Services included in Texas’ Medicaid Waivers & Community First Choice

Here’s a little overview of services you might find in each Texas’ Medicaid Waiver or through Community First Choice.

  • CLASS, HCS, MDCP, DMBD, TxHmL, and Star+Plus HCBS are 1915(c) Waivers.
  • CFC is a 1915 (b)(4) Waiver.
  • Access to Medicaid acute health insurance + other Medicaid-qualifying programs
    • One of the tools in several waivers is providing access to Medicaid with several criteria that are unique:
    • 1. Children under 18 years are evaluated as their own household, separate from their parents, so the parents income and assets do not disqualify them.
    • 2. Individuals can have a monthly income of 3x the limit to qualify for SSI-authorized Medicaid
    • Waivers that provided special Medicaid eligibility are:
    • Waivers that DO NOT provide special Medicaid eligibility are:
  • Case Management/Service Coordination: Who guides you through the program and advocates for you when needed.
  • Personal Assistance Services and Habilitation (PAS/Hab): Who helps with the activities of daily living (ADLs)
    • MDCP: Not a MDCP service
    • CLASS: CFC PAS/Hab – tool for functional assessment is Form 3596
      • Service paid as hourly rate
      • Service can be provided by a parent if individual is over 18 years old
    • HCS: 2 different services based on if the provider of care lives with the individual
      • Supported Home Living – CFC PAS/Hab – tool for functional assessment is Form 8510
        • Service paid as hourly rate
        • Service can be provided by a parent living at a different address if individual is over 18 years old
      • Host home/companion care – daily rate set by Level of Need tool
        • Service paid as a daily rate
        • Service can be provided by a parent living in the same home if the individual is over 18 years old
    • Non-Waiver CFC: CFC PAS/Hab – tool for functional assessment is Form H6516
      • Service paid as hourly rate
      • Service can be provided by a parent if individual is over 18 years old
  • Respite:
    • MDCP: Direct care to an individual to provide a caregiver temporary relief from caregiving activities when the caregiver would usually perform such activities.
    • CLASS: limited to 30 days per year which can be converted to 720 hours per year
      • In-home respite – provided in a home (provider or recipient’s) when the person who resides with the individual is unavailable to provide unpaid assistance and support
      • Out-of-home respite – If your family member needs services that you can’t have provided in your home, you may need to find a place you can drop them off for a few hours. Some may provide overnight or weekend services and some may provide more medical or nursing care. Options include:
    • HCS: includes both in home and out of home respite; limits unclear
  • Meaningful Day activities
  • Specialized Therapies: Music, Massage, Recreational, Aquatic, Therapeutic Horseback, and Hippotherapy
  • Traditional Therapies: Occupational therapy, Physical therapy, Speech therapy, Nutritional therapy, Psychological/Behavioral therapy
    • These are all covered by Medicaid for individuals under 21 years old under the CCP (Comprehensive Care Plan)
    • CLASS, HCS, and Star+Plus HCBS Waiver cover these items as needed for waiver recipients over 21 year old
  • Dental Care
    • These are all covered by Medicaid for individuals under 21 years old under the CCP (Comprehensive Care Plan)
    • CLASS, HCS, and Star+Plus HCBS Waiver cover these items as needed for waiver recipients over 21 year old
  • Adaptive Aids: A device that is needed to treat, rehabilitate, prevent or compensate for a condition that results in a disability or a loss of function and helps a person perform the activities of daily living or control the environment.
    • CLASS: Items need to be categorically listed on Appendix I of the CLASS Provider Manual; only $10,000 per budget year can be used for Adaptive Aids + Dental services.
    • MDCP: limited to $4,000 per budget year
    • HCS:
  • Minor Home Modifications: A physical change to an individual’s residence that is needed to prevent institutionalization or to support the most integrated setting for a person to remain in the community. Minor home modifications include Bathroom modifications, Doorway widening, and Ramps.
  • Financial Management Services: Services that assist an individual or family with managing funds associated with self-directing PAS/Hab, respite and adjunct support services through the Consumer Directed Services option.