Medicaid Waiver 101

Medicaid waivers are confusing. Entering each one is like walking into its own little universe. Each waiver serves a different population. Not all waivers are available in all counties in Texas. Each waiver provides a different set of services. Each waiver has different spending caps. Also the current waivers were designed to meet the needs of various disability groups before autism became so prevalent and it can be difficult to obtain many services that are appropriate for persons with autism through the waiver. This is slowly changing as some of the waivers, (TxHmL, HCS, and CLASS for example) now approve board certified behavior analysts as service providers. Also, you must sign up on each waiver’s waiting list separately. To find out how to sign up for the “interest lists”:

  • Call your Local Intellectual and Developmental Disability Authority (LIDDA) to get your name on the interest list for the HCS and Texas Home Living Waiver programs. You can search for your LIDDA’s telephone number.
  • Call 1-877-438-5658 for information about putting your child on an interest list for long-term services. This is for the CLASS and MDCP waivers.

Once your child has been met the eligibility requirements for receive services from the waiver program, he or she can receive more benefits than just therapy. He will become eligible for Medicaid health insurance. The family might qualify to be reimbursed for their private health insurance if they have it. The family can be reimbursed for mileage resulting from medical treatment or therapy. Please make sure that your case worker informs you completely about all the benefits associated with your child’s waiver program.

Many people confuse Medicaid with the Medicaid waiver programs. Medicaid is a health insurance program provided by the federal and state government to families with incomes at 180% of the federal poverty level. Exactly what that income is changes year to year, but it is pretty low. The federal government matches the dollars that the state is willing to put into its own Medicaid program.

Medicaid waiver program allows each state to serve whatever special population they see a need to serve. Each waiver program can be designed any way the state wants. They are called waivers, because the programs “waive” or by-pass the usual Medicaid eligibility criteria. Usually, BUT NOT ALWAYS, the two requirements that are waived for persons with specific needs due to a disability are 1) family income requirement and 2) the license requirement for service providers. All but the Texas Home Living waiver uses the INDIVIDUAL’S income rather than the family’s income. In most cases, children have no income–unless a generous grandparent or other relative has given them money under the Uniform Gift to Minor Act. (A child with a disability should have no assets in their name–it should be in a Special Needs Trust held for the child’s benefit.) By waiving the licensing requirement, the Medicaid waiver program could pay for services such as attendant care, day habilitation, respite, hippotherapy, recreational therapy, massage or other therapies not covered by “traditional” Medicaid.

Medicaid will ONLY reimburse services provided by “LICENSED practitioners of the healing arts.” This is a small but important detail. This means IF there is a health service offered by someone like a dental assistant (generally not licensed) they won’t pay, but they will for a dentist, who is licensed.

This website gives only brief descriptions of the various waiver programs. For more information, visit the Texas Department of Health and Human Services (HHS) website at  Texas Health and Human Services.

This site can be difficult to negotiate. Here are a few of the topics you will want to explore and the links for them:

All parents of individuals with Autism Spectrum Disorder are urged to add your child’s name to the Medicaid Waiver Interest lists as soon as possible. Currently the wait to access these programs can be years long. You are not committing to taking the services when you sign up but you are getting a place in line. You are also signaling our state and federal leadership that services for our population are wanted and needed!