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.

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

Barriers to Services

Texans with IDD face significant barriers in accessing Medicaid services and supports, including:

• Reimbursement rate cuts

• High demand for - and low supply of - community based waviers

• Historical growth in the number of aging Texans with IDD

• Consolidation of Medicaid services

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


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 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, and 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, and 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.

Employees with disabilities are rated by supervisors as being equally or more productive than co-workers and as achieving equal or better overall job performance. Hiring managers and executives reported that employees with disabilities stay in their jobs longer.

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

THE IMPORTANCE OF HCBS 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 disabilities to live and work in their community. All people with disabilities should have access to the services and supports when and where they need them. The state’s commitment to providing quality services and supports for Texans with IDD is best served by fully embracing the numerous opportunities to keep people out of institutions and in smaller community-based options of their choice via HCBS waivers. However, Texas currently does not serve every person in need.

HCBS waivers are not only the preferred choice of most Texans with IDD but are often the less expensive option, yet 50% of the state budget for individuals with IDD went to state supported living centers (SSLCs) this past biennium and served significantly fewer people.

THE WAITING GAME HCBS 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. Most individuals will wait over 10 years to receive HCBS waiver services. Waiting without needed supports increases risk for negative health outcomes, crisis, and unnecessary institutionalization.

SSLCs $26,767.67 per person per month. Community $4,290.08 per person 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


TCDDFact Sheets , January and February2019