Revision 25-2; Effective March 31, 2025

Terminology

A contract termination occurs when a provider (business entity) will no longer have a contract with the Texas Health and Human Services Commission (HHSC). A contract termination requires that the person receiving services from HHSC be transferred to a different provider before the effective date of the contract termination. For Community Care Services Eligibility (CCSE), the term contract termination replaces contract cancellation.

A contract assignment occurs when a contract is transferred from one business entity to another business entity. In this situation, there is an exchange between two business entities and the receiving business entity is assigned a new provider number. When a contract assignment occurs, the affected person’s service authorization record is transferred to the new provider through an automated mass transfer process in the Service Authorization System Online (SASO).

Not all changes in the provider’s operation require a provider change action. A contracted provider may have a change in ownership where part of the business ownership changes, a complete change in ownership, or a name change in the provider’s license. Not all of these provider operations result in the change in provider number. For CCSE, the term contract assignment replaces contract conversion.

Contract Termination Transfer Determination Procedures

When a contracted provider decides to terminate its contract with HHSC or when a contract assignment is needed, the contractor must notify HHSC contract staff. Notification of a contract termination may be received by contract or regional management staff. The contract termination end date negotiated with the provider must be 60 calendar days or less after the date the written notice of contract termination is received. If contract termination is due to license revocation, the end date is 30 calendar days or less. Expedited transfer procedures must be used if the contract termination or assignment occurs with less than 10 calendar days notification to HHSC.

Upon notification of a contract termination or contract assignment, the regional director determines if transfers will be handled as either routine or expedited transfers. The regional director must immediately report to the Community Care Services Eligibility (CCSE) director when a decision to apply expedited transfer procedures is made. A decision to apply routine procedures does not require notification to state office staff. The regional director will advise the caseworker if the transfer will be accomplished using routine or expedited transfer procedures.

The caseworker must not initiate transfer procedures due to a contract termination until contract or regional management staff issues an official written notice to the provider.
If there is adequate time to refer the person to a new provider without disrupting services or adversely impacting the person, the regional director will advise the caseworker to use routine transfer procedures.

If there is not adequate time to refer the person to a new provider without disrupting services or if implementing routine procedures may adversely impact the person, the regional director will advise the caseworker to use expedited transfer procedures. An adverse impact is likely to occur when the person:

• requires total care;
• is unable to transfer from a bed to a chair without help;
• is unable to manage toileting tasks without help;
• is in danger of not receiving daily nourishment because they are unable to prepare or eat their meals without help;
• requires nursing services; or
• has no caregiver available to provide the tasks necessary to maintain the person’s health or welfare.

In some instances, services may be disrupted for a short time. However, if there is no adverse impact to the person, the regional director may advise the caseworker to use routine transfer procedures.

CCSE Routine Transfer Procedures for Contract Terminations

If the regional director directs staff to apply routine transfer procedures, the CCSE caseworker completes the following activities:

• Contacts the person to advise of the contract termination and to request the person’s choice of a new provider. If the person does not select a provider agency from the list of contracted agencies in the service area, an agency may be selected for the person as a last resort. The selection is assigned from a regional agency rotation log. The rotation log must be maintained and kept up to date. The regional director may designate a time frame for provider selection depending on the contract termination date.
• Reviews the person’s service plan for accuracy and if any changes are needed, revises the service plan. If the CCSE caseworker is unable to determine the person’s needs by phone, or if an annual assessment is due within 30 days, the CCSE caseworker makes a home visit to complete a reassessment of the person. If there are changes in the service plan, the CCSE caseworker sends Form 2101, Authorization for Community Care Services, to the current provider agency. The required time frame for conducting an annual reassessment is no longer three months.
• Negotiates the transfer date with both provider agencies avoiding any service disruption to the person whenever possible.
• Sends an initial referral packet to the new provider agency within five calendar days of the contact and sends the losing provider a copy of Form 2101.

For a routine transfer referral, the receiving provider follows procedures and requirements for initial referrals except for Primary Home Care (PHC) and Community Attendant Services (CAS). For PHC and CAS, a new practitioner’s statement is not required for the transfer.

Expedited Transfer Procedures for CCSE Contract Terminations

An expedited transfer must be used when there is not adequate time to use the routine referral process to refer the person to a new provider without disrupting services. In an expedited transfer, special procedures are used to quickly transfer the person to a provider that can promptly begin service delivery. The regional director determines when an expedited transfer should be used. Generally, an expedited transfer is used when the contract termination occurs with less than 10 calendar days notification to HHSC, a large number of people are involved in the transfer, or both.

The regional director designates a coordinator to work with contract staff and providers to establish transfer dates. The coordinator or caseworker identifies people whose annual reassessments are due or in process and negotiates, as instructed by the regional director or coordinator, an expedited service initiation date for people with the new provider.

Using the expedited transfer process, the person is offered a choice of providers. If the person does not select a provider agency from the list of contracted agencies in the service area at the point of contact, the caseworker assigns a provider from the regional agency rotation log. The rotation log must be maintained and kept up to date.

