Texas Home Living Waiver: Who Qualifies, Services, and Interest List

The Texas Home Living waiver (TxHmL) is a Medicaid program that pays for up to $31,684 a year in support services for Texans with intellectual or developmental disabilities who live in their own home or with family.¹ To qualify, you have to meet both clinical and financial criteria, and to actually receive services you have to get on a statewide interest list and wait for a funded slot to open. The wait is long. Getting your name on the list early is the single most important thing you can do.

Who Qualifies

Eligibility runs on two tracks. You have to show that you clinically need this level of support, and you have to show that you cannot pay for it privately. Both have to be satisfied, and you cannot already be enrolled in another 1915(c) Medicaid waiver such as Home and Community-based Services.²

The Clinical Side

The applicant has to have a documented intellectual disability or a related condition that began before age 22 and causes similar functional limitations. Under 26 Texas Administrative Code Chapter 262, the applicant then has to qualify for Level of Care I or Level of Care VIII.³

The Level of Care determination looks at three things: primary diagnosis, IQ score, and adaptive behavior. For LOC I with an intellectual disability diagnosis, the IQ must be below 70. For LOC I with a related condition, the threshold is below 76. LOC VIII covers certain related conditions regardless of IQ, but only when adaptive behavior limitations are more significant.³ The determination itself is captured on Form 8578, the Intellectual Disability/Related Condition Assessment.⁴

The Financial Side

Monthly income cannot exceed 300% of the federal SSI benefit rate. Using the 2026 SSI figure of $994, that puts the ceiling at $2,982 a month.⁵ Countable resources are capped at $2,000.⁶ Only the applicant’s own income and resources count.

Two exclusions ease the resource limit. The applicant’s primary Texas residence does not count, and one vehicle does not count regardless of value.⁷ For minor children, parental income is not counted toward the child’s eligibility.⁸ A child can qualify even if their parents earn well above the income limit, which is a meaningful departure from many other Medicaid programs.

Watch bank balances as the application progresses. A balance that drifts even slightly over $2,000 on the wrong date can hold up approval.

What the Waiver Pays For

Services combined cannot exceed $31,684 in a plan-of-care year, a limit that nearly doubled from $17,000 effective September 1, 2025.¹ Within that budget, TxHmL covers community support (help with bathing, dressing, meals, and getting around), day habilitation, employment assistance and supported employment, occupational and physical therapy, speech-language pathology, behavioral support, skilled nursing, respite for family caregivers, adaptive aids up to $10,000 a year,⁹ minor home modifications like ramps and grab bars, and dental services.

The specific mix comes together in an Individual Plan of Care (IPC) built with a service coordinator. The IPC runs 365 days and can be revised mid-year if circumstances change.¹⁰ Services on the plan have to be ones you cannot get through other sources, including natural supports from family.

TxHmL is for people living in their own home or a family home. If the applicant is already enrolled in another 1915(c) waiver, TxHmL is not available on top of it.

Getting on the Interest List

There is no open enrollment. Everyone who qualifies goes on the Community Services Interest List (CSIL), which runs first-come, first-served. To get on it, the applicant, their legally authorized representative, or an actively involved person calls the CSIL hotline at 877-438-5658.¹¹

Some Texas Medicaid waiver interest lists stretch as long as 16 years. There is no way to jump the line, and no clinical or financial urgency argument shortens it. This is why families are urged to call the hotline as soon as an eligible person is identified, even if they are still a child and services are not needed yet.

Staying on the List

Your Local Intellectual and Developmental Disability Authority (LIDDA) has to contact you every two years to confirm your information and that you still want the program. If they cannot reach you after multiple attempts, your record is flagged “Inactive-Unable to Contact,” which effectively drops you from the list. Do not wait to be called. Push updates to the LIDDA any time your phone, address, or email changes. If you move to a different LIDDA’s service area within Texas, your interest list date transfers with you and your spot does not reset.¹¹ You can find your local LIDDA through the HHSC directory.¹²

When a Slot Opens

Once a funded slot becomes available, the LIDDA contacts the next person on the list to begin enrollment. A service coordinator schedules an interview, reviews records, confirms you still meet both clinical and financial criteria, and starts building your IPC. Have documents ready: a state-issued ID or birth certificate, medical records confirming the diagnosis, Form 8578, recent bank statements for every account, Social Security award letters, and records of life insurance or other countable resources.

