How Texas pays for disability services

Waiver inventory

Texas operates no 1915(i) state plan HCBS benefit and no 1915(b)(3) authority for IDD. The Youth Empowerment Services (YES) 1915(c) waiver is excluded as a children's serious emotional disturbance program.

State-only funded programs

Non-Medicaid Intellectual and Developmental Disability Community Services (HHSC strategy 6.1.3), delivered by Local Intellectual and Developmental Disability Authorities. FY2025 expended $51,231,426, of which $51,228,426 is General Revenue and $3,000 is License Plate Trust Fund. FY2026 budgeted $53,189,535. LBB reports the 2026-27 biennial total at $106.4 million All Funds, all General Revenue. Three sub-strategies:

• Intellectual Disability Community Services: $35,727,386 FY2025, $35,285,495 budgeted FY2026, almost entirely Grants ($34,526,942 FY2025). Funds eligibility determination plus service coordination, community support, employment services, day training services, therapies, and respite for people in the LIDDA priority population who live in the community and are not served through ICF/IID or a Medicaid waiver. Statutory authority Health and Safety Code sections 533.035(a) and 534.054.
• IDD Crisis Intervention: $14,004,040 FY2025 and FY2026, all General Revenue grants.
• IDD Outpatient Services: $1,500,000 FY2025, rising to $3,900,000 FY2026. Outpatient behavioral health for people in the LIDDA priority population with a co-occurring mental health condition, substance use disorder, or behavior support needs. LBB attributes a $4.8 million General Revenue increase to funding 12 new LIDDA outpatient mental health teams.

URLs: hhs.texas.gov and lbb.texas.gov

County / regional / local funding

Local Intellectual and Developmental Disability Authorities (LIDDAs) are the sub-state layer. They are locally governed entities, many of them community centers organized under Health and Safety Code chapter 534 with boards appointed by county commissioners courts or by multi-county arrangements. They are not a taxing mechanism; Texas has no county levy, county board tax, or mill levy for IDD services. LIDDAs matter as the fiscal and administrative channel for two streams:

• Non-Medicaid IDD Community Services (above), $51.2 million FY2025, pure General Revenue passed through as grants to LIDDAs by geography.
• Intake, Access and Eligibility (Local Authority), HHSC strategy 9.2.1 sub-strategy 1: FY2025 $118,045,426 All Funds, split $44,037,609 General Revenue, $29,274,926 GR Match for Medicaid, and $44,732,892 Federal Funds (Title XIX FMAP). FY2026 budgeted $116,463,867. Funds LIDDA eligibility determination and service coordination, and includes $45,213,867 in Grants plus $72,352,980 in Client Services. This is a mixed-fund stream, not state-only.

LIDDAs also maintain the local HCS and TxHmL interest lists in the Community Services Interest List (CSIL) system, which is why HCS and TxHmL interest list release and closure counts in the state data are attributed to Local Authority staff rather than to the state CARE system.

URLs: hhs.texas.gov fhb.hhs.texas.gov

Funding scale

• HHSC total 2026-27 biennium: $98,208.6 million All Funds ($39,958.3M General Revenue, $169.9M GR-Dedicated, $56,242.9M Federal, $1,837.5M Other). Of that, the Medicaid Waivers program area is $4,227.5 million, 4.3% of the agency. lbb.texas.gov
• Program-level client services (HHSC 2026 Operating Budget, hhs.texas.gov):

• SSLC 2026-27 biennium appropriations: $2.0 billion All Funds ($0.8 billion General Revenue), 11,788.0 FTE positions each fiscal year, 13 centers.
• Spending per participant, FY2025 average monthly cost: HCS $3,793.59 overall, $5,956.35 for people receiving residential services and $2,855.20 for those who are not; CLASS $5,025.88; TxHmL $2,370.71; DBMD $6,226.24; ICF/IID $5,094.03. Community Attendant Services $1,538.32.
• FMAP: 59.83% FFY2026 (https://public-inspection.federalregister.gov/2024-27910.pdf), 58.54% FFY2027 (https://www.govinfo.gov/content/pkg/FR-2025-11-28/pdf/2025-21351.pdf). CFC services qualify for a 6 percentage point increase in the FMAP rate.
• Medicaid long-term care non-entitlement average monthly caseload across HCS, CLASS, DBMD, TxHmL and PACE: 38,792 FY2024, 40,113 FY2025, targets of 40,653 FY2026 and 41,182 FY2027.
• Interest lists as of July 31, 2026 (https://www.hhs.texas.gov/sites/default/files/documents/interest-list-data-july-2026.xlsx):

