In Texas, Medicaid / HHSC can now be applied to Congregate Care Facilities (March 2025)

Many parents of adults with IDDs in Texas have been frustrated that Medicaid Waiver / HCS funds cannot be used to pay for “congregate care” or intentional communities (however one might describe them). This has meant that parents have had to shoulder the whole cost of care, for the rest of their child’s life, if they wanted to place their child in anything other than a group home. Medicaid only paid for placement in a private home, with 4-6 others, called a group home, and not in a larger community of others with IDDs, what some call a “congregate care” setting. (I call it assisted living.) Most private communities for adults with IDDs in Texas cost $3,500-$5,000 / month, and there are not many of them, fewer still any with vacancies, leaving parents with few placement options. 

SSI pays only about $900 / month. That’s a huge gap for parents to try to fill on their own!

Mark Olson explains the challenges in this video:

Over the years, Texas has been reluctant to allow any Medicaid funds to be used for assisted living facilities, or intentional / congregate care communities, justifying their position by classifying anything other than placement in a private residential home as placement in an institution. There is no middle ground. They don’t support “institutionalization” of people with IDDs. Because the Texas Administrative Code made it impossible for HCS Medicaid waiver funds be used to fund “institutions,” or anything resembling them, our private residential communities in Texas (what few we have)  do not take HCS funds, the Medicaid waiver program for mentally disabled people. For a long time, the philosophy was homes “in the community” are good but placement in anything else was bad. 

Most parents of an adult child with an IDD would prefer to place their child in a communal or congregate care setting on a campus where their adult child can be seen by others, walk around outside, talk to people, make friends and have needed supports and activities, instead of being placed into someone’s house, in a spare bedroom (often with another person with an IDD), often in some sketchy part of town where they are invisible and no, not part of the larger community. Maybe this is not a fair assessment of group homes, but parents do not necessarily want their adult child warehoused fostered inside a stranger’s home after they die.  

I want to announce the good news that according to Mark Olson, founder and CEO of LTO Ventures, the regulations in Texas have recently changed.

Mark organized a large coalition of parents to pressure the Texas legislature to change the wording of this regulation so that Medicaid waiver funds can be applied to these often costlier private settings. Mark indicated it is still difficult to get Texas Health and Human Services to pay, but maybe over time things will get easier. Of course, parents will still need to fill the gap between what small amount HCS pays and what the facility charges. I do not know how much they might pay toward residential care, but whatever it is, it is better than zero.

Thank you, Mark Olson, for fighting the good fight!