CCSE Expedited Transfer Procedures for Contract Terminations

If the regional director determines to apply expedited transfer procedures, the CCSE caseworker completes the following activities:

• Contacts the person to advise of the contract termination and to request the person’s choice of a new provider. If the person does not select a provider agency from the list of contracted agencies in the service area within the designated time frame, the person is assigned to a provider agency by rotation. The selection is assigned from a regional agency rotation log. The rotation log must be maintained and kept up to date.
• Reviews the person’s service plan for accuracy and if any changes are needed, revises the service plan. If the CCSE caseworker is unable to determine the person’s needs by phone or if an annual assessment is due within 30 days, the CCSE caseworker makes a home visit to complete a reassessment of the person. If there are changes in the service plan, the CCSE caseworker sends Form 2101 to the current provider agency. The required time frame for conducting an annual reassessment is no longer three months.
• Negotiates, as instructed by the regional director or coordinator, an expedited service initiation date for each person with the new provider and documents on Form 2065-A, Notification of Community Care Services, the negotiated effective date is due to expedited contract termination.
• Sends a referral packet to the new provider agency and notes Expedited Transfer on Form 2101 within five calendar days of the provider agency selection and sends the losing provider a copy of Form 2101.

For an expedited transfer referral, the receiving provider follows procedures and requirements for initial referrals except for PHC and CAS. For PHC and CAS, a new practitioner’s statement is not required for the transfer.

Contract Termination – Residential Living Arrangements

The transfer process for a person living in an adult foster care (AFC) home, assisted living (AL) facility, host family setting or residential care (RC) facility is complicated by the necessity to find a new living arrangement for the person. Use the following steps when handling a contract termination affecting a person living in an AFC, AL, host family or RC setting.

Depending on the option selected by the person when a residential setting contract is terminated, the caseworker completes the appropriate procedures to complete the action. For example, if a person in a residential setting chooses to go to his daughter’s home in the community, the caseworker follows normal procedures for authorizing services in the community. If a person chooses to move or return to a nursing facility permanently, the caseworker follows normal procedures to terminate program eligibility and services.

Contract Terminations When No Other Provider is Available

In some situations, a provider may request to terminate its contract and there is no other provider available in the service area to provide that service. For example, if a Home-Delivered Meals provider terminates its contract, there may not be another provider in the service area to deliver meals. In that case, the HHSC caseworker must contact the person and offer any other available resources to meet that need. In this example, the person may elect to receive services by an attendant to prepare meals or locate a congregate meal location.

When a service is terminated rather than transferred to a new provider, the HHSC case worker must send Form 2065-A to the person noting the service is terminated due to the contract termination. The effective date of termination would be date of the contract termination.

Contract Assignment

Residential and Non-Residential Settings

After HHSC contract staff have negotiated the contract assignment effective date, contract staff will notify the regional director that the provider plans to assign its contract, as well as the contract assignment effective date. A transfer due to a contract assignment must not occur before the contract assignment effective date.

On or within two working days after the contract assignment effective date, regional staff must send Form 2097, Provider Contract Assignment Notification Letter, to the person informing them of the change in provider. The letter informs the person of the change in contract and offers the option to change to a provider selected by the person or remain with the new provider. The letter informs the person of the change in contract and offers the option to change to a provider selected by the person or remain with the new provider.

Person Chooses to Remain With the New Provider

After receiving confirmation of the automated mass transfer, the caseworker reviews the Texas Medicaid and Healthcare Partnership error page in the Service Authorization System Online (SASO) to identify a person whose service authorization record transfer was not processed. It should not be necessary to check each service authorization record. However, for CCSE, the SASO wizard will not replicate the provider change until the caseworker runs the wizard, selecting Provider Transfer. To prevent billing problems, the CCSE caseworker must complete a provider transfer in the SASO wizard immediately for a person whose service authorization records were not automatically converted. For help with a person whose service authorization records were not automatically converted, contact the coordinator or the regional Claims Management Services (CMS) coordinator.

The losing provider should provide the new provider with all applicable forms. If the losing provider does not provide the forms to the new provider, the caseworker must provide copies of the current forms to the new provider. For CCSE, refer to Appendix XIII, Contents of Referral Packets, for the list of forms to be sent for provider transfers.

It is not necessary to get acceptance by the new provider or send Form 2065-A to the person or new provider. The caseworker must document the transfer was due to a contract assignment from the losing provider to the new provider. In a mass transfer completed through the automated transfer process, only the SASO service authorization records are automatically changed to end the losing provider and authorize all services to the gaining provider.

For CCSE, the SASO wizard does not automatically update all data. The provider transfer must be processed in the wizard so the history and Form 2101 data will match changes to the service authorization records.

Person Chooses to Change to a Different Provider

If the person chooses to change from the new provider that received the contract assignment to a provider selected by the person, the caseworker must complete two provider change actions. The CCSE caseworker uses the SASO wizard to complete the provider change actions. The first provider change action is to change service authorizations from the losing provider to the new provider for services delivered after the contract assignment effective date. The second provider change action is to change service authorizations from the new provider to the provider selected by the person for services.

Both CCSE provider change actions must be completed within the time frame in 4676, Change of Providers.