• Average wait: reported as time-on-list bands rather than a mean. HCS: 8,600 people at 0-1 years (6.4%), and people at every band up to 18-19 years (130 people), with 6,145 at 17-18 years and 7,468 at 16-17 years. TxHmL runs to 15-16 years (2,635). CLASS runs to 17-18 years (2,050). MDCP tops out at 2-3 years and STAR+PLUS HCBS is effectively current (99.9% at 0-1 years).
• Of people on the interest lists, 21,140 HCS registrants (15.7%) are already receiving some LTSS service and 53,420 receive SSI; 59,525 receive SSI or LTSS services. Comparable CLASS figures are 13,795 and 39,799. hhs.texas.gov

Residential funding detail

HCS, effective September 1, 2025, all per diem where "1 day = 18 hours" for the shift-staffed models:

• Supervised Living (3-bed, service code 47) and Residential Support Services (4-bed higher acuity, service code 46) share one identical rate schedule, tiered by Level of Need: LON 1 Intermittent $164.46; LON 5 Limited $176.62; LON 8 Extensive $194.31; LON 6 Pervasive $223.81; LON 9 Pervasive+ $341.83. Each rate decomposes into an attendant cost (LON 1 $91.94 to LON 9 $249.22), other direct care cost ($8.08 to $21.90), and indirect care cost ($64.44 to $70.71).
• Host Home / Companion Care (service code 18A), family-setting model: LON 1 $72.56; LON 5 $76.14; LON 8 $94.07; LON 6 $119.18; LON 9 $147.84 per day.
• Residential rates are built on a $13.00 per hour average attendant wage with 15.0% payroll taxes and benefits for residential settings and 14.0% for non-residential settings, per Rider 23 of the General Appropriations Act 2026-27, 89th Legislature.

ICF/IID, effective September 1, 2025, a single blended daily rate combining a day habilitation component and a residential component, tiered by facility size and LON:

DBMD: Assisted Living Services 18 hours or less $126.44 per day; Licensed Assisted Living 19 to 24 hours $146.20 per day; Licensed Home Health Assisted Living 19 to 24 hours $146.20 per day.

CLASS: Support Family Services $30.48 per day (family) or $34.06 per day (child placing agency); Continued Family Services same rates. CLASS has no group home or supervised living line.

TxHmL: no residential service. Out-of-home respite may be delivered "where SL or RSS is provided" or "where HH/CC is provided" at $23.42 per hour, but this purchases respite in someone else's residential setting, not placement.

Room and board. None of the HCS, TxHmL, CLASS, or DBMD rate sheets contain a room and board component; every published rate decomposes only into attendant cost, other direct care cost, facility cost, transportation cost, and indirect or administrative cost. Room and board in HCS residential settings falls to the person's own income, principally SSI, consistent with the 42 CFR 441.310(a)(2) prohibition on federal financial participation for room and board in 1915(c) waivers. ICF/IID is institutional, so room and board is inside the vendor rate with applied income offsetting it.

Rate structure summary. Residential is per diem with acuity tiers (five Levels of Need) and, for Supervised Living and Residential Support Services, an 18-hour day definition. Day services and community supports are hourly with acuity tiers. Employment services are hourly and flat across levels. Case management is per month in CLASS and DBMD; in HCS and TxHmL, service coordination is a LIDDA function funded outside the waiver fee schedule.

