Ultimate Guide To Medicaid Waiver Waitlists

Medicaid Waiver

Ultimate Guide To Medicaid Waiver Waitlists


In this guide, I’m going to share some valuable information about the Texas Medicaid Waiver Programs. 

These are programs that every parent who has a child with disabilities should know about because of the potential support they can offer your family. 

Once you finish this guide you will have a solid understanding of the following things: 

  • What are Medicaid Waivers Programs
  • Who qualifies for these programs
  • The services/treatment they provide
  • Types of Medicaid Waiver Programs
  • How to sign up for a Medicaid Waiver waitlist
  • The number of years you will be on a waitlist
  • 4 things to do once you get on a waitlist
  • Some things to remember once you receive Medicaid Waiver Program benefits

Let’s begin. 

What Are Medicaid Waivers Programs? 

Medicaid Waivers Programs provide supportive medical services, devices, and funds to adults and children who have disabilities. 

The Waiver Programs are paid for by Medicaid dollars. They are managed by the Texas Health and Human Services Commission and the Department of State Health Services. 

Who Typically Qualifies For A Medicaid Waiver Program? 

Individuals with the following conditions can potentially qualify for a waiver program: 

  • Intellectual disability
  • IQ lower than 75
  • A disability that starts prior to 22, but will last a lifetime
  • Cerebral palsy
  • Down syndrome 
  • Seizure disorders
  • Epilepsy
  • Autism 
  • Aspergers
  • Mental illness conditions
  • Paraplegia/Quadriplegia
  • Blindness/Deafness

To see a complete list of conditions that qualify, refer to Texas Health and Human Services Approved Diagnostic Codes for Persons with Related Conditions chart

What Services Do Medicaid Waiver Programs Provide? 

These are just a few of the services provided: 

  • Nursing care 
  • Car and home modifications (ramps, grab bars, etc) 
  • Respite care
  • Personal care for help grooming, bathing, etc

In follow up articles I will go into detail about the services each Waiver Program offers. 

How Many Medicaid Waiver Programs Are There? 

There are 7 different Texas Medicaid Waiver Programs. Below is a short summary of each:

  • Home and Community-Based Services (HCS) – This program provides home-based services to children/adults with an intellectual disability (ID) or a related condition. The goals are to help individuals avoid nursing facilities and live in the community. 
  • Community Living Assistance and Support Services (CLASS) – CLASS offers home and community-based services to children/adults with disabilities. There are 200 different disabilities, but some are; cerebral palsy, Autism, Aspergers, Epilepsy and more
  • Youth Empowerment Services (YES) – This program gives home and community-based services to children under 19 who need inpatient psychiatric treatment. 
  • Texas Home Living (TXHmL) – Provides home-based services to children/adults with an intellectual disability (ID) who live at home. 
  • STAR+Plus Home and Community-Based Services (HCBS) – Gives services to adults who are older than 21 to keep them in their community and not in a nursing facility. 
  • Medically Dependent Child Program (MDCP) – Offers services to children/adults 20 and younger who are considered medically fragile. This program aims to keep them in the community and out of a nursing facility. 
  • Deaf-Blind with Multiple Disabilities (DBMD) – Services offered to children/adults who are deaf and blind in addition to having another disability. 

How To Sign Up For A Medicaid Waiver Interest List

Each of the Medicaid Waiver Programs has a different waitlist. 

The enrollment process depends on the Medicaid Waiver Program you are interested in. Below I will tell you how to sign up for each program. 

Note: You are encouraged to sign up for a waitlist as soon as possible if you think your child has a disability. You do not have to wait until your child receives a diagnosis to get on a waitlist. Lastly, you can sign up for as many waitlists as you like. 

Contacting The Interest Line

For the CLASS, DBMD and MDCP waiver programs you must call the Health and Human Services Commission Interest Line at 877.438.5658

Contacting Your Local Mental Health or Intellectual Disability Authority 

For Youth Empowerment Services (YES), Home Based Community Services (HCS) and Texas Home Living (TxHmL) you will have to contact your local mental health and intellectual disabilities authority. 

In addition to being a starting point for anyone needing to get on a Medicaid Waiver waitlist, the mental health and intellectual disability authorities are the primary providers of these services in their particular area. If someone with mental illness is uninsured these are agencies that can assist them. The same goes for anyone with an intellectual disability. 

If you are reading this from Houston/Harris County, the Harris Center can help you to get on a waitlist. Call Harris Center at 713.970.7000 to get on either the YES, TxHmL or HCS waitlist. 

If you live outside the Houston area you will find your local MH/ID authority on the map above. Call them to request help getting on to a waitlist. 

How Long Will You Be On A Medicaid Waiver Waitlist? 

Medicaid Waiver Waitlist

It’s difficult to give you an exact timeframe however based on the information found on this Texas Interest List here are the best estimates. 

  • Community Living Assistance and Support Services – 14 years
  • Deaf-Blind with Multiple Disabilities  – 4 years
  • Home and Community-Based Services – 15 years
  • Medically Dependent Child Program – 4 years
  • STAR Plus Home and Community Based Services – 4 years 
  • Texas Home Living – 18 years 

If you would like to keep track of the monthly enrollments check the Interest List and Waiver Caseload Summary on a consistent basis. 

4 Things To Do After You Get On A Medicaid Waiver Waitlist

Doing these 4 things will help you avoid any future headaches. 

  1. After you are placed on a waitlist request an email confirmation or a letter mailed to your home. Make copies of these records and keep them in a safe place. 
  2. Next, you should update your address or phone number if it changes. If the waitlist is unable to contact you due to an old phone number you could be dropped from the list. 
  3. Each year it’s a good idea to call and learn about your position on the waitlist. Many parents do this around the child’s birthday. Write this number down in a notebook to keep up with your position each year. 
  4. Lastly, if you are on the Medicaid Waiver waitlist and your child has a crisis you can apply for something called a Crisis Diversion Slot. These are slots that are available for individuals who are at risk of being placed in a hospital long term. This can be the result of a deteriorating medical condition or a family caregiver passing away. 

Once You Climb To The Top Of A Medicaid Waiver Waitlist

Here are a few things to remember once you finally receive Medicaid Waiver benefits. 

  • You CAN remain on multiple waiver interest lists while receiving benefits from another waiver program. 
  • You CANNOT receive benefits from 2 or more waiver programs at the same time. 
  • It’s possible that you may be reimbursed for health insurance premiums you paid after your child is enrolled in a waiver program. This is done via a program called Health Insurance Premium Payment (HIPP)
  • Some utility and phone companies provide a discount for individuals enrolled in Medicaid Waiver Programs. You can contact your provider for more details. 
  • Consumer Directed Services allow you to hire or fire your child’s attendants as you see fit. 

Conclusion 

Medicaid Waiver Programs provide lots of assistance to individuals with disabilities. The only drawback is the timeframe you have to wait. Because of this, you are encouraged to sign up for a Medicaid Waiver waitlist as soon as possible. Remember you can sign up for multiple waitlists. 

To get on a waitlist for CLASS, DBMD or MDCP you will need to call the Health and Human Services Commission Interest Line at 877.438.5658

For YES, HCS or TxHmL you will need to call your local mental health/intellectual disabilities authority. 

 

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