Intellectual Disability in Texas: Waivers, Education, and Guardianship

Intellectual disability services in Texas are organized through a single practical front door — your Local Intellectual and Developmental Disability Authority, or LIDDA — which screens for eligibility, signs you up for Medicaid waiver programs, and connects you to housing, employment, medical, and social supports. The system is large, publicly funded, and defined by long waits: more than 198,000 Texans currently sit on interest lists for waiver services, and the earliest step most families can take is getting on those lists.¹

Where to Start: Your Local IDD Authority

The Texas Health and Human Services Commission (HHSC) oversees long-term care for people with intellectual or developmental disabilities, which it defines as chronic conditions caused by mental or physical impairments that manifest before age 22.² To qualify for most publicly funded services, a person needs a diagnosis of intellectual developmental disorder, autism spectrum disorder, or a related qualifying condition, plus U.S. citizenship or qualified legal alien status, Texas residency, and limited income and assets.

LIDDAs are units of local government — typically community centers sponsored by counties, cities, or hospital districts — and every one of Texas’s 254 counties is covered by one.³ Your LIDDA determines eligibility, enrolls you in Medicaid programs, manages interest lists, coordinates transitions from institutions to community living, and links you to training, medical care, and social services.⁴ If you are pursuing services for the first time, this is the phone call to make.

Medicaid Waivers and Interest Lists

Texas runs six Medicaid home and community-based services waivers. The ones most relevant to intellectual disability are:

Home and Community-based Services (HCS), which covers people living in their own homes or in small group homes of up to four residents, and pays for therapies, nursing, dental care, adaptive aids, and supported employment.
Texas Home Living (TxHmL), for people living with family or independently, with caps on service costs.
Community Living Assistance and Support Services (CLASS), for people with related conditions that manifested before age 22.
Deaf Blind with Multiple Disabilities (DBMD).
Medically Dependent Children Program (MDCP), for medically fragile individuals age 20 and younger.
STAR+PLUS HCBS, for adults 21 and older.⁵

The waits are extraordinary. For programs like HCS and CLASS, they can run 17 to 18 years. The lists work first-come, first-served, and Texas does not test eligibility when someone joins — only when the name reaches the top. In the two-year cycle ending August 2025, about 15,000 people were removed from lists because they turned out to be ineligible, couldn’t be located, or declined services; only about 2,500 were actually enrolled.¹

Because of these dynamics, The Arc of Texas recommends signing up for every applicable list as early in life as possible.⁶ For HCS and TxHmL, contact your LIDDA. For CLASS, DBMD, and MDCP, call 1-877-438-5658 or apply online through YourTexasBenefits.com.⁷ One program has no waitlist: Community First Choice (CFC), which provides basic attendant and habilitation services to Medicaid recipients with disabilities who need help with daily living.

New waiver slots trickle out through legislative funding and “attrition slots” freed as participants leave. Between February and August 2026, HHSC scheduled only 105 new HCS interest list slots statewide — 15 per month.⁸ The 89th Legislature funded roughly 950 new waiver slots overall.⁹

Housing Options and the Staffing Crisis

Depending on the level of need and which waiver applies, a Texan with IDD may live independently, with family, in a small HCS group home of up to four people, in a larger community Intermediate Care Facility (ICF/IID), or in one of the 13 State Supported Living Centers.² A host home or companion care arrangement, where someone lives with a family that may be paid through the HCS waiver, is another option.¹⁰ Without a waiver, private group homes can cost $2,000 or more per month.

More than 15,000 Texans with IDD live in group homes, and the sector is under severe pressure. Direct support professionals — the staff who provide hands-on daily care — are paid through Medicaid at rates set by the legislature. The base rate sat at $8.11 per hour for years. The 88th Legislature raised it to $10.60, which providers and advocacy groups said was still not enough.¹¹ DSP vacancy rates run 30 to 34 percent.¹² Between January 2023 and February 2024, 179 HCS homes and 50 ICF facilities closed, affecting about 1,600 residents.

Providers report rising medication errors, more behavioral incidents, and staff averaging 60 hours per week with some logging over 100.¹²¹³¹⁴⁹

State Supported Living Centers

Texas operates 13 State Supported Living Centers across the state, from Abilene to San Antonio. They are campus-based facilities providing 24-hour residential care, health services, and behavioral treatment for people with IDD who have significant medical or behavioral needs.¹⁵ Admissions come in four categories: voluntary, court commitment, respite (up to 30 days with one extension), and emergency (up to 12 months). The current maximum daily rate is $1,305.78.

The SSLCs spent more than 16 years under federal oversight. A 2009 consent decree required Texas to protect residents from harm and deliver services in integrated settings; on December 9, 2025, the U.S. Department of Justice and Texas jointly asked a federal court to dismiss the case, formally ending the decree.¹⁶

Special Education for Students with Intellectual Disabilities

Under the federal Individuals with Disabilities Education Act (IDEA) and the Texas Administrative Code, a student qualifies for special education on the basis of intellectual disability when they show significantly subaverage intellectual functioning — typically a score at least two standard deviations below the mean on a standardized test — along with concurrent deficits in at least two areas of adaptive behavior such as communication, self-care, or functional academics.¹⁷ The condition must have appeared during the developmental period and must adversely affect educational performance. A licensed specialist in school psychology or educational diagnostician conducts the evaluation, and the school’s Admission, Review, and Dismissal (ARD) committee makes the final call.

