The Long, Slow Collapse of Texas Disability Care: Who’s Left to Pick Up the Pieces?
The Texas Disability Care Crisis is a stark reflection of a state healthcare system crumbling under its own weight. While Texas once sought to move away from large-scale institutions in favor of a more humane, community-based care model for individuals with intellectual and developmental disabilities (IDD), today the entire system is in disarray. Staffing shortages, inadequate funding, and an archaic Medicaid waiver system have driven Texas’s care system to the brink. And despite investigative efforts, policy debates, and incremental reforms, the state has left vulnerable Texans abandoned by the very system meant to support them.
Texas’s year-long investigative reporting efforts, particularly from the Austin American-Statesman’s “Disabled & Abandoned” series, have revealed deep cracks within the infrastructure supporting those with disabilities. The stories of systemic violence, understaffing, and funding shortfalls paint a bleak picture of a system teetering on collapse. This article will examine the key failures in Texas’s IDD care system, how chronic underfunding and labor shortages have worsened, and why reform efforts remain stalled in the face of powerful political and financial obstacles.
The Staffing Crisis: Paying Pennies for Critical Work
At the heart of this issue are Direct Support Professionals (DSPs), the front-line workers tasked with providing hands-on care for individuals with disabilities. These workers assist with basic daily functions, such as feeding, bathing, administering medication, and ensuring the safety of people with sometimes severe medical or behavioral needs. Despite the essential nature of their work, DSPs are paid a paltry $10.60 an hour, a figure barely above minimum wage. And it’s not as if they are part-time workers — many DSPs find themselves working 60 to 100 hours a week due to severe staffing shortages. It’s a burnout cycle in the making, with devastating results for both workers and the people they care for.
According to reporting from the Austin American-Statesman, this meager wage is simply not enough to attract or retain the workers required to meet Texas’s needs. As DSPs leave for better-paying jobs in retail or fast food, vacancy rates have exploded to 34% in 2024. The direct result? Nearly 50% of group homes and care facilities in Texas are unable to meet federal standards for care. This means medication errors, missed appointments, and often unsupervised residents — many of whom require constant care to ensure their health and safety.
The Consequences of Staffing Gaps: A System on the Edge
Facility closures have become the norm rather than the exception. Between January 2023 and February 2024, 179 HCS (Home and Community-Based Services) homes and 50 ICF (Intermediate Care Facilities) shut down across Texas. With an additional 126 closures projected by the end of the year, families are scrambling to find alternative care for their loved ones in a system that simply doesn’t have the capacity to serve them.
As Texas falls further behind, many individuals with disabilities are being institutionalized — not because it’s better for them, but because there are no community-based options left. It’s a reversal of the state’s decades-long effort to move away from large, impersonal institutions and towards small, community-integrated settings. The move toward institutionalization isn’t just costly in terms of taxpayer dollars — it’s a violation of the principle of choice and independence for those with disabilities.
The Medicaid Waiver Disaster: A Bureaucratic Labyrinth
The Texas Medicaid waiver system is meant to provide a safety net for individuals with disabilities, allowing them to receive care and services in their communities rather than in institutions. But the system has devolved into a bureaucratic maze. There are six different waiver programs, each with different eligibility criteria, coverage limitations, and waiting periods that can last more than a decade.
More than 156,000 Texans are currently on waitlists for services. Some wait as long as 16 years to receive essential care — by the time their names come up, many no longer meet the same needs they did when they first applied. In some cases, they have died before receiving services. Families are forced to take on the burden of care in the meantime, often burning through their savings, losing employment opportunities, and facing severe emotional strain.
The waiver system’s complexities and failures were brought to light through extensive reporting by both local and national media outlets, including the Austin American-Statesman and the Dallas Morning News’s “Pain and Profit” series. These investigations found that care is frequently denied, delayed, or insufficiently coordinated, leaving the most vulnerable Texans without a lifeline.
The Funding Gap: Doing More With Less, or Just Less?
