible family support services, employment assistance, and minor home modifications.

Eligibility: Child must be under 21, qualify for Medicaid, and meet nursing facility level of care. Five of Texas's six waivers, including MDCP, are based on the child's income only without regard to parent income.

2026 update: In March 2026, HHSC published a draft rule establishing clinical criteria for nursing facility diversion slots, which would allow some children to access MDCP services without first being placed in a nursing facility. The rule requires children to meet at least two of eight specified high-acuity medical conditions to qualify for a diversion slot. Advocates including the Arc of Texas raised concerns that the criteria are too narrow and may exclude children with complex overlapping needs that don't fit neatly into rigid categories. As of the KERA News report on March 27, 2026, HHSC was accepting public comments on the draft rule. Families pursuing MDCP should contact HHSC directly for the current status of this rule.

Interest list: Contact 1-877-438-5658 to join.

CLASS: Community Living Assistance and Support Services

CLASS provides services to people with a related condition (such as cerebral palsy, epilepsy, or other conditions related to intellectual disability) that was diagnosed before age 22 and requires ICF/IID level of care. Services include supported home living, day habilitation, employment assistance, and residential support.

Eligibility: Related condition diagnosis established before age 22, Medicaid eligibility, ICF/IID level of care. Five of the six waivers are based on the child's income only.

Interest list: Contact 1-877-438-5658 to join.

HCS: Home and Community-based Services

HCS is the largest of Texas's Medicaid waivers and serves individuals with intellectual and developmental disabilities of any age. Services include residential support, day habilitation, employment assistance, respite, and supported employment.

Eligibility: IDD diagnosis, Medicaid eligibility, ICF/IID level of care. Services are coordinated through your Local Intellectual and Developmental Disability Authority (LIDDA). Contact your LIDDA directly rather than a general HHSC number, as LIDDA offices manage HCS enrollment locally.

2025 update: A September 1, 2025 amendment affected HCS program rules. Contact your LIDDA for current enrollment requirements.

Interest list: Contact your local LIDDA. To find your LIDDA, call 1-877-438-5658 or visit the Texas HHS LTSS program comparison page.

TxHmL: Texas Home Living

TxHmL serves individuals with IDD whose support needs don't require the full residential and day services structure of HCS. It provides a more streamlined set of services including respite, day habilitation, and employment assistance for people living at home with family or independently.

Eligibility: IDD diagnosis, Medicaid eligibility. Like HCS, enrollment is coordinated through your LIDDA.

Interest list: Contact your local LIDDA.

DBMD: Deaf Blind with Multiple Disabilities

DBMD serves individuals who have both deafblindness and at least one other significant disability. It provides highly specialized services including intervener services, orientation and mobility training, and supported employment tailored to the deafblind population.

Eligibility: Deafblindness plus an additional disability, Medicaid eligibility.

2026 update: A February 28, 2026 amendment affected DBMD program rules. Contact HHSC for current requirements.

Interest list: Contact 1-877-438-5658 to join.

YES: Youth Empowerment Services

YES serves children and adolescents ages 3 to 18 with a serious emotional disturbance (SED). It provides community-based mental health services, respite, family support, and crisis services designed to keep children in the home and community rather than in residential treatment.

Eligibility: Ages 3 to 18, SED diagnosis, Medicaid eligibility. Enrollment is coordinated through your Local Mental Health Authority (LMHA) rather than LIDDA. Contact your LMHA to apply.

Interest list: Contact your local LMHA. To find your LMHA, dial 2-1-1 or visit the Texas HHS LMHA directory.

Side-by-Side Comparison: All 6 Texas Medicaid Waivers

The table below compares each waiver's age range, target population, level of care, approximate 2026 slot count, and how to apply. Verify current figures before applying, as slot counts shift as new openings are released.

Slot counts are approximate figures pulled from kidswaivers.org/tx and reflect 2026 data. Check that site for current enrollment numbers, as figures change as slots open and close.

Does Any Texas Medicaid Waiver Cover ABA Therapy?

