Texas has always prided itself on being big. Big skies, big oil, big trucks, and a big ego when it comes to rejecting anything that smells like federal overreach. But what happens when that brash independence comes at the expense of the most vulnerable citizens? What happens when political ideologies trump the basic human need for care, compassion, and dignity? In the Lone Star State, the answer is playing out in real-time: people with intellectual and developmental disabilities (IDD) are paying the price for Texas’s political games, and it’s a price many cannot afford.
The failure of Texas to provide for its IDD population — people who require assistance with daily activities, medical care, and emotional support to lead lives with a semblance of dignity — is not a fluke or a mistake. It’s not an unintended consequence of a bureaucratic tangle. No, this is a deliberate, calculated decision made by the state’s leadership, a cynical refusal to expand Medicaid and adequately fund community-based services that leaves over 113,000 Texans stranded on an ever-growing waitlist for essential services. This isn’t just mismanagement. This is policy, and the human cost is staggering.
A State Built on Contradiction: Booming Economy, But Barren Social Services
It’s hard to square Texas’s booming economy with the desolate landscape of its social services. The state is flush with money. In the 2024–2025 biennium, Texas boasted a surplus of $32 billion. That’s right — billion. Texas is one of the wealthiest states in the nation, with industries from technology to oil thriving. Yet for people with IDD, this wealth means nothing. They’re stuck in a system that actively chooses to leave them behind, a system where waitlists stretch for decades and services are patchy at best. It’s not because Texas can’t afford to help them — it’s because the state’s political leaders simply don’t want to.
You see, Texas isn’t interested in expanding Medicaid, which could bring in billions of federal dollars to support services for low-income residents, including those with IDD. The refusal to expand Medicaid under the Affordable Care Act (ACA) has left an estimated 1.5 million Texans without coverage, but no group feels the effects of this more than those with IDD. Medicaid expansion would have provided a lifeline — access to healthcare, housing, and community-based support for thousands who currently get nothing but a place on a waitlist.
The state’s leadership — people like Governor Greg Abbott and Lieutenant Governor Dan Patrick — have made their disdain for the ACA well known. For them, expanding Medicaid is a nonstarter. It’s seen as an affront to Texas’s independence and a violation of their anti-government principles. But this ideological crusade has very real consequences. It’s not just abstract political theater; it’s a denial of care that leaves families shattered, caregivers overwhelmed, and lives lost.
The Myth of Fiscal Conservatism: Texas’s False Economy
The absurdity of Texas’s IDD support system lies in the fact that it’s not even a good fiscal decision. In fact, Texas’s refusal to invest in Medicaid expansion and community-based services is costing the state more in the long run. Take the State Supported Living Centers (SSLCs), Texas’s institutions where IDD individuals are effectively warehoused. They are 13 outdated facilities that house around 3,000 people, and they cost the state around $700 million annually — $230,000 per person per year. Compare that to the cost of supporting someone in a community-based setting under a Medicaid waiver, which is around $70,000 per year, and you start to see the twisted logic of Texas’s priorities.
Why the obsession with funding institutions over community-based services? The answer, as always, is politics. The SSLCs have powerful allies — namely contractors, suppliers, and local economies that rely on these institutions to survive. They’ve got a built-in constituency of people with vested interests in keeping the SSLCs open, regardless of whether it’s in the best interests of the residents. Politicians, particularly in rural districts where these centers are often located, know better than to mess with that.
What you end up with is a system where it’s easier to institutionalize people than to support them in the community, where people with IDD are treated as problems to be warehoused rather than individuals deserving of care, dignity, and independence.
The Human Toll: Families Trapped by Bureaucratic Indifference
Imagine this: you’re the parent of a child with severe intellectual or developmental disabilities. Your child needs constant care — help with eating, bathing, dressing, and moving around. You can’t work because you have to be a full-time caregiver. You hear about the Medicaid waiver program, which could give you access to home care services, therapies, and equipment that would make life manageable for both you and your child.