Comparable service rates

Official rate schedule links

• HCS payment rates effective 09/01/2025: pfd.hhs.texas.gov
• TxHmL payment rates effective 09/01/2025: pfd.hhs.texas.gov
• CLASS payment rates effective 09/01/2025: pfd.hhs.texas.gov
• DBMD payment rates effective 09/01/2025: pfd.hhs.texas.gov
• Non-state-operated ICF/IID payment rates effective 09/01/2025: pfd.hhs.texas.gov
• STAR+PLUS HCBS payment rates effective 09/01/2025: pfd.hhs.texas.gov
• Primary Home Care rates effective 09/01/2025: pfd.hhs.texas.gov
• Rate tables index and 2026-27 LTSS rate tables: pfd.hhs.texas.gov and pfd.hhs.texas.gov
• HCS and TxHmL Bill Code Crosswalk: hhs.texas.gov
• Information Letter 2025-11, discontinuation of the Attendant Compensation Rate Enhancement program: hhs.texas.gov

Notable features and flags

• September 1, 2025. All direct care rate enhancement programs ended. The Attendant Compensation Rate Enhancement program was discontinued and its funding folded into base rates under Rider 23 of the General Appropriations Act 2026-27, 89th Legislature. LBB scores this at $2.4 billion All Funds ($0.9 billion General Revenue) over the biennium: a $13.00 per hour base attendant wage, payroll taxes and benefits set to 15.0% in residential settings and 14.0% in non-residential, and a $0.24 per hour increase in the associated administrative rate. All rates published for September 1, 2025 are the current rates.
• September 1, 2025. New Employment Readiness rates introduced in HCS and TxHmL (LON 1 $8.55 per hour through LON 9 $26.41 per hour), which HB 4169 caps at no more than the Individualized Skills and Socialization rates.
• July 31, 2026. 200,128 unduplicated people are on the six interest lists, up from a duplicated 366,713 to 374,960 in eleven months. HCS added 8,107 new requests this biennium while enrolling only 476 people off the list, with 130 people now at 18-19 years of waiting. TxHmL closure data shows 1,349 closures for "could not locate" and 780 for "no response to letter," which materially inflates apparent list turnover.
• 2026-27 biennium appropriations. $69.4 million All Funds ($27.6 million General Revenue) for additional Medicaid waiver slots and $10.4 million All Funds ($4.3 million General Revenue) for MDCP diversion slots letting medically fragile children enroll without a nursing facility stay. Against interest lists of this size, this is a marginal reduction.
• March 1, 2023 forward. Day Habilitation was replaced by Individualized Skills and Socialization, split into on-site, on-site in-home, and off-site variants with Enhanced Staffing Levels 1 and 2. LON 9 rates for the new service are still explicitly pegged to the pre-March 2023 LON 9 Day Habilitation rate of $26.41.
• Institutional trend runs against the national direction. SSLC average monthly census fell from 2,962 in FY2018 to 2,574 in FY2025, but the 89th Legislature set targets of 2,637 for FY2026 and 2,669 for FY2027, a planned increase, backed by $2.0 billion All Funds and 11,788 FTEs. LBB notes SSLC operating costs have not fallen proportionally with census because of fixed overhead.
• CFC carries a 6 percentage point FMAP bonus and is an entitlement, which is why Texas routes attendant and habilitation services through CFC PAS/HAB inside all four IDD waivers rather than as waiver services. Consumer Directed Services is available across HCS, TxHmL, CLASS, and DBMD, with a Financial Management Services Agency fee of $210.08 per month.

Confidence

Solid: the complete September 1, 2025 rate schedules for HCS, TxHmL, CLASS, DBMD, and ICF/IID direct from HHSC Provider Finance PDFs; program-level enrollment, expenditure, and per-participant cost measures from the HHSC FY2026 Operating Budget performance measures; interest list counts and time-on-list distributions from the July 2026 HHSC data file; the LIDDA General Revenue streams broken to sub-strategy; SSLC appropriations and census targets; FMAP. Estimated or inferred: the room and board treatment in HCS residential settings, which I infer from the absence of any room and board component in the published rate decompositions plus the general 42 CFR 441.310(a)(2) prohibition, rather than from a Texas-specific citation I retrieved. Could not find: a separate published CFC participant count (it is folded into the Aged/Medicare-Related and Disability-Related entitlement sub-strategies); an MDCP service-level rate schedule at pfd.hhs.texas.gov (MDCP rates run through STAR Kids managed care); a verified count of LIDDAs from a primary source, so I describe the network without a number; and a stated average wait time, since HHSC publishes bands rather than a mean.