You then choose a program provider. The LIDDA has to give you names and contact information for every TxHmL provider in your service area, and you have 30 calendar days to make a choice and document it on the HHSC Documentation of Provider Choice form.¹³ If you want to visit providers or meet staff before deciding, the LIDDA has to arrange that. Missing the 30-day deadline can lead the LIDDA to withdraw the enrollment offer.

You will also sign an HHSC Waiver Program Verification of Freedom of Choice form, documenting that you are picking TxHmL over placement in an Intermediate Care Facility for Individuals with Intellectual Disabilities.¹³

Running Services Yourself: The CDS Option

You do not have to receive all services through a traditional agency. The Consumer Directed Services (CDS) option lets you, or your legally authorized representative, act as the employer of record for your own workers: recruit, hire, train, manage, and if needed fire them.¹⁴ You set wages within your allocated budget, approve timesheets, and carry liability for your employees’ actions, and you have to plan for coverage if a worker calls in sick or quits.¹⁵

Payroll and taxes are handled by a Financial Management Services Agency (FMSA) that you pick from an HHSC-contracted list. The FMSA registers with the IRS as your agent, runs payroll, files employment tax reports, verifies employee backgrounds, and helps build a working budget.¹⁴ You can appoint a designated representative to help with the employer duties, but you remain accountable for their decisions.

If You Are Denied

If HHSC denies your application, reduces your services, or takes any other adverse action, you can request a fair hearing. The deadline is 90 calendar days from the effective date of the action or the date of the denial notice, whichever is later.¹⁶ You can request the hearing in writing, verbally, or by checking the box on the notification form you received with the denial.¹⁷

There is a second, earlier deadline that matters if you are already receiving services. To keep services running while the appeal is pending, you have to file the hearing request before the effective date on the denial notice. Miss that earlier date and services stop while you wait.¹⁷ If you miss the 90-day window entirely, a hearings officer decides whether you had good cause. Without good cause, the agency’s decision becomes final.¹⁶

Keeping Eligibility After You Are Enrolled

Enrollment is not permanent. Form 8578 has to be completed annually to renew your Level of Care and Level of Need,⁴ and your IPC has to be renewed before the current one expires.¹⁰ If income rises above the limit or clinical needs change substantially, eligibility can be affected at the next review. The program provider handles the assessment paperwork, but keeping medical records and financial documents current is on you.

1
Texas Health and Human Services. IL 2025-19 IPC Revision Process to Update Attendant Rates
2
Texas Medicaid and Healthcare Partnership. 1915(c) Waiver Programs
3
Texas Health and Human Services. ID/RC FAQs
4
Texas Health and Human Services. 5000, Level of Care and Level of Need
5
Social Security Administration. SSI Federal Payment Amounts for 2026
6
Texas Health and Human Services. Appendix XXXI, Budget Reference Chart
7
Texas Health and Human Services. Appendix XII, Nursing Facility and Home and Community-Based Services Waiver Information
8
Texas Health and Human Services. E-7200, When Deeming Procedures Are Not Used
9
Legal Information Institute (LII). Texas Administrative Code Title 26 262.304 – Service Limits
10
Texas Health and Human Services. 6000, Individual Plan of Care (IPC)
11
Texas Health and Human Services. 7000, HCS and TxHmL Interest Lists
12
Texas Health and Human Services. Local Intellectual and Developmental Disability Authorities (LIDDA)
13
Legal Information Institute (LII). Texas Administrative Code Title 26 262.103 – Process for Enrollment of Applicants
14
Texas Health and Human Services. How CDS Works
15
Texas Health and Human Services. 8200, Consumer Directed Services
16
Texas Health and Human Services. 1400, Submitting a Fair Hearing Request Summary
17
Texas Health and Human Services. 2900, Appeals and Fair Hearings