Lawmakers hear calls for big changes as Texans face 17–18 year waits for IDD waivers

Lawmakers heard extensive testimony on gaps in Texas' IDD services, highlighting long waits, shrinking community capacity and a menu of legislative and regulatory fixes offered by agencies, local IDD authorities, providers and advocates.

HHSC officials said the state's four IDD waivers (CLASS, DBMD, HCS and Texas Home Living) are optional Medicaid programs and that a combination of attrition, slot‑release rules and cost growth determine how many new waiver slots the agency can offer after each session. HHSC noted the interest‑list questionnaire (implemented Aug 2023) has produced usable data showing more than half of respondents expect to need services within three months; the agency reported that uptake rates differ by waiver (HCS about 41.7% among those outreached). As Commissioner Muth summarized, the current system is fragmented: "It's not a holistic approach... it's difficult for families to navigate," she said.

Advocates and providers described on‑the‑ground realities: Jenny Goode (local IDD authorities) said local offices are frequently the point of referral from schools and that flexible local general‑revenue supports were cut in 2011 and not restored. Provider groups told the committee there is measurable unused capacity in certified beds — many unfilled beds reflect staffing shortages rather than lack of slots — and recommended near‑term statutory and administrative changes: publish real‑time vacancy/ICF availability information, allow flexible staffing models (including revisiting the 24‑hour awake‑staff requirement in four‑bed group homes), expand 'technology‑first' remote supports and make electronic documentation systems interoperable with HHSC reporting. Advocates urged that the legislature fund cost‑growth for existing waiver caseloads before funding new slots so intended new enrollments are not absorbed by base cost pressures.

Families and advocates described the human cost of waits: "In practice, this results in 17 to 18 year wait times for programs like HCS in class," said Sabrina Gonzalez Alcedo of The Arc of Texas. Lawmakers signaled interest in a stakeholder‑led redesign of waiver structure and in targeted, implementable changes to reduce crisis admissions and better use CFC and other interim programs while waiver reform proceeds.