For all programs, the person may change providers at any time, as described in current procedures regardless of any changes in the provider’s operation.

Revision 24-4; Effective Sept. 1, 2024

Under state law, the Texas Health and Human Services Commission (HHSC) may not purchase alternate care for a person when the cost per day of the care exceeds the cost per day in a nursing facility. Few combinations of Community Care Services Eligibility (CCSE) services even approach this cost. However, caseworkers must be careful when authorizing maximum levels of personal attendant services with another CCSE service.

To determine rates for services that vary by region or contract such as Family Care, Emergency Response Services or Home-Delivered Meals, the highest allowable rate is used. To ensure the correct amount of services are purchased, contact the regional contract manager to get the actual unit rate in a specific region.

When a person receives multiple services, contact the regional contract manager to:

• obtain current unit rates that apply to the services authorized; and
• determine the total cost of services to ensure that the nursing facility average is not exceeded.

Revision 21-1; Effective March 1, 2021

Attendant services are inappropriate for an applicant or recipient whose needs exceed the scope of the contract. Community Care Services Eligibility (CCSE) staff use the following examples of appropriate and inappropriate characteristics to decide if an applicant or recipient's needs can be adequately met through the program.

Revision 21-4; Effective December 1, 2021

Revision 21-3; Effective September 1, 2021

Revision 24-5; Effective Nov. 1, 2024

Revision Notice 25-5, Effective Dec. 1, 2025

Person’s Name:                               Caseworker:                                     County:                                    

Revision 25-4; Effective Sept. 1, 2025

*For decreases and terminations if the last day of any period is a Saturday, Sunday or a legal holiday, the period is extended to include the next day that is not a Saturday, Sunday or a legal holiday. Skeleton crew days are not legal holidays. Legal holidays are days when the agency is closed.

Refer to the instructions for Form 2065-A for the procedures to follow when a recipient requests a hearing in writing or in person.

Notes:

• For terminations, the effective date on Form 2065-A must be the same as the End Date on Form 2101.
• Do not send Form 2065-A when a recipient’s forwarding address is unknown, such as situations when the post office sends notification that the recipient left no forwarding address.
• Send Form 2065-A when a recipient is transferring from one service to another, whether or not the change is considered positive or negative.

3-2026

Left Side

Retention Tab

• Form 3052, Practitioner's Statement of Medical Need
• Form 3055, Physician's Orders (DAHS)
• Form 3050, DAHS Health Assessment/Individual Service Plan
• Form 1582, Consumer Directed Services Responsibilities
• Form 1584, Consumer Participation Choice
• Form 1575, Medicaid Estate Recovery Program Worksheet
• Form 8001, Medicaid Estate Recovery Program Receipt Acknowledgement
• Form 2061, Notification of Medicaid Estate Recovery Program Status
• Form 2307, Rights and Responsibilities
• Form 2066-IDT, Interdisciplinary Team (IDT) Meeting Letter
• Guardianship Documents

Right Side

Forms Checklist for Attendant Care Programs

2025 Tab

• All forms created or received during this calendar year that are not required to be filed under the retention tab.

Filing Notes:

The Community Care Services Eligibility (CCSE) Case Management Filing Guide is a suggested filing format to promote consistency in CCSE case records.

The objective will be to always have the forms and documents which need to be retained on the top left side under Retention tab. All other forms and documents should be filed under yearly tabs beginning with 2024, 2025 and so on, with the current calendar year on the top right side. The intent of the yearly tabs is to file forms as they are created or on receipt.

Revision 17-1; Effective March 15, 2017

Resources — CCSE Handbook Section 3420

Income Eligibility — CCSE Handbook Section 3300

Revision 21-4; Effective December 1, 2021

Initial Referral Packet Forms

The initial packet must Include:

• a cover sheet;
• the Long-term Care Services Intake System (NTK) generated Form 2110, Community Care Intake; and
• a copy of the following Service Authorization System Online Wizards (SASOW) generated forms.

Annual Reauthorization and Interim Reassessment Packet Forms

Must include a cover sheet and a copy of the following SASOW generated forms.

Termination Packet Forms

Must include a cover sheet and a copy of the following SASOW generated forms.

Note: In the SASOW, the following forms are generated as two forms:

• Form 2059 is generated as Form 2059 and the Provider Referral Supplement.
• Form 2060 is generated as Form "2060 and the Task/Hour Guide."

Revision Notice 25-5, Effective Dec. 1, 2025

The following chart may be used for the determination of financial eligibility based on automated records. The chart indicates the type program (TP) or type assistance (TA) a person may be receiving in Texas Integrated Eligibility Redesign System (TIERS), and how existing coverage affects eligibility for Community Care Services Eligibility (CCSE) services.

SNAP

TANF

Medical Assistance or Programs — Texas Works (TW)

Medical Assistance or Programs — Texas Department of Family and Protective Services (DFPS)

Medical Assistance or Programs — Social Security Administration (SSA)

Medical Assistance or Programs — Medicaid for the Elderly and People with Disabilities (MEPD)

STAR+PLUS members are entitled to Title XX services if all eligibility criteria are met. However, CCSE staff must first ensure that approval of the request would not result in a duplication of services.