ABA therapy for children under 21 in Texas is covered through Texas Medicaid's State Plan EPSDT benefit, not as a line item within any waiver. This means your child can access ABA therapy through Texas Medicaid regardless of waiver status. The waivers add services on top of what the State Plan covers, including respite care, habilitation, adaptive aids, and residential support, which the standard Medicaid State Plan doesn't fund.

The EPSDT benefit structure and prior authorization process for Texas Medicaid ABA sit alongside any waiver application. Alpaca is in-network with Texas Medicaid and can start ABA services without the typical 4-plus month clinic waitlist. Find a Texas BCBA through Alpaca's directory, or get matched with a BCBA through Alpaca in under 24 hours.

How to Apply: 5 Steps

Applying to a Texas Medicaid waiver means joining an interest list and staying responsive while you wait. The five steps below cover what to do today and how to hold your place over time.

1. Call the right number for your waiver. For MDCP, CLASS, and DBMD, call HHSC at 1-877-438-5658. For HCS and TxHmL, contact your local LIDDA. For YES, contact your local LMHA. Ask to be placed on the interest list for every waiver your child qualifies for.
2. Join multiple interest lists the same day. The lists are independent. Being on one does not affect your position on another. Apply to every program your child qualifies for at once.
3. Check your placement annually. HHSC and your LIDDA or LMHA can tell you your current position on the interest list. Call once a year to confirm you're still active and that your contact information is current.
4. Respond immediately when contacted. When a slot opens, HHSC will contact you. Families who don't respond quickly lose their place and must rejoin the list from the beginning. Keep your phone number and mailing address current with every program you've applied to.
5. Prepare your documents in advance. When a slot opens, you'll need to move quickly. Keep the following on hand: your child's Medicaid ID, current diagnosis documentation, physician's statement supporting level-of-care eligibility, and a summary of current services and supports.

What to Do While You Wait

Interest list waits for Texas Medicaid waivers can run 10 to 20 years for some programs. That's not a reason to delay applying, but it means families need a parallel plan for the years between application and enrollment.

Texas Medicaid State Plan: ABA therapy, speech therapy, and OT are available through the State Plan EPSDT benefit for children under 21 right now, without waiver enrollment. If your child isn't already receiving these services through Medicaid, that's the first step.

Community First Choice: Texas implemented the Community First Choice Option in 2015, which provides attendant care and habilitation services to Medicaid-eligible individuals without a waiting list. Texas is allowing some individuals on waiver interest lists to access this benefit while they wait. Ask your HHSC caseworker whether your child qualifies.

Medicaid Buy-In for Children: If your family income exceeds standard Medicaid limits, the Medicaid Buy-In for Children program allows families to pay a monthly premium to access Medicaid coverage for a child with a disability. This can bridge the gap while you wait for waiver enrollment.

Texas autism grants: Several grant programs provide funding for therapy and support services for autistic children while waiver applications are pending. The PDSES grant, ACT Today, and UnitedHealthcare Children's Foundation are all among the available Texas autism grants families can apply to.

PDSES grant: The PDSES grant provides a one-time $1,500 benefit eligible families can use for approved educational services that support a child's learning. Applications open annually through the Texas Education Agency. Apply as soon as the window opens, as funds are first-come, first-served.

Private-pay ABA: Families who need to start ABA before Medicaid approval or grant funding comes through can review hourly ABA rates by Texas city to plan around private-pay options and insurance coverage.

Texas advocacy organizations: Several organizations support families through the waiver application process and can help with appeals and working through HHSC processes. Texas Parent to Parent, Disability Rights Texas, The Arc of Texas, Partners Resource Network, and Protect TX Fragile Kids all provide free support and advocacy resources.

What's Changing in 2026

• MDCP nursing facility diversion rule (March 2026): HHSC published a draft rule on nursing facility diversion slots requiring children to meet two of eight high-acuity conditions. Open for public comment as of late March 2026.
• HCS amendment (September 1, 2025): A rule amendment affecting the HCS program took effect September 1, 2025. Contact your LIDDA for current enrollment details.
• DBMD amendment (February 28, 2026): A rule amendment affecting the DBMD program took effect February 28, 2026. Contact HHSC for current requirements.
• TMHP portal transition (effective June 12, 2026): The Texas Medicaid and Healthcare Partnership portal is transitioning to the TMHP IAMOnline platform effective June 12, 2026, with provider site-verification deadlines beginning in late April 2026. Confirm current prior-authorization procedures with your caseworker or provider.
• One Big Beautiful Bill Act (OBBBA): For Medicaid renewals on or after December 31, 2026, the OBBBA introduces six-month redeterminations and 80-hour-per-month work requirements for Medicaid expansion adults ages 19 to 64. Children's Medicaid and CHIP are not directly affected, but confirm with your caseworker at renewal.