New Funding Model Under SB 568

SB 568, sponsored by Senator Paul Bettencourt, restructured how Texas pays for special education. The old model was placement-based; the new one uses eight tiers of funding tied to the intensity of services a student requires.¹⁸ The law also raises reimbursement for special education transportation, creates a parent-directed grant program at $1,500 per student, and funds dyslexia training and hiring of qualified special education teachers.¹⁹ The intensity-based funding for residential and day placement programs takes effect with the 2026–2027 school year. Separately, HB 2 invested $8.5 billion in public education, with $1.3 billion earmarked for special education.²⁰

The Caytlin Handley Act

HB 1188, the Caytlin Handley Act, requires school districts to tell families of students eligible for special education about their Local IDD Authority and available Medicaid waiver programs when the disability is identified, rather than waiting until age 14 for transition planning.²⁰ Given how long waiver interest lists run, earlier notice matters.

Education Savings Accounts: A Trade-Off Families Should Understand

SB 2 created a statewide Education Savings Account program letting families use public funds for private school tuition and related services. Students with disabilities can receive up to $30,000 per year and get priority in the enrollment lottery if household income is at or below 500 percent of federal poverty guidelines.²¹ The program begins in the 2026–2027 school year.

The trade-off: private schools are not required to provide special education services, so families who use an ESA effectively give up IDEA protections, including the right to an Individualized Education Program (IEP) and due process. Nonreligious private schools remain subject to the ADA and Section 504, but religious private schools are not subject to the ADA at all.²² Disability Rights Texas has cautioned families to weigh those consequences carefully.

Employment Supports

Texas is an “Employment First” state, meaning its policy framework prioritizes competitive, integrated employment for people with disabilities.²³ The Texas Workforce Commission runs Vocational Rehabilitation (VR) services, which help people with disabilities prepare for, find, and keep jobs. VR counselors build individualized employment plans and can provide vocational counseling, tuition assistance, adaptive equipment, assistive technology, and therapeutic services.²⁴ You can self-refer through the TWC’s “Start My VR” portal.

The HCS waiver also funds supported employment services such as job coaching and workplace accommodations. For students still in school, the ARD team is responsible for writing employment goals and transition plans into the IEP, ideally starting by middle school.²³

Turning 18: Guardianship and Its Alternatives

When a young person with an intellectual disability turns 18, families often ask about legal decision-making authority. Texas law instructs courts to design any guardianship in the least restrictive way possible, and several lighter options exist.

In 2015, Texas became the first state to codify Supported Decision-Making Agreements (SDMAs) into law. Under an SDMA, an adult with a disability chooses a trusted “supporter” who helps them gather information and understand options, while the individual keeps full decision-making authority. The supporter cannot make decisions for the person. Any adult whose physical or mental impairment substantially limits a major life activity can enter into an agreement voluntarily, and the law imposes no specific capacity threshold.²⁵ The agreement must be signed before two witnesses or a notary.²⁶

Durable powers of attorney, governed by Chapter 751 of the Texas Estates Code, are another route. Unlike an SDMA, a power of attorney does grant another person authority to act on the individual’s behalf, including for financial and legal matters.²⁷ Disability Rights Texas publishes a “Right to Make Choices” toolkit and sample SDMA forms.

Social Security Disability Benefits

Texans with intellectual disabilities applying for Social Security disability benefits are evaluated under Listing 12.05 of the SSA’s “Blue Book.” An applicant must show significantly subaverage intellectual functioning, significant deficits in current adaptive functioning, and evidence the disorder began before age 22.²⁸ SSA looks at daily functioning as a whole, including the support a person receives from family or structured settings. Relying on those supports does not disqualify someone, and being able to handle routine tasks like cooking or shopping does not by itself prove absence of disability.

Reporting Abuse, Neglect, or Exploitation

For situations that are not life-threatening but need investigation within 24 hours, the Texas Abuse Hotline at 1-800-252-5400 is the main resource. Reports can also be filed online. You do not need proof — suspicion is enough — and reporter identities stay confidential.²⁹

One jurisdictional change matters for institutional residents. Since March 1, 2024, reports involving residents of ICF/IID facilities and State Supported Living Centers are no longer handled by the Department of Family and Protective Services. Those reports go to the HHS Complaint and Incident Intake (CII) at 1-800-458-9858 or online.³⁰

Disability Rights Texas, the state’s federally designated protection and advocacy agency, has independent authority to investigate abuse and neglect of people with disabilities in institutions. In 2024, the Fifth Circuit affirmed the agency’s broad investigatory powers under federal law, including the right to compel a psychiatric hospital to produce surveillance footage related to alleged patient abuse.³¹

Community Integration Rights

The 1999 U.S. Supreme Court decision in Olmstead v. L.C. held that the unjustified institutionalization of people with disabilities is discrimination under the ADA. States must provide services in the most integrated setting appropriate to a person’s needs. Texas has been the subject of significant Olmstead litigation. In Steward v. Young, filed in the Western District of Texas, advocates challenged the unnecessary placement of more than 4,000 people with IDD in nursing facilities.³² A 2013 interim settlement expanded home and community-based waiver services, required person-centered transition plans, and set up assessments of nursing facility residents to identify those with developmental disabilities; the DOJ intervened on behalf of the plaintiffs.³³ As of August 2025, the Center for Public Representation had submitted a proposed remedial order. In June 2025, a federal judge issued a landmark ruling in a long-running case concerning people with IDD housed in Texas nursing facilities.³⁴

What’s Ahead

The Texas House Committee on Human Services is evaluating the overall availability of IDD services and is expected to issue recommendations for the 90th legislative session, which begins in January 2027.¹ One structural change under discussion is a tiered eligibility system based on medical necessity, though officials have noted that everyone currently eligible for these waivers already has significant needs. HB 2542, enacted in 2025, established a workgroup under HHSC to study gaps in acute and long-term care for people with IDD who also have mental health conditions or high behavioral needs; the workgroup’s final report is due by December 2026.³⁵

1
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2
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3
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