Medicaid HHSC Resources

Long-term Services and Supports

As family members, we often think we can care for our children forever. But as we age, our children get bigger and may need support we can no longer provide. This is where long-term supports come in. There are a variety of long-term support services for people with disabilities and ways to access those services.

For information about how to be added to the interest list, please contact your Local Intellectual or Development Disability Authority (for HCS and TxHmL) or by calling 1-877-438-5658 for other waiver programs (CLASS, MDCP, DBMD, STAR+Plus)

HELPFUL COMPARISON TOOL FOR SERVICES PROVIDED BY EACH WAIVER

RATES PAID FOR EACH WAIVER

Medicaid Fee for Service Ra tes

TO SEARCH AVAILABLE OPENINGS in:
ICF/IDD Homes – https://apps.hhs.texas.gov/LTCSearch/
HCS Homes – https://resources.hhs.texas.gov/find/HCS
Assisted Living Facilities – https://apps.hhs.texas.gov/LTCSearch/

Texas Health & Human Services (HHS) is the State Agency responsible for many State/Federal Programs that help people with disabilities.

Start by calling 211 Texas or by visiting the Your Texas Benefits website (Click on the Start Tool). Here you will find out what services and supports may be available to your child or family. You will find information on Medicaid, CHIP, Family Services, Supplemental Nutrition Assistance Program (SNAP or food assistance), and Temporary Assistance for Needy Families (TANF).

Texas Medicaid Programs

Traditional Medicaid:

This program primarily serves low income families and children. Often the children also receive supplemental security income (SSI).

Even if your child has a disability and receives Medicaid, you will need to get your child’s name on the “interest lists” for long-term services and supports (see “Medicaid Waivers” below).

If you child is under 20, receives Medicaid and has a disability, benefits are provided through the STAR Kids managed care program (see below).

For information on Personal Care Services, call the Texas Medicaid & Healthcare Partnership (TMHP) PCS Client Line at 1-888-276-0702 (toll free).

Children’s Health Insurance Program (CHIP):

CHIP covers children in families who have too much income to qualify for Medicaid, but cannot afford to buy private insurance. Your child must be under age 19.

Medicaid Buy In:

If you make TOO much money for Medicaid or CHIP, but need health insurance for your child, the State of Texas has a Medicaid Buy In Program. If your child is under age 20 and receives Medicaid and has a disability, benefits are provided through the STAR Kids managed care program (see below). If you make too much income due to disability, survivor or retirement Social Security benefits, and you are an adult with a disability, you may also need to apply for Medicaid Buy In to keep your medicaid services.

STAR Kids:

STAR Kids is the Texas Medicaid managed care program that provides Medicaid benefits to children and adults 20 and younger who have disabilities. This program is mandatory for any child with a disability under age 20 who is on Medicaid because they receive SSI, participate in a Medicaid buy in program, or participate in a waiver program (DBMD, MDCP, YES, CLASS, HCS, or TxHL).

STAR+Plus:

This is a Texas Medicaid managed care program for individuals who are over age 21 and have disabilities. There are some exceptions. See the STAR+PLUS Client FAQs.

Community First Choice:

This is NOT a Medicaid waiver program, but an entitlement program for personal attendant/habilitation services through your Medicaid Star Plus program. Your child MUST already be Medicaid eligible. For many, this means your child is an adult and receiving SSI & Medicaid (STAR Plus) and you are waiting for a waiver slot.

For more information on seeking services through this program, please contact your Managed Care Organization (MCO). The MCO will do an initial assessment and refer you to the local Intellectual and Developmental Disability Authority (LIDDA) for a Determination of Intellectual Disability (DID), Level of Care, and Functional Assessment. The Local Authority will complete the DID and a level of care assessment and submit the level of care assessment to HHSC. HHSC will either approve or disapprove the level of care. If approved – the LIDDA will perform a functional assessment to determine the services needed and give this to the MCO. The MCO will authorize services and the LIDDA will provide service coordination (case management).

Medicaid Waivers ( Long Term Services & Supports) :

Medicaid Waiver programs are a key part of long term services & support for people with disabilities. Waiver services are services for your child (young or old).

While the long-term services are for those who are Medicaid eligible, your child will automatically become Medicaid eligible when they receive a Waiver slot in one of the programs that do not include parent income (all except TxHL). To understand the different waivers, this Comparison of Medicaid Waiver Programs is helpful.

In Texas, there is a waiting or “interest” list to receive Medicaid waivers that is years long (7-16 years). It is important to add your child’s name to the Medicaid Waiver interest lists as soon as possible.

Many of the services that a person with a disability receives can be Consumer Directed Services (CDS) – which allows more flexibility for families and sometimes higher pay rates (especially with HCS waiver). While many case managers will encourage you to choose a provider vs CDS due to the quantity of paperwork involved – Please call Family to Family Network BEFORE you make a decision and we can guide you.

For those with intellectual or developmental disabilities:

Home & Community-based Services (HCS) and
Tx Home Living (TxHL) Programs

To register for these “Interest Lists” (HCS, Tx Home Living, etc.), contact the local authority agency for your county.

For those with medical or physical disabilities:

Community Living Assistance and Support Services (CLASS),
Medically Dependent Children’s Program (MDCP),
Deaf Blind Multiple Disabilities (DBMD),
Community Attendant Services (CAS), and
Personal Attendant Services (CMPAS) Programs

For these programs, please contact your local Aging & Disability Resource Center. Click here to find the office nearest you – or call 1-877-438-5658.

Please note – if you move while waiting for services, please call the agency and update your information so that the agency can find you when a waiver slot becomes available.

Assessment for Long Term Services:

For most of these programs, there will be an assessment for services. Remember to answer as if you were not there to do things for your child or provide the level of support you may give (Can they do something independently?). Here are links to various assessments:

Form 8510 (TxHmL, HCS, CFC PAS/HAB assessment)
Form 8578 (IDD/Related Service Condition Assessment – Assigns LOC & LON for all waivers & CFC)
Form 6516 (CLASS/DMDB Nursing Assessment)
Form 3596 (CLASS/DMDB/CFC PAS/HAB Plan to justify services)
STAR Kids Assessment (MDCP)

STAR KIds SAI Manual Download

The Long Term Care Provider Search is a searchable data base where you can find and compare providers of long-term services and supports. These include nursing facilities, home health agencies, adult day care and others. You can also see reports on specific providers and any possible violations.

The Quality Reporting System is a searchable data base where you can find and compare providers of long-term services and supports. These include nursing facilities, home health agencies, adult day care and others. You can also see reports on specific providers and any possible violations.