STAR members are entitled to Title XIX and Title XX services if all eligibility criteria are met. However, CCSE staff must first make sure that approval of the request would not result in a duplication of services.

CCSE staff must not authorize any Title XX services for people enrolled in the STAR+PLUS HCBS program.

Note: When Medicaid type indicates facility or institutional living arrangement the person is not eligible for CCSE services. Review asterisks below for specific instructions for reporting changes.

 * Not eligible for CCSE programs under this type assistance (TA) or type program (TP). Confirm living arrangement with the person or authorized representative (AR), send H1746-A to MEPD staff to process the change in living arrangement and referral. MEPD staff will test for community programs.

** Not eligible for CCSE under this TA or TP. Confirm living arrangement with the person or AR, then have them contact SSA at the local office or at 800-772-1213 to correct the living arrangement.

Note: HHSC is not responsible for making SSA changes. All changes need to be reported to SSA.

Revision 17-1; Effective March 15, 2017

Eligibility

Does the individual continue to meet all eligibility requirements for the Community Care Services Eligibility (CCSE) services that are authorized?

• Does the individual continue to be financially eligible? Have there been any changes in income, resources, or categorical status?
• Does the individual appear still to be functionally eligible? (See "Individual Condition" below.)
• Does the individual need and want CCSE services?
• Does the individual still need assistance that would not be met without this CCSE service?

Condition

Has there been any change in the individual's condition that affects service delivery or the adequacy of the service plan?

• What is the individual's current medical, physical and mental condition? Has it changed?
• Has the individual been hospitalized? Has there been an accident or illness? Is the individual getting medical services as needed?
• Has there been a change in the individual's degree of self-sufficiency?
• Has there been a change in the tasks the individual can perform?
• What are the individual's current needs? Have these changed?
• What is the individual's risk status?

Situation

Has there been any change in the individual's situation that affects service delivery or the adequacy of the service plan?

• Has the individual moved? Has there been another change in the individual's home or environment? Does any change affect the individual's safety or service needs?
• Who (if anyone) has moved in with the individual? Who has moved out of the individual's residence?
• Has there been any change in the individual's social support or resources? Has there been any change in the assistance that is given by family or community resources?
• Does the individual continue to have the same caregivers? Has there been any change in the amount or type of assistance they give the individual? Has there been any change in the ability, dependability, or availability of the individual's caregiver?

CCSE Services

Have CCSE services been delivered according to the service plan?

• Were services initiated as scheduled? Has the provider agency delivered the correct amount of services at the scheduled times?
• Is the individual satisfied with the service? Does the service meet the individual's needs?
• What is the quality of the services that are being provided to the individual? Are there any problems with the quality of the services? Does the paid attendant carry out the required tasks? Does the attendant arrive on time? Is there a problem that needs to be reported to the agency supervisor or the contract manager?
• Has the individual been away from his residence when in-home services were scheduled? Has the individual used out-of-home services as authorized? Has the individual in some other way prevented the delivery of authorized services?

Service Plan

Does the service plan need to be changed?

• Are the authorized services meeting the individual's current needs?
• Does the individual still concur with the service plan?
• Does the individual continue to need the same amount of services?
• Is the current schedule effective for meeting the individual's needs?
• Does the individual need additional service(s)?
• Does the individual need a referral to some other agency or community resource?

Revision 24-4; Effective Sept. 1, 2024

Revision 25-2; Effective March 31, 2025

Intake Procedures

Assessment and Reassessment Procedures

Authorizations and Reassessments

Service Monitoring and Evaluation

Denying or Reducing Services

Responding to Requests for Service Interruptions, Suspensions and Reported Changes

Revision 20-4; Effective December 1, 2020

Revision 17-1; Effective March 15, 2017

Section 42, Code of Federal Regulations, §431.10, specifies that Medicaid eligibility must be determined by a single state agency. The Texas State Plan designates the Texas Health and Human Services Commission (HHSC) as the sole agency with the authority to make eligibility determinations for Medical Assistance Only (MAO) cases.

Therefore, financial eligibility for Community Attendant Services (CAS) is determined exclusively by Medicaid for the Elderly and People with Disabilities (MEPD) staff. However, Community Care Services Eligibility (CCSE) staff must make an effort during the initial visit with each applicant to gather as much documentation as possible to hasten the MEPD specialist’s completion of the eligibility determination.

I. Income and Resource Eligibility

The following income and resource verifications/documentations must be included in the MEPD specialist’s case record to make a financial eligibility decision for a CAS case.

II. Citizenship Requirements for Eligibility

Public Law 109-171, Deficit Reduction Act of 2005, requires that documentation be provided at the initial determination, and for ongoing cases, at the next redetermination of eligibility for all Medicaid cases. Verification of citizenship and identity for eligibility purposes is a one-time activity. Once verification of citizenship is established and documented by MEPD staff, verification is no longer required, even after a break in eligibility.

