You may or may not realize, but each program has it’s own “structure” – the agencies who do each job to deliver the needed services.
This may not seem important.
But it is.
Depending on how many “steps” or agencies there are between you and the government may have a big effect on how much money actually goes DIRECTLY toward YOUR CARE & SERVICES.
Example for CLASS
Here is a diagram of the services for CLASS:
As you can see, there are 3 ways of receiving Direct Services in CLASS:
1. Direct Services Agency – each hours of attendant care costs Texas $14.85, but all that comes into your home is whatever your attendant receives $8-$10/hour. After employer taxes, the DSA makes a profit
2. Consumer Directed Services – each hour of attendant care costs Texas $13.05 + a $202 CDS fee each month, and you can pay your attendant all but the amount needed for Employer taxes (11% or less). This saves the state $1.80/hour (less $202/month), gives you more staffing responsibility & control, but does not give you access to this additional funding.
3. Microboard – each hour of attendant care costs Texas $14.85. After employer taxes, the entire profit would be saved for other expenses for YOU/YOUR CHILD to meet their goals.
Texas Medicaid Waivers Explained 
