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Texas MedicaidWaiver ComparisonHCSCLASSDBMD14 min Read

Texas Medicaid Waivers Decoded: HCS vs. CLASS vs. DBMD (2025)

Compare the Texas HCS, CLASS, and DBMD waivers. Discover 2025 spending limits, residential setting rules, eligibility requirements, and interest list updates.

The Texas Medicaid system for Long-Term Services and Supports (LTSS) is notoriously fragmented. Unlike states with consolidated waivers, Texas operates a siloed system where your diagnosis and age determine your path.

For families navigating this "alphabet soup," the three most critical 1915(c) waivers to understand are HCS (Home and Community-based Services), CLASS (Community Living Assistance and Support Services), and DBMD (Deaf Blind with Multiple Disabilities).

Making the wrong choice can leave you without residential options or capped at a budget that covers only a fraction of your needs. This guide decodes the eligibility thresholds and financial limits for the 2025 billing cycle.1

Key Takeaways

  • Distinct Populations: HCS is for intellectual disabilities (IDD); CLASS is for related conditions (e.g., cerebral palsy, spina bifida); DBMD is strictly for deafblindness with multiple disabilities.1
  • Residential Coverage: Only HCS covers group homes and Host Homes. CLASS provides no residential funding (support in own home only).1
  • Financial Caps (2025): CLASS and DBMD are capped at $149,774 annually. HCS can go up to $392,318 for individuals with the highest Level of Need (LON).1
  • The Waitlist Crisis: The "Interest Lists" for these programs can span 15+ years. You must register immediately.2
  • Different Lines: To join the HCS list, you call your LIDDA. To join CLASS/DBMD, you call the CSIL Hotline (877-438-5658).3

1. The Texas LTSS Landscape

Texas utilizes 1915(c) waivers to divert individuals from institutional care (Intermediate Care Facilities or ICF/IID). This means the state is "waiving" the requirement that you live in a facility to receive funding, allowing you to use that money in the community instead.4

However, because these are "waivers" and not "entitlements," the number of slots is limited by the state legislature. This has created a massive backlog known as the Community Services Interest List (CSIL).3

2. Home and Community-based Services (HCS)

Target Population: Individuals with an Intellectual Disability (IQ 69 or below) or a related condition with an IQ of 75 or below.1

The "Super Waiver": HCS is often considered the most robust waiver because it is the only one that funds 24/7 residential settings.

  • Group Homes: 3-to-4 person residences managed by a provider.
  • Host Homes: "Adult Foster Care" where a participant lives with a paid family or provider.

Financial Limit: HCS budgets are scaled by "Level of Need" (LON). A participant with intense medical or behavioral needs (LON 9) can access a budget cap of $392,318, making it the primary option for those with profound disabilities.1

3. Community Living Assistance and Support Services (CLASS)

Target Population: Individuals with a "related condition" (e.g., cerebral palsy, muscular dystrophy, spina bifida) that manifested before age 22, causing substantial functional limitation.1

The "Independence Waiver": CLASS is strictly for individuals living in their own home or family home.

  • No Residential Funding: It does not pay for room and board or group homes.
  • Cap: Funding is capped at roughly 210% of the cost of an ICF/IID, which for 2025 translates to $149,774.5

If your loved one requires a group home setting, CLASS is not the right vehicle.

4. Deaf Blind with Multiple Disabilities (DBMD)

Target Population: Individuals who are legally deafblind and have a third disability (e.g., IDD or a physical impairment).1

Niche Support: This waiver services a very small, highly specific population (~300 Texans). It includes specialized communication therapies (interveners) and orientation/mobility training not found in other waivers.

