If you're raising an autistic child in Texas, another parent or a provider has probably told you to "get your child on the Medicaid waiver lists." Then you start looking and find several programs instead of one list. Each comes with its own rules and its own unfamiliar terms.
As a parent, I know how overwhelming it feels when you're simply trying to figure out what help your child can get. You don't have to know which waiver your child will end up using before you start making calls.
Texas runs several Medicaid waiver programs that help children with disabilities get services while living at home. Some of the interest lists are long, so learning about them early gives your child more time in line.
Key Takeaways
- Join every list that fits your child: Each Texas waiver keeps its own interest list, so ask to join every list your child may qualify for.
- A place on a list is not an approval: Texas checks whether your child qualifies when a spot opens. Until then, the list only holds your child's place in line.
- Therapy doesn't have to wait for a waiver: Regular Medicaid can pay for medically necessary behavior therapy, speech therapy, and occupational therapy while your child waits.
- You can get help starting therapy now: If your child has Texas Medicaid and you're ready to begin applied behavior analysis, you can start your intake.
Get on every Texas waiver list this week, with the number and questions for each call.
We also sent the link to your email.
What is a Medicaid waiver program in Texas?
A Medicaid waiver is federal permission for a state to pay for long-term care at home or in the community instead of in an institution. In Texas, depending on the program, that can include respite care, nursing, behavioral support, adaptive aids, specialized therapies, and help building daily living skills.
Texas calls its waiting lists interest lists. A name on an interest list doesn't mean your child has been approved, because the state checks eligibility only when a spot opens. That's why it makes sense to ask about a list before you know for sure that your child qualifies.
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How Texas decides whether a child qualifies for a waiver
Each waiver has its own rules. Texas looks at your child's diagnosis, household income and resources, and whether your child meets that program's level of care. Level of care means your child needs the kind of help a certain facility gives, such as a nursing facility. The waiver then delivers that help at home instead.
The order matters here. Texas says anyone can put their name on an interest list. The full eligibility check comes later, when the program releases your child's name. The Arc of Texas, a statewide disability advocacy group, puts it plainly: you don't have to prove eligibility to join a waiting list.
Is there a Medicaid waiver program Texas families can use for autism?
Is there an "autism waiver" in Texas? No, but an autistic child may qualify for one or more programs based on diagnosis and support needs. The table below lines up all six children's waivers side by side.
| Program | Ages | Who it serves | Level of care | Whose income counts | Where to sign up |
|---|---|---|---|---|---|
| HCS | All ages | Intellectual or developmental disabilities | ICF/IID | Child's only | Local LIDDA |
| TxHmL | All ages | Intellectual or developmental disabilities, living at home | ICF/IID | Parents' income counts | Local LIDDA |
| CLASS | All ages | A related condition that began before age 22 | ICF/IID | Child's only | 877-438-5658 |
| MDCP | 20 and younger | Children with complex medical needs | Nursing facility | Child's only | 877-438-5658 |
| DBMD | All ages | Deafblindness plus another disability | ICF/IID | Child's only | 877-438-5658 |
| YES | 3 through 18 | Serious mental, emotional, and behavioral needs | Psychiatric hospital | Child's only | Local mental health authority |
ICF/IID stands for intermediate care facility for individuals with an intellectual disability or related conditions, a 24-hour residential setting. A LIDDA is your local intellectual and developmental disability authority, the office that handles HCS and TxHmL for your county.
Home and Community-based Services (HCS)
HCS serves people of any age with intellectual or developmental disabilities who meet an ICF/IID level of care. Its services include respite, nursing, behavioral support, adaptive aids, and professional therapies. It also pays for individualized skills and socialization, the service Texas used to call day habilitation.
Texas Home Living (TxHmL)
TxHmL serves people with intellectual or developmental disabilities who live in their own home or their family's home. It can pay for behavioral support, respite, nursing, specialized therapies, and employment services, up to a yearly limit of $17,000 per person.
Community Living Assistance and Support Services (CLASS)
CLASS serves people with a related condition. Texas defines that as a disability other than an intellectual disability that began before age 22 and affects daily life. A diagnosis alone doesn't qualify a child, since Texas also looks at day-to-day functioning and the ICF/IID level of care.