Long Term Services and Supports (LTSS) case workers must be prepared to assist individuals with this process by informing LTSS individuals of the requirement and helping to identify the documentation needed to prove citizenship and identity. Information available at the time of the home visit must be collected and submitted with the application for an MEPD determination. Individuals may obtain and forward copies to HHSC for transmittal to MEPD staff.

MEPD staff accept copies and faxes only if clear and legible. If the LTSS case worker receives an affidavit as verification, ensure that the reason the applicant or recipient is unable to produce documentary evidence of citizenship and identity is documented on the affidavit. If the affidavit does not contain this information, the reason another source is not available is documented and transmitted to MEPD staff on Form 2067, Case Information, along with the affidavit. The case worker must ensure the applicant/individual is signing the affidavit under penalty of perjury.

Acceptable Documentation for Both Citizenship and Identity

Supplemental Security Income (SSI) Recipients – State Data Exchange (SDX) contains the needed information to verify citizenship. For any active Supplemental Security Income (SSI) recipient, MEPD staff are able to use SDX as verification of both citizenship and identity. For any denied SSI recipient, SDX can be used as a valid verification source of both citizenship and identity when the denial is for any reason other than citizenship. The SDX printout will show action code N13 if the denial is for citizenship.

Medicare Recipients – Active Medicare recipients are exempt from the requirement to provide evidence of citizenship and identity. The Social Security Administration documents citizenship and identity for Medicare recipients.

For any individual entitled to or enrolled in Medicare Part A or B, and subsequently denied Medicare, use the State On Line Query (SOLQ) or Wire Third Party Query (WTPY) System as documentation of both citizenship and identity when the denial is for any reason other than citizenship. If there is an end date listed for Medicare, the individual must provide documentation regarding the loss of Medicare.

All Other Individuals – The following primary documents may be accepted as proof of both identity and citizenship:

• U.S. passport,
• Certificate of Naturalization (N-550 or N-570), or
• Certificate of U.S. Citizenship (N-560 or N-561).

Documents that establish citizenship are divided into second, third and fourth levels based on the reliability of the evidence:

• One document that establishes U.S. citizenship, and
• One document that establishes identity.

Hierarchy of Approved Documentation Sources

Primary Evidence of Citizenship and Identity

• U.S. passport
• Certificate of Naturalization
• Certificate of U.S. citizenship
• SDX for denied SSI recipients when the denial reason is for any reason other than citizenship (N13)
• SOLQ/WTPY and documentation on reason for Medicare denial

If primary evidence of citizenship is not available, the individual must provide two documents – one to establish U.S. citizenship and one to establish identity, as outlined below. Begin with the second level of evidence of citizenship and continue through the levels to locate the best available documentation.

Second Level of Evidence of Citizenship (Use only when primary evidence is not available)

• Rico (if born on or after Jan. 13, 1941), Guam (on or after April 10, 1899), the Virgin Islands of the U.S. (on or after Jan. 17, 1917), American Samoa, Swain’s Island or the Northern Mariana Islands (after Nov. 4, 1986) - Contact Bureau of Vital Statistics (BVS) for an individual born in Texas. If an individual’s date of birth is earlier than 1903 or if the birth was out of state, accept a legible/non-questionable copy. For a birth out of state, individuals may obtain a birth certificate through the following: BirthCertificate.com; vitalchek.com; usbirthcertificate.net or the toll-free number, 1-888-736-2692.
• Report of Birth Abroad of a U.S. Citizen (FS-240)
• Certification of Birth Abroad (FS 545 or DS-1350)
• U.S. Citizen identification card (Form I-179 or I-197)
• Northern Mariana identification card (I-873)
• American Indian card (I-872) issued by Department of Homeland Security with classification code “KIC”
• Final adoption decree showing the child’s name and U.S. place of birth
• Evidence of U.S. Civil Service employment before June 1, 1976
• U.S. Military record showing a U.S. place of birth (Example: DD-214)

Third Level of Evidence of Citizenship (Use only when primary and second level evidence is not available)

• Hospital record of birth showing a U.S. place of birth
• Life, health or other insurance record showing a U.S. place of birth
• Religious record of birth recorded in the U.S. or its territories within three months of birth, which indicates a U.S. place of birth showing either the date of birth or the individual's age at the time the record was made

Fourth Level of Evidence of Citizenship (Use only when primary, second level and third level evidence is not available)

Any listed documents must include biographical information including a U.S. place of birth.