  • Residential: Covers small Assisted Living Facilities (ALFs).
  • Cap: Like CLASS, it is capped at $149,774.1

Comparison Matrix (2025)

The table below outlines the critical differences affecting your long-term planning.1

FeatureHCSCLASSDBMD
Max Budget Cap$392,318 (LON 9)$149,774$149,774
Residential SettingsGroup Homes (3-4 bed), Host HomesNone (Own/Family Home only)Assisted Living (4-6 bed)
Case ManagementLIDDA Service CoordinatorCase Management Agency (CMA)Provider Agency
Waitlist ActionCall your local LIDDACall 877-438-5658Call 877-438-5658
Minor Home Mods$10,000 Lifetime Limit$10,000 Lifetime Limit$10,000 Lifetime Limit
Adaptive Aids$10,000 Annual Limit$10,000 Annual Limit$10,000 Annual Limit

5. Navigating the Interest List Crisis

Texas has over 170,000 individuals waiting for these services. The wait time for HCS currently exceeds 15 years.2

Strategic Action Plan

  1. Get on ALL Lists: You can be on the HCS, CLASS, and DBMD lists simultaneously. Do not choose just one.
  2. Call Immediately:
    • For HCS: Search for your county's "Local Intellectual and Developmental Disability Authority (LIDDA)" and request to be added to the HCS Interest List.
    • For CLASS/DBMD: Call the CSIL Hotline at 1-877-438-5658.3
  3. Update Contact Info: If you move or change your phone number, you must update the state. If they call you in 12 years and you don't answer, you are dropped.6

Important: Being on the list does not mean you have been approved. Eligibility is only verified when your name finally reaches the top of the list ("slot release").7

Frequently Asked Questions (FAQ)

1. Can my child receive therapy while on the waitlist?

Yes. While waiting for a waiver slot, any Medicaid-eligible child can receive Community First Choice (CFC) services (attendant care) and acute therapy (PT/OT/ST) through their Managed Care Organization (MCO). Getting CFC does not remove you from the waiver waitlist.8

2. What if my child doesn't have an IDD diagnosis?

If your child has a physical disability but a normal IQ, they likely qualify for CLASS, not HCS. However, you should still put them on both lists just in case a future evaluation reveals a qualifying condition.1

3. Does parental income count?

For these specific waivers (HCS, CLASS, DBMD), parental income is disregarded. If the child qualifies for the waiver, they qualify for Medicaid regardless of how much money the parents earn. This is why "deeming" waivers are so valuable.7

4. Can I buy my way into a slot?

No. The lists are strictly first-come, first-served based on the date of request. The only exceptions are "Crisis Diversion" slots for individuals at imminent risk of institutionalization or homelessness.9

5. What is the Texas Home Living (TxHmL) program?

TxHmL is a "mini-waiver" with a much lower budget cap (~$17,000/year). It is reserved for people already receiving services through valid local authorities. It does not provide the robust comprehensive care of HCS.1

Conclusion

The Texas waiver system is a test of endurance. The HCS waiver offers the profound safety net of residential placement and high budgets, but it requires navigating the local authority system. CLASS offers flexibility for physical disabilities but lacks the housing component.

The most important step you can take is to get on every list today. Do not wait for a diagnosis to be "final" or for a crisis to hit. In Texas, time on the list is the only currency that matters.

Footnotes

  1. HHSC LTSS Waivers Provider Guide. The definitive source detailing cost ceilings and residential settings. Reliability: Primary State Source. ↩ ↩2 ↩3 ↩4 ↩5 ↩6 ↩7 ↩8 ↩9 ↩10 ↩11 ↩12

  2. Texas CSIL Data (July 2025). Raw spreadsheet data confirming waitlist volumes. Reliability: Primary State Source. ↩ ↩2

  3. HHSC Interest List Reduction Report. Provides the statistical reality of wait times and slot allocations. Reliability: Primary State Source. ↩ ↩2 ↩3

  4. HHSC 1915(c) Waiver Overview. Introduces the federal waiver framework. Reliability: Primary State Source. ↩

  5. HHSC Information Letter No. 2025-24. Documents payment rate actions effective Sept 1, 2025. Reliability: Primary State Source. ↩

  6. The Arc of Texas Waiver Guide. Delineates how to join specific waitlists. Reliability: High (Advocacy). ↩

  7. Navigate Life Texas Guide. Explains parental income deeming rules. Reliability: State-Sponsored Resource. ↩ ↩2

  8. HHSC System Redesign Report 2023. Notes interaction between waivers and Community First Choice. Reliability: Primary State Source. ↩

  9. HHSC House Committee Presentation. Contextualizes institutional level of care. Reliability: State Government Presentation. ↩

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