Waivers for medical, vision and hearing, or mental health needs
Some autistic children also have complex medical, sensory, or mental health needs that make another waiver worth a call. These three programs are built around those needs.
Medically Dependent Children Program (MDCP)
MDCP is for children and young adults age 20 and younger who need a nursing facility level of care but can be safely served at home. It pays for respite, flexible family support services, minor home modifications, and adaptive aids, all delivered through your child's STAR Kids health plan.
Deaf Blind with Multiple Disabilities (DBMD)
DBMD is for people who are deafblind and also have another disability. Services include intervener services, meaning one-on-one support from someone trained to relay what's happening around your child. It also covers behavioral support, nursing, therapies, and orientation and mobility training.
Youth Empowerment Services (YES)
YES focuses on serious mental, emotional, and behavioral difficulties. It serves children ages 3 through 18 with a qualifying mental health diagnosis who are at risk of being placed outside the home. Parent income does not count toward its Medicaid eligibility.
Does a Texas Medicaid waiver pay for ABA therapy?
Your child can start applied behavior analysis (ABA) without a slot. ABA comes through the regular children's benefit, a separate door from the waivers. Federal rules require every state to cover medically necessary care for children on Medicaid. That rule is the basis for Medicaid coverage for ABA across the country.
Texas Medicaid covers ABA for children and youth 20 and younger with autism when it's medically necessary. That means a clinician has documented that your child needs the therapy. The plan also needs a recent autism diagnosis and a signed referral. Then it needs prior authorization, meaning your plan's written approval before therapy starts.
So if your child already has Medicaid, call the health plan and ask what it needs to approve ABA. If you're weighing private pay while coverage gets sorted out, our breakdown of ABA costs in Texas shows what families pay.
How Texas Medicaid waiver waiting lists work and how long they take
This is the most frustrating part for many families. Texas funds a limited number of waiver slots. The Arc of Texas reports that more than 170,000 Texans are waiting, some for as long as 16 years.
Places are filled first come, first served, so the people who have been on a list the longest are enrolled first. HHSC, the Texas Health and Human Services Commission, contacts everyone on its lists once a year. The call checks that you still want the spot and that your details are current. Wait times depend on the program and on how much funding the Legislature provides, so no single estimate fits every child.
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How to get on every interest list your child may qualify for
You don't have to pick one program before making calls. Each waiver keeps its own list, and your child can be on several of them at once.
- Write down the programs that may fit your child's needs.
- Call the right office for each list.
- Ask for your child to be added to every list that fits.
- Record the date of each request and the name of the person you spoke with.
- Keep your phone number and mailing address current with every office.
- Answer quickly when Texas or your local office contacts you.
Signing up for CLASS, DBMD, and MDCP
Call HHSC Interest List Management at 877-438-5658. One call can cover all three lists, though that line doesn't handle HCS, TxHmL, or YES.
Signing up for HCS and TxHmL
Contact your LIDDA, which adds names to the HCS and TxHmL interest lists. Texas HHS keeps a LIDDA directory where you can look up the office for your county.
Signing up for YES
Contact your local mental health authority and ask to be added to the YES Waiver inquiry list. Use that exact term, since Texas calls this list an inquiry list. You can find your office with the HHS mental health authority search.
Get on every Texas waiver list this week, with the number and questions for each call.
We also sent the link to your email.
What your child can get while you wait
Years on a list can feel like years of nothing, but your child can get help in the meantime. Texas HHS says getting other services doesn't affect a person's place on an interest list. In fact, about half the people on these lists already get other services through Medicaid or state programs.
Therapy and personal care through regular Medicaid
Children who already have Medicaid may qualify for medically necessary ABA, speech therapy, occupational therapy, nursing, or personal care, based on their individual needs. If your household income is above the regular limits, the Medicaid Buy-In for Children may open that door.
Community First Choice services
Community First Choice pays for personal assistance with daily tasks and habilitation, which teaches daily living skills. It has no interest list, but it's limited to Medicaid members who meet an institutional level of care. Ask your child's health plan or caseworker whether your child qualifies.
Crisis diversion slots for emergencies
Texas holds some HCS slots for people with intellectual or developmental disabilities in crisis situations, including people at imminent risk of being admitted to an institution. A family facing that kind of crisis should call their LIDDA right away instead of waiting on the regular list.
