Medicaid Waiver Survey/Interest List Question Title * 1. Name of the person completing this survey Question Title * 2. Tell me about your interest in the Texas waitlist for services Person with a disability on the wait list for services Parent of a child/young adult on the waitlist for services Community stakeholder Mental Health Authority Question Title * 3. How long have you been on the HCS wait list/interest list for services? less than 3 years over 3years 4 -10 years 11-15 years 15-20 years 21- 25 years 25 years or more Question Title * 4. What are your current needs? Housing Assistance Specialized therapies (Speech, Occupational Therapy, Physical therapy, etc...._ Behavior Management Training Employment Services Vocational Training Services Medical Services Other Question Title * 5. Are you currently receiving medicaid waiver services through one of the following waivers? I am not receiving services. Community Living Assistance & Support Services (CLASS) Texas Home Living (TxHml) Home Community Supports (HCS) Medically Dependent Children Program (MDCP) Question Title * 6. What are you or your child/adults unmet needs? Question Title * 7. Are you willing to join us in contacting your state legislatures to request that additional funds are allocated to reducing the HCS wait list in Texas? Yes No Question Title * 8. What is your email address? Question Title * 9. What is the name of the mental authority that is managing your wait list status? ACCESS Andrews Center Austin Travis County Bluebonnet Trails Border Region Burke Center Camino Real Center for Life Resources Central Counties Central Plains Coastal Plains Community Healthcore Denton County Emergence Health Network Gulf Bend Center Gulf Coast Center Heart of Texas Helen Farabee Centers Hill Country Mental Health Lakes Regional Life Path Systems Brazos Valley Harris County Nueces County Tarrant County Concho Valley North Texas Pecan Valley Centers PermiaCare Spindletop Center StarCare Texana Center Texas Panhandle Texoma Community Center The Center For Health Care Services TriCounty Services Tropical Texas West Texas Centers Done