Texas Medicaid Resources

• State Medicaid Website: Texas
• Texas Council for Developmental Disabilities Website
• The Arc of Texas

Texas Medicaid Facts: From Kaiser Family Foundation Medicaid Fact Sheet (2009)

There are 535,700 people with disabilities covered by Medicaid in Texas. Texas spent $13,572 for each Medicaid recipient with a disability in 2007.

13% of all people covered by Medicaid in Texas have a disability, while the national percentage of people covered by Medicaid who have a disability is 15%.

Texas spends 38% of all the money it spends on Medicaid on services for people with disabilities, while the national percentage of Medicaid spending on these services is 42%.

Texas NorthStar:

This program provides substance abuse and mental health services that cover children and adults with disabilities.

Restrictions: This program is not available everywhere in Texas.

• Health: crisis treatment, detoxification, inpatient and outpatient treatment, mental health rehabilitation
• Social Services: targeted case management

Texas Star:

This program provides basic health services to adults and children with disabilities.

• Community: transportation
• Health: dental, durable medical equipment, early and periodic screening, diagnosis and treatment, family planning, hearing, immunization, hospital, mental health, substance abuse, laboratory, pharmacy, physician, vision, x-ray

Texas Star Plus:

This plan provides services to adults and children with disabilities, including some who are also eligible for Medicare. The program provides basic Medicaid services.

• Health: durable medical equipment, early and periodic screening, diagnosis, and treatment, family planning, hearing, hospice, immunization, mental health, substance abuse treatment, laboratory, long-term care, physician services, vision, x-ray
• Home: home health care
• Social Services: case management

Texas PCCM (Primary Care Case Management):

This is a basic Medicaid program that covers a wide range of health services for adults and children with disabilities. It does not cover those who are living in nursing or intermediate care facilities, those participating in the HCBS waiver, or those who are also eligible for Medicare. Some children considered to have “special needs” as defined by the state and the BBA are also excluded, so children should seek more information about their eligibility.

• Health: chiropractic, dental, disease management, durable medical equipment, early and periodic screening, diagnosis, and treatment, family planning, hearing, hospice, hospitalization, immunization, mental health, substance abuse treatment, institutional care, laboratory services, occupational therapy, pharmacy, physical therapy, physician, podiatry, speech therapy, transportation, vision, x-ray
• Home: home health services
• Social Services: case management

Texas Disease Management Program:

This provides access to disease management services to adults with disabilities who have asthma, diabetes, pulmonary disease, congestive heart failure, and coronary artery disease.

• Health: disease management

Program of All-Inclusive Care for the Elderly (PACE):

PACE programs are designed for people 55 and older who need nursing care, which includes many people with disabilities. These programs provide integrated care and support including a high level of preventive care. PACE programs must provide all services otherwise included in a person’s Medicaid or Medicare benefit, as well as all other services deemed medically necessary.

Ages: 55 and older

Level of Care: nursing

Restrictions: you must live close enough to an approved center to be eligible.

• Community: day care, health-related transportation
• Health: primary and specialty care, nursing, physical therapy, occupational therapy, speech therapy, recreation therapy, prescription drugs
• Home: home care, home and environmental modifications
• Social Services: case management

Non-Emergency Transportation Program:

This is a program to provide people with disabilities and other medical needs transportation to and from routine medical appointments and related errands. People who are also eligible for Medicare do not qualify for this program through Medicaid.

• Community: transportation

Community-Based Alternatives (CBA) waiver:

This waiver is a home and community-based services waiver that provides services so that people do not have to live in a nursing home or intermediate care facility. In some cases, enrolling in this program also means enrolling in the STAR+PLUS managed care program (see below). The CBA waiver covers people with disabilities as well as older adults.

Ages: adults with disabilities 18 and older, and adults with and without disabilities 65 and older

Level of Care: nursing

Option for Self-Direction: This program allows people with disabilities to direct some of their own care.

• Health: adaptive aids, medical supplies, emergency response
• Home: adult foster care, assisted living, residential care

STAR+PLUS Program:

This is a managed care program serving people with mental and physical disabilities and older adults who need long-term care. Participants in this program choose a health plan from the options available in their counties, and Medicaid helps pay for services from these providers. Many support services can be provided in the home, helping people avoid moving into institutions. Enrollment in the STAR+PLUS program is mandatory for people who live in certain areas and receive Medicaid. These people include those with mental or physical disabilities, and all people who receive SSI, and all those who qualify for Community-Based Alternative (CBA) services. The main feature of STAR+PLUS is support coordination, so clients have to work with state Medicaid agencies and their local health care providers to determine which services will be available to them.

• Social Services: support coordination

Community Living Assistance and Support Services (CLASS):

This waiver is the complement to the CBA waiver for people with physical and intellectual disabilities who need lower level of care. It provides services for people who don’t want to move into an intermediate care facility, but who also need long-term care.

Ages: 18 to 64 for people with disabilities, 65 and older for people with or without disabilities

Level of Care: intermediate

Option for Self-Direction: This program allows people with disabilities to play a role in directing their own care.

• Health: adaptive aids, medical supplies habilitation services
• Home: minor home accessibility modifications
• Social Services: case management

Consolidated waiver program:

This waiver is supposed to offer services from many other waivers, including the CBA and CLASS waivers, Home and Community Services, and Children’s program, to people who live in certain areas.

Level of Care: intermediate

Restrictions: this waiver is not available in all areas.

• Health: nursing, adaptive aids and durable medical supplies, habilitation
• Home: personal assistance, respite care

Multiple Disabilities waiver:

This waiver serves people who are deaf and blind who also have at least one other disability. In order to be eligible, the person with the disability must receive services in the community.

Level of Care: intermediate

Option for Self-Direction: This waiver allows people with disabilities to have a voice in directing their own care.

• Health: adaptive aids, medical supplies
• Home: assisted living, chore services
• Social Services: case management

Home and Community-Based Services (HCS) Program:

This service provides care for people with intellectual and developmental disabilities of all ages who want to live at home rather than in institutions. The services are available statewide, but you might have to wait until a waiver slot becomes available.

• Health: adaptive aids, audiology, speech and language therapy, occupational therapy, physical therapy, dietary services, psychology, dental, nursing
• Home: minor home modifications, supported home living, foster or companion care, supervised living, residential support, respite, day habilitation
• Social Services: case management, social services
• Work: supported employment

Medically Dependent Children Program (MDCP):

This program provides in-home services to children with disabilities.

Level of Care: nursing

• Health: adaptive aids
• Home: independent living, minor home modifications respite care

Texas Home Living Program:

This program serves people with intellectual and developmental disabilities who need support to live independently in their homes. It provides a wide array of services.

Integrated Care Management Program (ICS) for SSI and related:

This program is like the STAR+PLUS program, but is available in different areas. This program provides both immediate care and long-term care services, and full Medicaid benefits. It is supposed to support people to live in their own homes by making services available to them outside of institutions. This program is mandatory for people with disabilities who use Medicaid, are over the 21, and receive SSI. It is optional for people under 21.

Restrictions: This waiver is only available in Dallas, Collin, Ellis, Hunt, Kaufman, Navarro, Rockwall, Denton, Hood, Johnson, Parker, Tarrant, and Wise counties.

• Community: day activities
• Health: health services, including many other services offered under the CBS waiver
• Home: home health care