Money for other costs can come from Texas autism grants and the state's PDSES grant for students in special education. Our guide to autism support in Texas lists more help outside the waiver system.
What happens when a waiver slot opens for your child
Getting the call doesn't mean your child is enrolled. It's the point when the full eligibility process begins.
- A slot opens: The program releases your child's name from the interest list and contacts you.
- You confirm interest: Tell the program you still want services.
- Eligibility is checked: Texas reviews household income, resources, and whether your child meets the program's level of care or medical need.
- Your child is assessed: HHSC or your child's health plan assesses your child's needs, depending on the program.
- A service plan is built: You choose a provider or a service coordinator helps you set up the plan.
- Services begin: Your child starts getting the services in the plan.
The exact steps vary by waiver. Answer letters and calls quickly, because if a program can't reach you, your child's record can be marked inactive.
How to choose a STAR Kids plan with ABA providers near you
The plan matters less than its network. STAR Kids is the Texas Medicaid managed care program for children and youth 20 and younger with disabilities. A health plan delivers your child's care through its own list of providers. If your child needs ABA, look at who is in that list before you look at the plan's name.
Comparing plans before you choose
Every area has at least two STAR Kids plans. Before you pick one, ask:
- Which ABA providers near me are in-network right now?
- Are those providers taking new patients?
- Does my child's current ABA provider work with this plan?
- What does the plan need before it approves ABA?
- Who can help if I can't find an in-network provider?
Confirming ABA providers are in the plan's network
It helps to check with the plan and the provider. Texas HHS tells families to ask the provider which plans they work with or search the plan's provider tool. Networks change, so a phone call to the ABA provider is the surest check.
Changing plans when ABA isn't available
Medicaid members can change health plans at any time. Call the Texas Enrollment Broker Helpline at 800-964-2777 or log into Your Texas Benefits, and expect the change to take 15 to 45 days. Before switching, check that your child's other doctors, specialists, medications, and therapies are covered by the new plan too.
How Alpaca Health helps Texas families start ABA through Medicaid
Texas Medicaid can feel like a maze of waiver lists, managed care plans, referrals, and authorizations. You don't need to understand every part of it before asking for help.
Alpaca Health accepts Texas Medicaid, including STAR Kids. At intake, you share your child's Medicaid details and Alpaca Health checks what your plan needs for ABA. Your family is then matched with an independent board certified behavior analyst (BCBA) in Texas, who assesses your child and writes the therapy plan. Starting ABA this way doesn't affect your child's place on any waiver list.
If you're ready to start ABA while the waiver lists run, begin your intake today.
Get on every Texas waiver list this week, with the number and questions for each call.
We also sent the link to your email.
Frequently asked questions about Texas Medicaid waivers
What's the difference between Medicaid and a Medicaid waiver?
Regular Medicaid pays for health care such as doctor visits, prescriptions, and medically necessary therapies, including ABA for children with autism. A waiver adds long-term services at home, like respite care and adaptive aids, for people who meet that program's rules.
What is the income limit for a Medicaid waiver in Texas?
No single income limit covers every Texas waiver. Five of the six children's waivers look only at your child's income, and TxHmL is the one that counts parents' income. So don't rule out a waiver because of what your household earns.
Can my child be on more than one waiver in Texas?
Your child can be on several interest lists at the same time but can be enrolled in only one waiver at a time. Texas rules for HCS, for example, require that a person is not enrolled in another waiver. The Arc of Texas notes that many families accept the first waiver offered while they wait for another.
Can I put my child on a waiver list before an autism diagnosis?
Yes, because Texas says anyone can put their name on an interest list and checks eligibility only when a slot opens. Whether your child qualifies then depends on that waiver's rules. Our guide to the steps after a diagnosis can help you plan.
Do autistic kids get free Medicaid in Texas?
An autism diagnosis doesn't make a child eligible for Medicaid on its own, since eligibility depends on the program and its income and other rules. Some waivers count only your child's income, so they're worth a call even if your household earns too much for regular children's Medicaid. If your child already has Texas Medicaid, you can start ABA intake without waiting on a waiver.
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