The IDD population can be the most complex to support and the most rewarding.

Approximately 475,000 Texans have an intellectual or developmental disability. Intellectual and developmental disabilities (IDD) are lifelong conditions that uniquely affect the trajectory of the
individual’s physical, intellectual, and/or emotional development, requiring services and supports across the lifespan. Autism spectrum disorders (ASD), Down Syndrome, and Cerebral Palsy are common examples of these conditions. About one-third of individuals with IDD also have a mental health condition.

From Special Education to Adult Life in the Community

Texans with intellectual and developmental disabilities are legally entitled to public education up to 21years of age. This education includes a variety of services and supports such as: social integration, life skills, learning strategies, educational assistant support (paraprofessional), toileting, feeding, behavior management, and more.

When school services end at age 22, individuals with IDD and the families who care for them frequently lose a critical foundational support system. When families are able access to Medicaid state-funded services, they can and do support adult loved ones at home and in the community for many years.

One of the greatest concerns families face is what will happen when they can no longer provide that care. That is why Medicaid is also the safety net for people with IDD throughout their lives, regardless of their level of family supports and whether they receive services in their own home or a shared home in the community (group home, host home/companion care or a community-based intermediate care facility).

Medicaid Long-Term Services and Supports for People with IDD

Because IDD is lifelong and the functional skills of individuals with IDD generally do not change after graduation, Medicaid-funded long-term care services and supports pick up where the public education system ends. Long-term services and supports, like curriculum in public school, are developed around the goals, abilities, and desires in a person’s individual plan of care (IPC). Services are designed to help people develop and retain the knowledge and skills they need to live as independently as possible in the
community.

This model of services, called habilitation, is different than personal attendant services (where an attendant supports a person with physical disabilities with eating, bathing, and other personal care activities). Although individuals with IDD, particularly those with physical disabilities, may also need personal attendant services, habilitation services are essential for lifelong skill development.

Medicaid Service Options Available for Persons with IDD

In the community, Texas serves about 44,774 individuals with IDD in various Medicaid mandatory benefit and waiver (community based) programs.

1. Mandatory Benefit Programs

State Supported Living Centers (SSLCs) and Intermediate Care Facilities (ICF-IIDs) are state mandatory benefit programs that provide 24-hour care to individuals with IDD living in a facility or a staffed home in the community. There are no interest lists for mandatory benefit programs, they are offered statewide, and are available to anyone who meets the eligibility requirements, which includes a diagnosis of an intellectual or a developmental disability.

• SSLCs are large, state-owned and operated institutional facilities. There are 13 SSLCs across the state with a census of 2,869 individuals in FY 2021.
• Community-based ICF-IIDs can be public or privately owned and operated facilities and may be small (up to 8 beds), medium (9-13 beds) or large (14 or more beds). The majority of ICFs are small. HHSC projects 5,600 individuals were living in an ICF-IID in FY 2021.

2. Community Waiver Programs

Most Texans with IDD are served through community-based waiver programs. Waiver programs for individuals with IDD are not a mandatory benefit, meaning people do not automatically receive services if they are eligible, they can be put on a waitlist, or an “interest list,” and the Legislature determines how many people receive services each legislative session in the budget. The Home and Community-based Services (HCS) waiver, which is the largest IDD waiver, has an interest list of113,913 individuals. Some individuals have waited up to 18 years to receive services.

• Home and Community-based Services (HCS)
  The largest and most comprehensive waiver, HCS services include residential options: three or four-bed group homes and host home/companion care (foster care type arrangement). Services include supports in a person’s own home or in the community including transportation, Individualized Skills and Socialization (formerly called day habilitation), employment services, and more. 26,960 individuals were served in 2021.
• Texas Home Living (TxHmL)
  Services are delivered in a person’s own home or family home and include Individualized Skills and Socialization, employment services, and transportation. This is the only waiver program that considers family income for eligibility – 3,670 individuals were served in 2021.
• Community Living Assistance and Support Services (CLASS)
  Services are delivered in a person’s own home or family home and include a variety of specialized therapies only available in this waiver. 6,066 individuals were projected to be served as of 2022.
• Deaf-Blind Multiple Disability (DBMD)
  Must have a diagnosis of deaf-blindness or a condition that will cause deaf-blindness, along with at least one other disability that impairs independent functioning. Unique services to this waiver include intervener services and orientation/mobility services. 340 individuals projected to be served as of 2022.