TEXAS
FTexas's system, honestly. A letter grade is a summary, not a verdict on your family — a low grade doesn't mean nothing is available, it means the path is narrower. What's behind it is below.
Do this first
Call your Local IDD Authority (LIDDA) and ask to be added to the HCS and TxHmL interest lists today, then call HHSC at 1-877-438-5658 for CLASS, DBMD and MDCP. The lists are independent — joining one does not affect your place on another, and the wait is measured in years, so the date you call is the number that matters.
Last verified 2026-06-26
HOW WE GRADE TEXAS
Full methodology (v2.1) →Texas's strongest area is waiver program count & breadth; what pulls the grade down most is waitlist burden.
Waitlist Burden
30% of grade0/1001,036 people waiting per 100,000 residents
Nobody waiting scores 100. 225 per 100,000 scores 0.
- This state does not screen applicants for eligibility before adding them to the list. Its list is an interest list and is structurally larger than a screened service waitlist — the burden score understates access here.
Source:KFF State Health Facts, People Waiting for HCBS by Target … (FY2025 (KFF Medicaid HCBS Waiver Program Survey, FY 2025))US Census Bureau Vintage 2025 state population estimates (2025-07)
HCBS Spending Per Capita
25% of grade11/100$253 spent per resident
$200 per resident scores 0. $675 scores 100.
Source:CMS / Mathematica — Medicaid LTSS Annual Expenditures and … (CY2023)
Self-Direction Index
20% of grade67/10067 out of 100 on the self-direction index
Scored directly on its own 0–100 scale.
Source:CMS approved 1915(c) waiver application (2026-08-05)CMS approved 1915(c) waiver application (2026-08-05)
Waiver Program Count & Breadth
15% of grade75/10075 out of 100 on program breadth
Scored directly on its own 0–100 scale.
Source:Medicaid.gov State Waivers List, Authority=1915(c), Status… (Section 1915(c) counts: Medicaid.gov State Waivers List retrieved 2026-08-05. Target populations & 1915(k): KFF Medicaid HCBS Survey 2025 (FY2025). 1915(i): CMS SPA database retrieved 2026-08-05.)KFF Medicaid Home Care (HCBS) in 2025, Appendix Table 2 (Section 1915(c) counts: Medicaid.gov State Waivers List retrieved 2026-08-05. Target populations & 1915(k): KFF Medicaid HCBS Survey 2025 (FY2025). 1915(i): CMS SPA database retrieved 2026-08-05.)KFF Medicaid Home Care (HCBS) in 2025, Appendix Table 1 (Section 1915(c) counts: Medicaid.gov State Waivers List retrieved 2026-08-05. Target populations & 1915(k): KFF Medicaid HCBS Survey 2025 (FY2025). 1915(i): CMS SPA database retrieved 2026-08-05.)
Each factor is scored against a fixed bar, not against the other states, so Texas's grade moves when Texas moves. Think we have it wrong? Every number above links to its source — email hello@spectrumpathways.ai and we will correct it in public.
WHAT THINGS ARE CALLED IN TEXAS
Use these exact words when you search, call, or fill out forms — they're what Texas's own offices use.
- Medicaid here is
- Texas Medicaid (STAR Kids under 21; STAR+PLUS for adults)
- The DD agency is
- Health and Human Services Commission (HHSC)
- You contact
- Local IDD Authority (LIDDA)
- The plan is
- Person-Directed Plan (PDP) / Individual Plan of Care (IPC)
- Self-direction is
- Consumer Directed Services (CDS)controlling your own budget and hiring your own people
- A denial arrives as a
- written notice of denialthe letter that gives you the right to appeal
WHO TO CONTACT, IN ORDER
Five different offices, and they don't talk to each other. Disability services, health coverage, and income each run through a separate agency — applying to one does not start the others. Ask each office for the name of the person you spoke to and write down the date; if something is later denied, that record is what an appeal is built on.
- 1
Developmental disability services
This is the office that decides whether your child is eligible for disability services. Ask for "intake" or "eligibility determination" by name. In Texas, you contact Local IDD Authority (LIDDA).
- 2
Health coverage — Texas Medicaid (STAR Kids under 21; STAR+PLUS for adults)
Almost every waiver and personal-care route requires this first, and it is decided by a different office from the one above. Apply in parallel rather than waiting.
- 3
Help at home, and who can be paid for it
Unless you say otherwise, services come the traditional way: the agency picks and pays the providers. Self-direction — where you get a budget and hire your own people — is opt-in almost everywhere and is not offered automatically. Here it is called Consumer Directed Services (CDS). Ask for it by that name.
- 4
Income — SSI
Federal, so it's the same everywhere: 1-800-772-1213 (TTY 1-800-325-0778). There is no minimum age — you can apply for a newborn. Until 18, the parents' income is deemed to the child, so an early denial is usually about that rather than the child's disability. In many states an SSI award also opens Medicaid automatically — ask when you call.
- 5
If you get told no
Every state has a Protection & Advocacy agency by federal law — free legal help on disability services and appeals. Most families never hear of it, and it is the number to have before a deadline, not after. Yours is Texas Protection & Advocacy agency.
RUNNING IT YOURSELF
In many states you can control the budget and hire your own people — including, sometimes, family. Most families are never told this is an option. Here's what we've verified for Texas; where we haven't verified an answer we say so — it does not mean the answer is no, and it is worth asking.
Can you control the budget?
Yes — a CDS budget you manage, though the financial management agency has to approve it
Can a family member be paid to provide care?
Yes for most relatives, but NOT for whoever holds the employer role — the legally authorised representative (a parent, stepparent, guardian or conservator of a minor, or an adult's guardian), their spouse, the designated representative and that person's spouse are all barred from being paid. Respite and transportation also cannot be provided by anyone who lives with the person, related or not
Who is legally the employer of the people you hire?
You are — or your legally authorised representative. If the person is under 18, the parent is the employer of record
How freely can money move between services?
Low at the service level, real at the wage level. Your service plan sets an annualised dollar maximum, and any change to the AMOUNT of a service delivered through CDS must go back through the service planning process and an IPC revision — it is not something you file yourself mid-year. Within the authorised amount you set your employees' pay, and you and the FMSA share responsibility for not running over.
Can the budget buy things, not just staff time?
Partly — 'employer support services' covers the things you need to BE an employer, such as office supplies and recruiting costs, rather than goods for the person
Is your case manager independent of your providers?
Not verified yet — ask, don't assume the answer is no.
Deadlines reflect this state’s rules as researched; they can change — always confirm the current deadline with your state agency or Protection & Advocacy office before relying on it.
HOW TO GET SERVICES & APPEAL IN TEXAS
- Receive Notice of Agency Action (FFS) or Adverse Benefit Determination (MCO)
- FFS incl. HCS/TxHmL IDD waivers: request State Fair Hearing within 90 days
- Managed care STAR+PLUS HCBS: MCO internal appeal within 60 days (must exhaust)
- State Fair Hearing within 120 days after MCO decision
- Hearing before HHSC Appeals Division
KEY AGENCIES & RESOURCES
NOTABLE WAIVERS
HCS (Home and Community-based Services)
SourceChildren and adults with intellectual or developmental disabilities who need community-based supports.
Waitlist: Severe interest lists, often 10-15+ years; register on the Interest List early through your LIDDA.
CLASS
SourcePeople with related conditions who need habilitation, respite, adaptive aids, and community supports.
Waitlist: Severe interest lists, often 10-15+ years; join CLASS and other relevant lists at the same time.
Full milestone guide
View the Texas Roadmap →
Six age-based stages — state-correct programs, benefits, and milestones from birth through adulthood.
