The federal government created Medicaid to pay medical bills for low-income Americans. Congress has expanded Medicaid to include the elderly, people with disabilities, children and pregnant women. A diagnosed intellectual or developmental disability usually qualifies a person to receive Medicaid.

Although it is not a requirement, all 50 states do participate in the Medicaid program. The main rules for Medicaid are made at the national level, but Medicaid is different in each state. As a result, there are many different laws and rules. Sometimes the government allows exceptions to certain rules so people can receive needed services. These are called Medicaid waivers.

The first Medicaid waiver was given to a little girl from Iowa named Katie Beckett who lived most of the first three years of her life in a hospital hooked up to equipment to help her breathe. Katie could have just as easily and more cheaply been cared for in her home, but a Medicaid regulation allowed her medical expenses to be paid for only when she was hospitalized. Her mother lobbied in Washington D.C., and President Ronald Reagan demanded that the income limit rule for Medicaid be “waived.” By making this exception to the rule, Katie was able to go home just in time to celebrate Christmas in1981 and spent the rest of her childhood at home. This resulted in huge savings for Medicaid, as in-home care costs less than hospital care.

The Medicaid waiver programs began shortly after in 1982 when President Reagan signed the Katie Beckett waiver into effect. This made Medicaid funds available to similar families with special needs children who otherwise did not qualify for assistance and care in the home. Since then, states have developed a variety of Medicaid waivers which have allowed people to receive needed services in their homes and communities rather than in an institutional setting. Each state has different waiver programs with different eligibility requirements and services.

Texas has several Medicaid waiver programs, two of which are provided by the Andrews Center:

  • HCS – Home and Community Based Services
  • TxHmL – Texas Home Living

The Intellectual and Developmental Disabilities Authority department of Andrews Center maintains an interest list for the HCS and TxHmL waiver programs. To place a name on the interest list, contact the interest list coordinator at:




Also, the IDD Intake staff can share information about other Medicaid waiver programs provided by other agencies.