But when you apply, you’re told there’s a 15-year waitlist. Fifteen years. In a state with an annual surplus in the tens of billions, that’s the best they can offer you. So, what do you do? You become another cog in Texas’s brutal machine of neglect. You sell your house, spend your life savings, and sacrifice your own health and well-being to provide care because the state has abandoned you.
This is the story of thousands of families across Texas. Parents who should be retiring are instead working themselves into an early grave, providing 24/7 care for adult children because there is no other option. Siblings are forced to step in as caregivers when their parents can no longer cope. And when the caregivers die, the state finally steps in — by sending their loved ones to an institution.
One particularly heartbreaking story comes from Connie Henson, whose adult son has autism. He has been on the waiver list for 16 years. Connie was told he would be eligible for services “soon,” but soon came and went long ago. Now, she’s exhausted, living off her savings, and wondering what will happen when she’s no longer able to care for him. “What happens when I die?” she asks. “Who will take care of my son?”
The state of Texas has no good answer for that.
The Workforce Crisis: Starving the Front Line of Care
If you think things are bad for families, wait until you hear about the people who actually provide care — the Direct Support Professionals (DSPs). These are the folks who work with IDD individuals every day, providing the care that keeps them safe, healthy, and able to live as independently as possible. DSPs do the work that most of us wouldn’t even consider — feeding, bathing, dressing, administering medication, and managing behavioral issues. And what does Texas pay them for this life-sustaining work? A whopping $10.60 an hour.
That’s right. The people doing some of the hardest, most important work in the state are being paid poverty wages. It’s no wonder the turnover rate is astronomical. Why would anyone stick around in a job that’s emotionally and physically draining, only to get paid less than they would at a fast-food joint?
But Texas isn’t interested in raising wages for DSPs. Instead, it has created a two-tiered system where SSLC workers — who are doing essentially the same job in an institutional setting — are paid up to $17.50 an hour. Why the disparity? Because SSLCs are part of the state’s budgetary priorities. Community-based care is not.
This pay gap has real consequences. As more DSPs leave the profession, community-based care providers are left understaffed, overworked, and unable to meet the needs of the people they’re supposed to serve. This creates a vicious cycle: understaffed facilities provide lower-quality care, leading to more people being institutionalized, which in turn strengthens the argument for funding SSLCs over community services.
A Political System Rigged Against the Vulnerable
At the root of all this suffering is a political system that has no interest in addressing the needs of the most vulnerable Texans. The state’s leadership views people with intellectual and developmental disabilities as little more than a line item on a budget spreadsheet — an expense to be minimized rather than a population to be cared for.
Governor Greg Abbott, a man who rarely misses an opportunity to trumpet Texas’s booming economy and low taxes, has steadfastly refused to expand Medicaid, even though doing so would bring billions of dollars in federal funding into the state. His rationale? Expanding Medicaid would “grow a broken system.” But the real reason is simple: Texas Republicans have built their brand on resisting anything that smacks of “big government,” and they’d rather let people suffer than be seen as giving in to Washington.
The refusal to expand Medicaid is the purest distillation of the state’s priorities. It’s not about saving money; it’s about political theater. Texas has the resources to provide care for everyone on the waiver list, to raise DSP wages, to ensure that every person with IDD gets the support they need. But it won’t, because that would require acknowledging that the current system is broken and that the state has a moral obligation to fix it.
In Texas, that kind of acknowledgment is seen as weakness. And so, the suffering continues.
Bottom Line: Abandoned in the Name of Ideology
For people with intellectual and developmental disabilities in Texas, there is no “Lone Star miracle.” There is only waiting, neglect, and abandonment. Families are left to fend for themselves, caregivers are paid starvation wages, and the most vulnerable Texans are shuffled off to institutions where they are forgotten.
This is not an accident. It is a deliberate choice, made by politicians who value ideology over human life. Until Texas’s leaders stop treating IDD services as a political pawn and start recognizing the basic humanity of the people they’ve abandoned, nothing will change.
And in the meantime, more Texans will suffer, more families will break under the strain, and more lives will be lost to a system that’s as broken as the politicians who created it.
You can view our sources and citations in our research document found here.
