MDCP Waiver Texas: Eligibility, Services, and What Happens at Age 21
What the MDCP Waiver Is
MDCP stands for Medically Dependent Children Program. It is one of six Medicaid 1915(c) Home and Community-based Services (HCBS) waivers in Texas, designed specifically for children and young adults under age 21 who require a nursing facility level of care but whose families want to keep them at home.
MDCP serves a narrower population than the HCS or CLASS waivers. The qualifying criterion is medical complexity — the child must have health conditions severe enough that they would otherwise require placement in a nursing facility. The waiver funds the supports that make home-based care possible.
Who Qualifies
MDCP has three eligibility requirements:
Age: The individual must be under 21 years old at the time of enrollment. MDCP services can continue until the individual's 21st birthday.
Medical: The individual must meet the nursing facility level of care, as assessed by HHSC. This means they need daily skilled nursing services, have complex medical conditions requiring ongoing monitoring, or need a level of personal care that exceeds what standard Medicaid home health covers.
Financial: The individual must qualify for Texas Medicaid. MDCP uses institutional income rules, which evaluate only the child's own income — parental income is not considered for the child's Medicaid eligibility determination under this waiver.
What MDCP Covers
MDCP funds community-based services that would otherwise only be available in a nursing facility:
- Skilled nursing — RN and LVN services provided in the home
- Adaptive aids — medical equipment and assistive technology
- Minor home modifications — ramps, bathroom modifications, widened doorways
- Respite care — temporary relief for primary caregivers (in-home or out-of-home)
- Employment assistance — for older youth preparing for work (age 16+)
- Transition assistance services — support for moving from an institution to the community
The waiver does not cover the full scope of day habilitation, supported employment, or residential services available under HCS. MDCP is focused on medical care in a home setting.
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The Interest List
Like HCS and CLASS, MDCP is not an entitlement — there are a limited number of slots. Families join the interest list by calling the centralized HHSC line at 1-877-438-5658 or registering through the Your Texas Benefits portal. MDCP's interest list is managed centrally by HHSC, not by local LIDDAs.
Wait times vary and are generally shorter than HCS waits, but they can still stretch to several years depending on demand and available slots.
The Age-21 Transition: The Cliff Families Must Plan For
This is where MDCP creates a planning challenge. MDCP services end at the individual's 21st birthday. On that date, the waiver terminates regardless of the individual's medical condition or ongoing needs.
Families with a medically complex young adult approaching 21 must have an adult-service plan in place well before the transition:
STAR+PLUS HCBS waiver: This is the adult equivalent for individuals age 21 and older who meet nursing facility level of care. STAR+PLUS is managed through Medicaid managed care organizations (MCOs) and does not have the same decades-long waitlists as HCS.
HCS or CLASS waivers: If the individual also has an intellectual or developmental disability or a related condition, they may qualify for HCS or CLASS. These waivers serve all ages — but they have years-long interest lists, so families should register well before age 21.
Community First Choice: CFC is available immediately (no waitlist) and covers attendant care and habilitation for individuals who meet an institutional level of care. It can serve as a bridge while transitioning from MDCP to an adult waiver.
Standard Medicaid home health: If the individual qualifies for Medicaid but does not have a waiver slot, Texas Medicaid's State Plan home health benefit covers some skilled nursing and personal care services, though at a lower intensity than MDCP.
The critical planning step: register on the HCS and CLASS interest lists through your LIDDA or HHSC as early as possible — ideally by age 14 — so the waitlist clock is running while MDCP covers current needs.
For the full timeline of adult benefit transitions, including how MDCP fits alongside SSI, ABLE accounts, and the age-18 redetermination, the Texas SSI at 18 & Adult Disability Benefits Guide provides a chapter-by-chapter walkthrough.
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