The HCS waiver in Texas is a Medicaid program that pays for long-term support services so people with intellectual disabilities or related conditions can live at home or in small community settings instead of an institution. To qualify, you need a documented intellectual disability (or qualifying related condition) with an IQ of 69 or below that originated before age 22, and you have to meet Medicaid’s income and resource limits. You apply through your Local Intellectual and Developmental Disability Authority, but almost everyone spends years on an interest list before a slot opens.
Who Qualifies
Eligibility sits in Title 26 of the Texas Administrative Code, Chapter 263.1Legal Information Institute. Texas Administrative Code Title 26 Part 1 Chapter 263 – Eligibility Criteria for HCS Program Services You have to meet the diagnostic, financial, and residency rules all at once.
The Diagnostic Standard
The core requirement is a documented intellectual disability with an IQ of 69 or below, confirmed through a formal Determination of Intellectual Disability (DID), and the disability must have originated before age 22. A person with a related condition and an IQ of 69 or below also qualifies. People with IQ scores between 70 and 75 who have a related condition and adaptive deficits can access some state-funded IDD services, but they are generally not eligible for the HCS waiver.1Legal Information Institute. Texas Administrative Code Title 26 Part 1 Chapter 263 – Eligibility Criteria for HCS Program Services That line catches many families off guard when an older evaluation sat right at the borderline.
Based on the DID, HHSC also has to determine that the applicant qualifies for an Intermediate Care Facility for Individuals with an Intellectual Disability (ICF/IID) level of care. The waiver is built for people who would otherwise need that institutional level of support.2Texas Health and Human Services. Home and Community-Based Services (HCS)
Financial Limits
HCS is a Medicaid waiver, so income and resources matter. For 2026, the waiver institutional income limit is $2,982 per month for an individual and $5,964 for a couple. The resource limit is $2,000 for an individual and $3,000 for a couple.3Texas Health and Human Services. Community Care Services Eligibility Handbook – Appendix XI, Income and Resource Limits These are not the SSI community limits of $994 per month. Because the waiver uses the higher institutional standard, some people who earn too much for SSI alone still qualify for HCS.
Countable resources include bank accounts, stocks, and similar financial assets. A primary home, one vehicle, and personal belongings typically do not count. Pull together bank statements, Social Security award letters, and asset documentation early so Medicaid verification doesn’t drag.
Residency and Status
Applicants have to live in Texas and show proof, such as a utility bill or lease. U.S. citizenship or qualifying immigration status is required for Medicaid coverage, and the categories of noncitizens eligible for full Medicaid are narrowing effective October 1, 2026.4Medicaid.gov. Implementation of Section 71109 Alien Medicaid Eligibility of the Working Families Tax Cut Legislation Families with noncitizen members should confirm status with HHSC before applying.
The Cost Cap
Each participant’s annual service plan has a dollar cap tied to their assigned Level of Need (LON). For 2026:
- LON 1, 5, or 8: $167,468 per year
- LON 6: $168,615 per year
- LON 9: $305,877 per year
If projected service costs exceed the cap for the applicant’s level, HHSC can deny enrollment.1Legal Information Institute. Texas Administrative Code Title 26 Part 1 Chapter 263 – Eligibility Criteria for HCS Program Services
How to Apply
What You’ll Need
The most important document is a current psychological evaluation supporting the Determination of Intellectual Disability: diagnosis, IQ score, and documented functional limitations. For a related condition instead of intellectual disability, a physician’s certification showing the condition began before age 22 takes the place of the DID.
You’ll also need financial records for Medicaid verification — bank statements, Social Security award letters, documentation of assets, proof of income — plus proof of Texas residency. Having everything in hand before you contact the local authority avoids the back-and-forth that stalls many applications.
Contacting Your LIDDA
The Local Intellectual and Developmental Disability Authority (LIDDA) is the entry point. Every county is assigned to one, and HHSC publishes a directory you can search by county or ZIP code.5Texas Health and Human Services. Local Intellectual and Developmental Disability Authorities (LIDDA) The process usually starts with a phone call to the intake worker, who explains what to bring and sets up an initial appointment.
After the LIDDA receives your paperwork, a diagnostician reviews it. Incomplete records and outdated evaluations are the most common reason applications stall. The LIDDA may also conduct an interview or home visit. Once the file is complete, the LIDDA sends the enrollment packet to HHSC for a final level-of-care determination. If HHSC approves clinical and financial eligibility, the applicant’s name goes on the statewide HCS interest list, and the date the LIDDA received the initial request becomes the interest list date.6Legal Information Institute. Texas Administrative Code Title 26 – 263.103, HCS Interest List That date controls everything about when a slot is eventually offered.