• Federal or state census record showing U.S. citizenship or a U.S. place of birth and the individual’s age (generally for individuals born 1900-1950)
• Seneca Indian Tribal census record showing a U.S. place of birth
• Bureau of Indian Affairs Tribal census records of the Navajo Indians showing a U.S. place of birth
• U.S. State Vital Statistics official notification of birth registration showing a U.S. place of birth
• Statement showing a U.S. place of birth signed by the physician or midwife who was in attendance at the time of birth
• Institutional admission papers from a nursing facility, skilled care facility or other institution showing a U.S. place of birth
• Medical (clinic, doctor or hospital) record, excluding an immunization record, showing a U.S. place of birth
• Affidavits from two adults regardless of blood relationship to the individual (use only as a last resort when no other evidence is available)

Evidence of Identity

• Driver license issued by a state either with a photograph or other identifying information such as name, age, sex, race, height, weight or eye color
• School identification card with a photograph
• U.S. Military card or draft record
• Department of Public Safety identification card with a photograph or other identifying information such as name, age, sex, race, height, weight or eye color
• Birth certificate
• Hospital record of birth
• Military dependent’s identification card
• Native American Tribal document
• U.S. Coast Guard Merchant Mariner card
• Certificate of Degree of Indian Blood or other U.S. American Indian/Alaskan Native and Tribal document with a photograph or other personal identifying information
• Data matches with other state or federal government agencies (for example, Employee Retirement System and Teacher Retirement System)
• Adoption papers or records
• Work identification card with photograph
• Signed application for Medicaid (accept the signature of an authorized representative or a responsible person acting on the individual’s behalf)
• Health care admission statement
• School records for children under age 16, which may include nursery or day care records
• An affidavit signed by a parent or guardian for a child under age 16, stating the date and place of birth of the child (use as a last resort when no other evidence is available and if an affidavit is not used to establish citizenship)

In the hierarchy of approved documentation sources, some documents listed to verify citizenship are also acceptable to verify identity. When using the hierarchy of approved documentation sources, the same document cannot be the source to verify both citizenship and identity.

If an individual is unable to provide any other documentary evidence of citizenship, an affidavit signed under penalty of perjury will only be accepted as a last resort. MEPD staff are required to document the reason another source is not available to verify citizenship. If the LTSS case worker is provided an affidavit, ensure the reason the applicant or recipient is unable to produce documentary evidence of citizenship and identity is documented on the affidavit. If the affidavit does not contain this information, the reason another source is not available is documented and transmitted to MEPD staff on Form 2067, along with the affidavit. The copies of the affidavit form, available online at https://hhs.texas.gov/laws-regulations/forms, are to be made available in all HHSC benefits offices.

Reasonable Opportunity to Provide Verification

The LTSS case worker must inform all applicants if MEPD staff do not receive documentation of citizenship and identity by the application due date, certification may be delayed and eventually denied if verification documentation is not provided.

Inform ongoing recipients that they will be asked to provide documentation verifying citizenship and identity at the redetermination. If an ongoing recipient cannot provide the required verification(s) at the initial request, eligibility will continue until the next redetermination. Eligibility will be denied if the recipient does not provide the required verification(s) at the next complete redetermination.

Assistance to Individuals in Obtaining Documentary Evidence

To assist an individual who is unable to provide documentary evidence of citizenship and identity in a timely manner because of incapacity of mind or body or the lack of a representative to assist, staff may make referrals to the following entities:

• Department of Family and Protective Services, Adult Protective Services
• Legal Aid
• Community-based organizations
• Social Security Administration
• 2-1-1

For individuals born out of state, some sources to obtain a birth certificate are:

• BirthCertificate.com
• Vitalchek.com
• Usbirthcertificate.net or the toll free number, 1-888-736-2692

When assisting the individual in providing documentary evidence of citizenship and identity, use any available documents, regardless of level of evidence.

Revision 24-4; Effective Sept. 1, 2024

The caseworker completes Form 2101. This renews the prior approval process for all ongoing Primary Home Care people, including transfer cases, not certified as Community Attendant Services (CAS) people. Instructions for items other than numbers 4 and 5, are covered in the instructions for Form 2101 in the Forms and Reports section.

Revision 25-3; Effective June 1, 2025

All rules referenced below appear in the Texas Administrative Code (TAC), Title 26, Part I.

Adult Foster Care is provided under Title XX of the Federal Social Security Act relating to block grants to states for social services at 42 USC Section1397 and what follows.

Case management rule base: TAC Section 271.73Contracting rule base: TAC Chapter 271, Subchapter C.

Community Attendant Services is provided under Title XIX of the Federal Social Security Act relating to grants to states for medical assistance programs at 42 USC Section1396 relating to home and community care for functionally disabled elderly people. This program was formerly known as Section1929(b) or Frail Elderly.

Case management rule base: TAC Section 271.81.

Contracting rule base: TAC Chapter 271.

Consumer Managed Personal Attendant Services is provided under Title XX of the Federal Social Security Act relating to block grants to states for social services at 42 USC Section 1397 and what follows.

Rule base: TAC Chapter 275

Day Activity and Health Services is provided under Title XX of the Federal Social Security Act, relating to block grants to states for social services, at 42 USC Seciton1397 and what follows.

Case management rule base: TAC Section 271.77

Contracting rule base: TAC Chapter 271, Subchapter C

Emergency Care is provided under Title XX of the Federal Social Security Act (relating to block grants to states for social services) at 42 USC §1397 et seq.

Case management rule base: TAC Section 271.87

Emergency Response Services is provided under Title XX of the Federal Social Security Act, relating to block grants to states for social services, at 42 USC Section1397 and what follows.

Case management rule base: TAC Section 271.95

Contracting rule base: TAC Chapter 271

Family Care is provided under Title XX of the Federal Social Security Act, relating to block grants to states for social services, at 42 USC Section1397 and what follows.

