TX Medically Dependent Children Program Waiver

The Medically Dependent Children Program (MDCP) Waiver in Texas provides services and support to families caring for medically dependent children and young people in their homes as an alternative to a nursing facility.

Overview of the MDCP Waiver

The MDCP Waiver was established in 1985 to prevent institutionalizing children and young adults who are medically dependent and under 21 years old. Medically dependent means the individual requires daily skilled nursing care due to a chronic physical condition. The MDCP Waiver operates under a 1915c authority, meaning Texas can waive specific federal rules and regulations that apply to regular Medicaid services, such as income limits, service limits, and provider qualifications. This gives Texas more flexibility and freedom to design and implement the MDCP Waiver according to the particular needs and preferences of the target population.

Eligibility requirements

To be eligible for the MDCP Waiver, an individual must meet the following criteria1:

• Be under 21 years old
• Be eligible for Medicaid
• Meet the medical necessity criteria for nursing facility care or hospital care
• Have a chronic physical condition that results in the need for daily skilled nursing care
• Live at home or be willing to leave a nursing facility
• Have an individual service plan (ISP) that can be safely met in the home
• Have an unmet need for at least one waiver service
• Not be enrolled in another Medicaid waiver program

Additionally, the individual's income must be at most 300% of the SSI federal benefit rate, which is $2,742 per month for an individual and $4,113 per month for a couple in 2023. The individual's resources must be at most $2,000 for a single person or $3,000 for a couple.

Services and supports

The MDCP Waiver provides various services and supports to help individuals remain in their homes and communities. These services include: 

• Respite: This service provides temporary relief to the primary caregiver by providing substitute care for the individual. Respite can be delivered by an attendant or a nurse in the home or another setting.
• Flexible family support services: This provides financial assistance to families to purchase items or services not covered by Medicaid or other sources. These items or services must relate to the individual's medical condition and help them remain at home.
• Minor home modifications: This service provides home modifications to ensure the individual's health, welfare, and safety or enable them to function independently.
• Adaptive aids: This service offers devices or equipment to assist individuals with daily living activities or improve their quality of life.
• Transition assistance services: This service provides one-time assistance to individuals transitioning from a nursing facility to their own or family's home. The assistance may include moving expenses, security deposits, utility deposits, household items, or environmental modifications.
• Employment assistance: This service helps individuals locate paid employment in the community by providing support such as job coaching, job development, job placement, or transportation.
• Supported employment: This service helps individuals maintain paid employment in the community by providing ongoing support such as supervision, training, or transportation.
• Financial management services: This service helps individuals manage their MDCP funds by providing their employees with payroll, tax, and accounting services. Individuals can choose between two types of financial management services: agency option or consumer-directed services (CDS) option.

Compensation for caregivers

One of the benefits of the MDCP Waiver is that it allows individuals to choose their service providers for certain services. This means they can hire their caregivers, such as family members or friends if they are not their spouse. This option is called consumer-directed services (CDS), and it is available for respite services, flexible family support services, employment assistance, supported employment, and financial management services.

To participate in CDS, individuals must meet specific eligibility criteria and be able to manage their services or have someone who can help them do so. They can hire, train, manage, and fire their employees and set their service schedules and goals. They will also have a financial management services agency to handle their employees' payroll and tax responsibilities.

The compensation for caregivers under CDS varies depending on the type of service, the level of care, and the market rate. The MCO service coordinator will help the individual determine the appropriate employee rate based on these factors. The MCO will also monitor the individual's budget and ensure they stay within their authorized funds.

CDS is an excellent option for individuals who want more flexibility and control over their services and prefer receiving care from someone they know and trust. However, CDS has more responsibilities and risks, such as liability, worker's compensation, and employee disputes. Therefore, individuals should carefully weigh the pros and cons of CDS before deciding to use this option.

A note from Givers

The MDCP Waiver in Texas is a valuable program providing services and support to families caring for medically dependent children and young adults. If you are interested in applying for the MDCP Waiver or determining eligibility for compensation as a caregiver, please complete this form.