The case manager is responsible for verifying the individual’s eligibility for the CLASS program by ensuring the following criteria are met.
- The individual is eligible for Medicaid through Social Security or Texas HHS
- The individual has been diagnosed prior to age 22 with a related condition as described in the Texas Approved Diagnostic Codes for Persons with Related Conditions.
- The individual has a qualifying adaptive behavior level of II, III, or IV (i.e., moderate to extreme deficits in adaptive behavior) obtained by administering a standardized assessment of adaptive behavior.
- The individual demonstrates a need for CFC PAS/HAB;
- The individual has an Individual Plan of Care (IPC) cost for CLASS services at or below $114,736.07.*
- The individual is not enrolled in another Medicaid waiver program.
- The individual resides in his or her own home or family home.
* CFC services are paid for by Medicaid State Plan funds and do not go into the calculation of CLASS IPC cost.