Case management rule base: TAC Section 271.69

Contracting rule base: TAC Chapter 271

Home-Delivered Meals is provided under Title XX of the Federal Social Security Act, relating to block grants to states for social services, at 42 USC Section 1397 and what follows. Additional funding is provided by local resources and contractor match.

Case management rule base: TAC Section 271.71

Contracting rule base: TAC Chapter 271

Primary Home Care is provided under Title XIX of the Federal Social Security Act, relating to state plans for medical assistance, at 42 USC Section 1396a.

Case management rule base: TAC Section 271.81

Contracting rule base: TAC Chapter 271

Residential Care ad Assisted Living is provided under Title XX of the Federal Social Security Act, relating to block grants to states for social services, at 42 USC Section 1397.

Case management rule base: TAC Section 271.85

Contracting rule base: TAC Chapter 271

Special Services to Persons with Disabilities is provided under Title XX of the Federal Social Security Act relating to block grants to states for social services, at 42 USC Section1397 and what follows.

Case management rule base: TAC Section 271.75

Contracting rule base: TAC Chapter 271

Revision 25-4; Effective Sept. 1, 2025

Appendix XXV, Community Services Interest List (CSIL) Closure Code User's Guide (PDF).

Revision 24-5; Effective Nov. 1, 2024

Determining Unmet Need(PDF)

Revision 21-3; Effective September 1, 2021

Revision 25-3; Effective June 1, 2025

Do not hire (PDF)

Revision 25-2; Effective March 31, 2025

• Adult Foster Care Services Eligibility Process (PDF)
• Community Attendant Services Eligibility Process (PDF)
• DAHS Eligibility Process: Request by a Facility (PDF)
• DAHS Eligibility Process: Request by a Person (PDF)
• Emergency Response Services Eligibility Process (PDF)
• Family Care Services Eligibility Process (PDF)
• Home Delivered Meals Services Eligibility Process (PDF)
• Primary Home Care Services Eligibility Process (PDF)
• Residential Care Services Eligibility Process (PDF) 

Revision 17-8 Effective September 1, 2017

Income and Resource Exemptions

Exempt income is not included in the income eligibility calculation. Once identified and documented, caseworkers will not be required to monitor exempt income at subsequent financial redetermination. Sources of exempt income include:

(1) interest income.

(2) cash received from the sale of a resource. This cash is a resource, not income.

(3) income of minor children who are supported by or dependent upon the client.

(4) refunds from the Internal Revenue Service for earned income tax credit.

(5) reimbursement from an insurance company for health insurance claims.

(6) any cash from a non-governmental medical or social services organization if the cash is:

for medical or social services already received by the individual and approved by the organization, and which does not exceed the value of those services; or a payment restricted to the future purchase of a medical or social service.

(7) proceeds of either a commercial loan or an informal loan, for which repayment is required with or without interest. The proceeds (amount borrowed) are not counted as income in the month in which they are received, but are considered to be a resource in the following month(s). To claim exemption of the proceeds of a loan, a client must prove that he acknowledges an obligation to repay and that some plan for repayment exists. If these conditions can be verified, no written contract is required.

(8) the amount of the cost-of-living increase in any pension or benefit, received on or after January 1, 1985, that would cause the client to be ineligible for continued services. This exclusion applies only to community care clients who are already receiving services or case management and would become ineligible because of the increase. It does not apply to applicants.

(9) in-kind income, such as food, clothing, shelter, rent subsidies.

(10) one-time or lump-sum payments from any source.

(11) funds from the Transition to Life in the Community Program.

(12) payments from the Agent Orange Settlement Fund or any other fund established in settlement of the Agent Orange product liability litigation. Public Law 101-239 exempts the payments from countable income and resources. The law is retroactive as of January 1, 1989.

(13) any payment received under the Radiation Exposure Compensation Act (Public Law 101-246).

(14) any payment received under the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970.

(15) payments to volunteers under the Domestic Volunteer Services Act. This exclusion applies to any payments to volunteers in the Retired Senior Volunteer Program, and Foster Grandparent Program, and the Senior Companion Program. Also included are payments under Title III of the same act, which includes the Service Corps of Retired Executives (SCORE), the Active Corps of Executives (ACE), and the Action Cooperative Volunteer Program (ACV).

(16) interest or other earnings on any designated account established for Supplemental Security Income (SSI) clients under age 18 for retroactive benefits, as required by Public Law 104-193, effective August 22, 1996.

(17) payments by the Federal Disaster Assistance Administration authorized by the Disaster Relief Act, as amended.

(18) value of any housing assistance paid on a house under the United States Housing Act of 1937, the National Housing Act, the Housing and Urban Development Act of 1965, §101, or Title V of the Housing Act of 1949, as authorized by Public Law 94-375.

(19) home energy assistance, except food or clothing, under Public Laws 97-377 and 97-424. Home energy assistance is assistance in cash or in-kind that is provided by a private, nonprofit organization or a utility company. Some examples of home energy assistance are heating, cooling, weatherization, storm windows, and blankets.