The state’s refusal to adequately fund the system has been a consistent theme. Despite increased allocations in recent legislative sessions, the funding still falls short by billions of dollars. Texas providers argue that the $77 million allocated in 2021 to reduce the waiver waitlists wasn’t even close to what was needed to begin addressing the scale of the crisis. Add to that the loss of $300 million in federal special education funding due to improper reporting of Medicaid services, and you have a system that’s choking under its own lack of resources.
The wage increase from $8.11 to $10.60 per hour for DSPs, while celebrated by some as progress, is widely seen by advocacy groups like Time to Care as woefully inadequate. These organizations have pushed the legislature to increase pay to at least $15 an hour, arguing that anything less will do little to address the exodus of workers or to attract new talent into the field. In the meantime, the disparity between DSP wages in the community-based system and those paid at state-supported living centers (SSLCs) — where DSPs make up to $17.50 per hour — has only worsened the staffing crisis in the community system.
The Legislative Bottleneck: Political Inaction and Special Interests
One might wonder, with such obvious problems and such a clear human toll, why the Texas Legislature hasn’t done more. The answer, in part, lies in the influence of powerful special interests that benefit from the status quo. Privatized Medicaid providers, whose services were scrutinized heavily in the Dallas Morning News’s “Pain and Profit” exposé, continue to receive billions of dollars despite failing to provide adequate care. The financial incentives built into the system favor large contractors over small, community-based providers, leaving local agencies to compete with far fewer resources.
Efforts to reform the system, such as House Bill 3659, which sought to streamline services and reduce wait times, have repeatedly stalled in the legislature. Lawmakers, wary of the price tag attached to significant reforms, have chosen to kick the can down the road rather than enact the sweeping changes needed to fix the system.
The Personal Cost: Stories Behind the Statistics
The numbers tell one story, but the real toll of the Texas disability care crisis is felt most keenly by those whose lives have been upended by it. Sandra Adams, a mother of two children with IDD, waited more than 11 years for her family to receive waiver services. By the time her youngest child was finally approved, her family had been forced to sell their home and move into a smaller apartment in order to afford the cost of care in the meantime.
The story of Paul Richards, a 35-year-old with autism, is another tragedy borne out of the system’s failures. After spending eight years on the waiver list, Paul was placed in a group home that was so understaffed that he was left unsupervised for hours. One day, he wandered away from the home and was found hours later, dehydrated and confused, miles from his residence. His mother has since filed a lawsuit against the state, but the family remains unsure if they will ever receive the support they need.
The Push for Reform: Can Texas Fix Its Disability Crisis?
Advocates aren’t giving up, though. Organizations like Disability Rights Texas, The Arc of Texas, and the Texas Council for Developmental Disabilities have continued to push for reforms, from wage increases for DSPs to a revamping of the waiver system to prioritize those with the most urgent needs. They’re calling for greater oversight of care providers, higher Medicaid reimbursement rates, and a commitment to ending the backlog of waiver applicants.
In 2023, the Time to Care coalition pushed a legislative agenda that included proposals to reduce wait times, increase funding, and address the geographic disparities in care — rural areas, in particular, have been left behind. But the road ahead is long. Without political will and a commitment to reform, many fear that Texas’s IDD care crisis will continue to deteriorate, further punishing those who are least able to advocate for themselves.
Leaving the Most Vulnerable Behind
The crisis in Texas’s disability care system is, at its core, a story of neglect — not just of individuals with disabilities, but of the very principles of care and community that are supposed to define a just society. The investigative reporting from the Austin American-Statesman and the Dallas Morning News has peeled back the curtain on a system that is failing at every level, from the underpaid DSPs to the families left waiting for years for services. The question now is whether the Texas Legislature will take the bold steps needed to fix the problem, or whether the state will continue to abandon its most vulnerable citizens in the name of fiscal conservatism. Until that answer comes, the lives of more than half a million Texans hang in the balance.
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