Start ABA in Texas While Your Waiver Application Moves Through the Queue

A Texas Medicaid waiver can take a decade or more to come through, but ABA therapy doesn't have to wait that long. Texas Medicaid's State Plan EPSDT benefit funds ABA for children under 21 today, independent of any waiver. Alpaca matches families with a Texas BCBA in under 24 hours and is in-network with Texas Medicaid, so care can start while your interest list position holds. Start your intake to get matched with a BCBA this week.

Frequently Asked Questions About Texas Medicaid Waivers

Which Texas Medicaid waiver should I apply for first?

Apply to every waiver your child qualifies for when you can. The interest lists are independent and joining one does not affect your position on another. If your child has an IDD diagnosis, start with HCS through your local LIDDA and TxHmL at the same time. If your child has complex medical needs, add MDCP. If your child has a related condition diagnosed before age 22, add CLASS. Applying to multiple lists at once is the only way to maximize your chances given how long the waits are. While the interest list runs its course, start your Alpaca intake to begin ABA care now.

How long are the Texas Medicaid waiver waitlists?

Wait times vary significantly by program. Some families wait 10 to 20 years for HCS slots. MDCP wait times depend on interest list position and slot availability, with some families waiting decades according to advocates. There is no published average wait time because it depends on when slots open in your area. The most current slot counts are at kidswaivers.org/tx. Join the list immediately and check your position annually.

Can I apply to more than one Texas Medicaid waiver at the same time?

Yes. You should. The interest lists are independent of each other, and being on multiple lists is both allowed and recommended. Apply to every program your child qualifies for on the same day you start the process.

Does a Texas Medicaid waiver cover ABA therapy?

ABA therapy is covered through Texas Medicaid's State Plan EPSDT benefit for children under 21, not as a specific line item within any waiver. This means your child can receive ABA through Medicaid right now without needing to wait for a waiver slot. The waivers add supplemental services like respite, habilitation, and adaptive aids on top of what the State Plan covers. Alpaca is in-network with Texas Medicaid and can bill ABA through the EPSDT benefit without a separate waiver slot.

What happens when my child turns 21 on MDCP?

MDCP is for children under 21. Before your child ages out, you need to transition to an adult waiver program. The most common adult pathway is HCS, which has significant waitlists of its own. If your child is on MDCP, contact your caseworker well before age 18 to begin planning the adult transition and to make sure your child is on the appropriate adult interest lists.

Can I use the Medicaid Buy-In program while waiting for a waiver?

Yes. The Texas Medicaid Buy-In for Children program is separate from the waiver programs and allows families who exceed standard income limits to pay a monthly premium to access Medicaid for a child with a disability. The income thresholds and application steps for Medicaid Buy-In sit alongside any waiver interest list. Being enrolled in Buy-In does not affect your position on any waiver interest list.

What is the difference between an interest list and a waitlist?

An interest list tracks families who want services when slots become available. It does not guarantee a spot. A waitlist in the traditional sense implies a defined order and a defined wait for a defined outcome. Texas's waiver interest lists work differently: when a slot opens, HHSC contacts you and you must respond quickly to claim it. Families who don't respond lose their place. This distinction matters because it means active management of your position is required. Check in annually and keep your contact information current.

What if I don't hear back after joining an interest list?

No response is normal, and it does not mean something went wrong. Interest list waits are measured in years. Call the relevant agency (HHSC at 1-877-438-5658, your LIDDA, or your LMHA) once a year to confirm you are still active on the list and that your contact details are current. If you move or change your phone number, update HHSC and your local authority immediately, as a missed contact can result in losing your place. Families who want to start ABA while they wait can find a Texas BCBA through Alpaca's directory.