What is IDD?

More than 500,000 Texans have Intellectual and Developmental Disabilities (IDD).

Below are some examples of types of IDD:

• Autism spectrum disorder

• Down syndrome

• Cognitive disabilities

• Cerebral palsy

While over 500,000 Texans have IDD, less than 62,000 Texans with IDD receive Medicaid Long-Term Services and Supports.

Where Does Texas Rank?

Texas consistently ranks 50th in the nation for promoting independence for people with IDD. Texas has the fourth worst rate of Medicaid Long-Term Services and Supports use in the country. Funding for IDD services in Texas is almost 50% less than the national average.

Why is Medicaid Important?

Medicaid is a vital resource that can help people with IDD live at home or in the community. Services provided by Medicaid programs include:

• Behavioral support

• Housing assistance

• Personal attendants

• Speech, physical & occupational therapy • Supported employment

When Are Texans Being Served?

Almost 140,000 Texans are waiting for comprehensive Medicaid waiver services

• Over 105,000 have been on waiver interest lists for over 5 years

• Most will wait over 10 years for comprehensive waiver services

Employment First

It is policy and law in the State of Texas that earning a living wage through competitive integrated employment is the first and preferred outcome for adults with disabilities who receive public benefits. Employment First promotes the expectation that Texans with disabilities are valued members of the workforce and able to meet the same employment standards, responsibilities, and expectations as other working-age adults.


Competitive Integrated Employment

Competitive integrated employment means full or part-time work in the community for which the person is paid at least minimum wage. Integrated settings are typical businesses in which individuals with disabilities: 

  • Work side-by-side with people without disabilities

  • Encounter members of the public 

  • Are eligible for the same advancement opportunities as workers without disabilities.   

However, only 5% of Texans with IDD served by the Texas Health and Human Services Commission (HHSC) work in settings where they are integrated with other people without disabilities. Through competitive integrated employment:

  • People with IDD gain an important entry into their communities

  • Develop a sense of being valued

  • Earn wages and job benefits

Get an opportunity to make a meaningful contribution 


Employment Services

In 2000, 50% of Texas waiver participants with IDD had employment services included as part of their service plan. However, in 2017, only 3% of Texas waiver participants with IDD had employment services included as part of their service plan. 


Low Integrated Employment

Over 90% of Texans with IDD work in segregated settings and only 5% of Texans with IDD work in integrated settings with other people without disabilities

The Importance of HCBS

153,551 Texans have unmet needs and are waiting for comprehensive Medicaid waiver services. Most will wait over 10 years.


Medicaid HCBS waivers are a lifeline for Texans with intellectual and developmental disabilities (IDD). Medicaid HCBS waivers provide cost-effective long-term services and supports such as personal attendant services, nursing, and employment support – none of which are typically covered by private insurance. This effective and cost-efficient program allows people with disabilities to live and work in their community.


The Waiting Game

Waiver availability is dependent on legislative appropriations to include more individuals or when an existing waiver recipient vacates services. Because the demand far outweighs the resources made available by the legislature, Texans with IDD are placed on interest lists until an appropriate HCBS waiver slot becomes available. In fact, Texas’ HCBS program must grow 535% overall just to keep up with population growth and increased need.


Cost Comparison of State Supported Living Centers (SSLCs) and Community Living 

SSLs                     Community

$26,767.67/person $4,290.08/person

per month             per month

In FY 17, the cost to support a person to live in an SSLC was more than six times the cost to support a person to live in the community.


Reaching Those In Need

Since 2007, the Texas Medicaid program has consistently been ranked as one of the worst states in the nation in serving people with IDD and their families. In 2019, Texas ranked 51st in reaching those in need and 49th in promoting independence among people with IDD, primarily due to the low level of funding and number of people in HCBS.


TCDDFact Sheets , January and February2019

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