If You’re Denied
You have the right to a fair hearing, and the request must be made within 90 days of the date on the denial notice. You can file by calling 2-1-1, submitting a written request, or visiting a local HHSC office.7Texas Health and Human Services. Fair and Fraud Hearings Federal rules give HHSC 90 days from receipt of the request to issue a decision, with limited exceptions for extensions or emergencies.8eCFR. 42 CFR 431.244 – Hearing Decisions
The Interest List and the Wait
HHSC keeps a single statewide interest list because open slots never come close to matching the number of eligible applicants. Names are ordered chronologically by the date the LIDDA received the initial request, and when a slot opens it goes to the person with the earliest date.6Legal Information Institute. Texas Administrative Code Title 26 – 263.103, HCS Interest List For applicants under 22 who are leaving an ICF/IID or nursing facility, the interest list date is set to the date they were admitted to the facility, which can move them ahead of people who applied later.
Wait times stretch for years. HHSC has periodically received legislative authorization to release additional slots, but demand stays far ahead of supply. While you wait, your LIDDA may be able to connect you with Community First Choice services, general revenue-funded IDD services, and local school district programs for minors.
Keeping Your Place
If HHSC loses contact with you, your name can come off the list. Keep your mailing address, phone number, and email current with your LIDDA, and respond to any check-in confirming you still want services. If you’re removed and request reinstatement within 90 days, HHSC will generally restore your original interest list date on the first occurrence. After that, or if more than 90 days pass, you risk being assigned a new date and going to the back of the line.
Crisis Diversion Slots
A small number of slots are reserved for people at imminent risk of institutional admission. The applicant has to meet the LIDDA’s diagnostic criteria, and the LIDDA has to show that community alternatives — other Medicaid waivers, ICF/IID placements, general revenue services — have been exhausted.9Texas Health and Human Services. LIDDA Handbook – 12000, Protocol for Offering an HCS Crisis Diversion Slot If HHSC agrees and a slot is available, it authorizes an enrollment offer within one business day. Crisis diversion is not a shortcut for people who want to move faster; it exists for situations where institutionalization is imminent.
What the Waiver Covers
Services are organized into a person-directed plan built around the individual’s needs and goals.10Texas Health and Human Services. Home and Community-based Services Handbook – 4000, Person-Directed Plan
On the residential side, participants can choose host home or companion care (living with a trained caregiver in the caregiver’s residence), supervised living in a shared home with on-site staff, supported home living in their own home or apartment with periodic staff visits, or a small group home of three or four residents. All of these settings are in the community.
Clinical and support services include occupational, speech, and cognitive rehabilitation therapies, dietary services, audiology, behavioral support, and nursing from registered or vocational nurses based on medical need. Employment assistance and supported employment help participants find and keep jobs, and day habilitation covers structured daytime activities focused on life skills and community involvement. The waiver also pays for adaptive aids, minor home modifications like ramps or bathroom grab bars, respite care, dental services, social work, and transition assistance.2Texas Health and Human Services. Home and Community-Based Services (HCS)
Participants who want to choose their own workers can use the Consumer Directed Services (CDS) option. Under CDS, the participant or a legally authorized representative acts as the employer — hiring, scheduling, training, and supervising providers — while a Financial Management Services Agency handles payroll and tax filings. Services eligible for CDS include nursing, respite, employment assistance, supported employment, cognitive rehabilitation therapy, and Community First Choice services.11Texas Health and Human Services. Consumer Directed Services (CDS) It gives families real control, but the employer responsibilities are real too.12Texas Health and Human Services. Consumer Directed Services Option Frequently Asked Questions
Room and Board Is on You
Federal law prohibits Medicaid from paying for room and board in community waiver settings.13eCFR. 42 CFR Part 441 Subpart G – Home and Community-Based Services: Waiver Requirements Food and housing costs are the participant’s responsibility. Many HCS participants cover these costs with SSI, which pays an eligible individual $994 per month in 2026.14Social Security Administration. SSI Federal Payment Amounts In a host home or small group home the provider sets a room and board charge; in supported home living, the participant pays rent and buys groceries directly. Respite care in an approved facility is the one narrow exception where Medicaid can cover part of room and board.
Staying Enrolled
Each participant’s care runs on a person-directed plan (PDP) linked to an individual plan of care (IPC) that renews annually. The PDP is reviewed and updated at each renewal, and the service coordinator can update it mid-year if circumstances change.10Texas Health and Human Services. Home and Community-based Services Handbook – 4000, Person-Directed Plan
HHSC also reassesses the participant’s level of care periodically to confirm they still meet ICF/IID-level criteria. If they no longer meet it, services can be reduced or terminated. The same fair hearing rights apply.15Texas Health and Human Services. Community Care Services Eligibility Handbook – 2900 Appeals and Fair Hearings If you get a notice that services are being cut, request a hearing within 90 days. Doing so before the effective date of the reduction may let services continue during the appeal.