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Futures Planning

Medicaid Waivers - What are they?

A Medicaid waiver allows the state to be more flexible in how it spends money to provide some long-term services to some people with disabilities or elderly citizens who are eligible for Medicaid. In the past, people had to be in nursing homes or other large institutions for Medicaid to pay for long-term services. Waivers override certain rules for how that funding can be used. Now, if they meet the eligibility requirements, people can get the services they need in their own homes or other community settings, instead of having to go into a nursing home or institution.


In Texas, there are seven different waiver programs that offer a broad range of home and community-based services to people with disabilities and elderly citizens. There are different rules and funding amounts for each of the different waivers.


How long is the waiting list for waiver services in Texas?

When you call to access services in Texas you will learn of an “interest list", known by families and individuals who have a disability as actually being a “waiting list". The list varies in length depending on the Waiver program. Some people have been on the list 11+ years. There are over 3x's as many people waiting for waiver services as there are receiving them. Also, there is a transfer process when a child becomes an adult, so there may be a gap in services when a child ages out.


Below are additional resources regarding the Medicaid Waiver program in Texas.

Texas Medicaid Waiver


Texas Health and Human Services


Home and Community Based Services Providers in Harris County







When a child with disabilities reaches the age of majority (age 18), guardianship may need to be considered since parents do not automatically remain their child’s natural guardian.   It is a difficult decision in many cases, since the individual is deemed to be incapacitated, loses all civil rights, including the right to vote, drive, or marry.  Guardianship is determined by a judge in a court of law and services of an attorney are often required. Guardianship is necessary if the individual’s parents, doctor, psychologist, and caregivers all agree that the individual is not capable of making decisions even with appropriate guidance and information. 


All adults with severe disabilities do not require a guardian.  Guardianship should only be used after other less-restrictive alternatives have been considered.   There are many such alternatives to guardianship that give people with disabilities support to make decisions without taking away their rights. 


Alternatives to guardianship can include:

  • Supported decision-making
  • Medical power of attorney
  • Durable power of attorney
  • Special needs trust
  • Medicaid services such as CFC, HCS, CLASS, etc.
  • Money management programs.



For more information on alternatives to guardianship, please visit the websites below.


Catholic Charities

Disability Rights Texas

National Resource Center for Supported Decision-Making

Texas Able

Texas Council of Developmental Disabilities

Texas Guardianship Association

Texas Law Help

Texas Project First

The ARC of Texas: Alternatives to Guardianship