For much of the twentieth century, people with significant disabilities often had few alternatives to institutional care. That began to change when Congress authorized Medicaid Home and Community-Based Services (HCBS) waivers in 1981. The new authority allowed states to “waive” certain Medicaid rules and fund supports in homes and communities instead.
Texas developed the Home and Community-based Services (HCS) waiver in 1985 for people with intellectual and developmental disabilities who chose community living rather than services in an institution. Over time, Texas added and expanded waiver programs serving different populations and needs, including HCS, Texas Home Living, CLASS, DBMD, MDCP and STAR+PLUS HCBS.
These programs do more than change where support is delivered. They are built around individualized planning, community participation and the idea that people with disabilities should have meaningful choices about their lives.
Consumer Directed Services is one expression of that progress. Through CDS in Texas, eligible individuals can direct certain approved services while a Financial Management Services Agency (FMSA) supports payroll, taxes and required administrative functions. Waiver programs continue to evolve, but their central promise remains powerful: people should be supported in the homes and communities they choose.
