Should you recommend a Medicaid waiver program?
“Waivers let states use Medicaid funds for long-term home and community-based services for people with disabilities or special health care needs in order to help them live in the community.”
Texas Health and Human Services Commission’s Navigate Life Texas website, 2026
On your appointment schedule today are three young patients whose parents have expressed that they would like help supporting their children’s medical and developmental needs. Review the following case examples and determine whether you should encourage these parents to have their child added to a Texas Medicaid waiver waiting list, which is known as an interest list.
Sofia
20 months
Case Example 1: Sofia, age 20 months
Sofia is a toddler with autism spectrum disorder and global developmental delay. She is nonverbal and has significant sensory regulation difficulties. She has recently begun wandering away and requires constant supervision. She receives early intervention services, and her parents report growing difficulty managing her daily care and keeping her safe at home as her needs become more complex.
Marco
4 years
Case Example 2: Marco, age 4
Marco has spastic cerebral palsy diagnosed in infancy. He uses a gait trainer, needs help with dressing, bathing and transfers, and receives physical, occupational and speech therapy. He lives with his parents and three siblings. His parents report increasing caregiving strain and express concern they will be able to manage his needs as he grows up.
Liam
5 years
Case Example 3: Liam, age 5
Liam, the oldest of three children, has delayed speech and sensory sensitivities. He attends preschool and is making progress with school-based and outpatient therapies. He has not been diagnosed with a developmental disorder and is not medically dependent, but his parents express the need for support in getting services to help him.
Check your knowledge of Texas Medicaid waiver programs and then determine whether to recommend that these parents have their child placed on an interest list.
Drag each card to the correct category, or use arrow keys to select a bucket and press Enter to confirm.
A child may be on more than one waiver interest list at the same time, even though the child cannot be enrolled in more than one waiver program at the same time.
A child must prove final program eligibility before the family be placed on a Medicaid waiver interest list.
Children should be signed up for a Medicaid waiver interest list as early as possible because it can take 15 years or longer to reach the top of the list.
Sofia may qualify for the Community Living Assistance and Support Services (CLASS) waiver or another program due to her intellectual disability and functional limitations.
Marco is unlikely to qualify for a waiver program because his parents have demonstrated they can care for him at home.
Liam should be referred for case management rather than a waiver program for support with obtaining needed support services.
Your recommendation to parents is important
Providers should encourage parents to add children who may qualify to appropriate waiver interest lists as early as possible. Texas waiver interest lists can be very long, and many programs determine placement on a first-come, first-served basis.
Early enrollment protects options for the future, especially because a child’s needs may become more complex over time. It also allows families to join more than one list, which may increase the chance of accessing services sooner. Families can decline services if the child’s needs change or the waiver is no longer a good fit. This is why providers play an important role in raising the topic early—often when a child is first diagnosed or when functional needs begin to emerge.
Learn more about Medicaid waiver programs and how you can counsel parents by taking the quick course Texas Medicaid Waivers: What Texas Health Steps Providers Should Know.