(20) reparation payments received by Holocaust survivors from the Federal Republic of Germany. The payments may be made periodically or as a lump sum. The Texas Department of Human Services accepts the client's signed statement of amounts involved and dates of payment. Public Law 101-508 established this exemption effective January 1, 1991.

(21) payments from a state-administered fund to aid victims of crime. Public Law 101-508 established this exemption effective May 1, 1991.

(22) payments a state or local government may make as relocation assistance. Public Law 101-508 established this exemption effective October 15, 1990.

(23) hazardous duty pay of a spouse or parent absent from the home because of active military service.

(24) restitution payments made by the United States government under Public Law 100-383 to Japanese-American (or, if deceased, to their survivors) who were interned or relocated during World War II.

(25) reparation payments received under §§500-506 of the Austrian General Social Insurance Act.

(26) payments under the Netherlands' Act on Benefits for Victims of Persecution 1940-1945 (Dutch acronym, WUV).

(27) payment from any source made to individuals because of their status as victims of Nazi persecution. Public Law 103-286 established this exemption effective August 1, 1994.

Emergency or Disaster Relief

Payments precipitated by an emergency or major disaster are not counted as income or resources when determining financial eligibility.
A major disaster is any natural catastrophe such as a hurricane or drought, or, regardless of cause, any fire, flood or explosion, which the President determines causes damage of sufficient severity and magnitude.

An emergency is any occasion or instance for which the President determines that federal assistance is needed to supplant state and local efforts and capabilities to save lives and to protect property and public health and safety, or to lessen or avert the threat of a catastrophe.

Disaster Unemployment Assistance is emergency assistance authorized under Public Law (P.L.) 100-107 and received by individuals who are unemployed as a result of a major disaster. Individuals receiving Disaster Unemployment Assistance are not eligible for other unemployment compensation and cannot receive both at the same time.

If precipitated by an emergency or a major disaster, do not consider the following as income:

• Payments received under the Disaster Relief Act of 1974 (P.L. 93-288, Section 312(d)), as amended by the Disaster Relief and Emergency Assistance Amendments of 1988 (P.L. 100-707, Section 105(i)) and disaster assistance comparable to these payments provided by states, local governments and disaster assistance organizations
• Payments from the Federal Emergency Management Agency (FEMA), Individual and Family Grant Assistance program (IFG), grants or loans by the Small Business Administration (SBA), voluntary disaster assistance organizations, such as the Red Cross, or private insurance payments for losses due to a major disaster such as flood, wind, land movement
• Each payment made to farmers under the Disaster Assistance Act of 1988 (P.L. 100-387) for crop losses or failure in a disaster
• Income received from public and private organizations by individuals working in disaster relief efforts and funded under a National Emergency Grant by WIA, Title 1 (P.L.105-220)
• Disaster Unemployment Assistance
• Payments for flood mitigation received by a homeowner under the National Flood Insurance Act of 1968, as amended by P.L. 109-64
• Government payments designated for the restoration of a home damaged in a disaster.

Additional Exemptions

Income from the following sources is exempt as income and as a resource and must not be considered in determining eligibility. Exempt the following payments:

• Payments from the Ricky Ray Hemophilia Relief Fund
• Alaska longevity bonus
• Payments from the Energy Employees Occupational Illness Compensation Act (EEOICA) (Public Law 106-398, October 2000) for medical benefits and compensation
• Filipino Veterans Equity Compensation Fund created by the American Recovery and Reinvestment Act of 2009.
• The value of assistance to children under the National School Lunch Act (60 Stat. 230, 42 U.S.C. 1751 et seq.) as amended by Public Law 90-302 (82 Stat. 117, 42 U.S.C. 1761(h)(3))
• Any grant or loan to any undergraduate student for educational purposes made or insured under any program administered by the commissioner of education, as provided by Section 507 of the Higher Education Amendments of 1968, Public Law 90-575 (82 Stat. 1063)
• Incentive allowances received under Title I of the Comprehensive Employment and Training Act of 1973 (87 Stat. 849, 29 U.S.C. 821(a))
• Compensation provided to volunteers by the Corporation for National and Community Service (CNCS), unless determined by the CNCS to constitute the minimum wage in effect under the Fair Labor Standards Act of 1938 (29 U.S.C. 201 et seq.), or applicable state law, pursuant to 42 U.S.C. 5044(f)(1)
• Value of federally donated foods distributed pursuant to Section 32 of Public Law 74-320 or Section 416 of the Agriculture Act of 1949 (7 CFR 250.6(e)(9), as authorized by 5 U.S.C. 301)
• All funds held in trust by the Secretary of the Interior for an Indian tribe and distributed per capita to a member of that tribe under Public Law 98-64
• Funds held by Alaska Native Regional and Village Corporations (ANRVC) are not held in trust by the Secretary of the Interior and therefore ANRVC dividend distributions are not excluded from resources under this exclusion.
• Home energy assistance payments or allowances under the Low-Income Home Energy Assistance Act of 1981, as added by Title XXVI of the Omnibus Budget Reconciliation Act of 1981, Public Law 97-35 (42 U.S.C. 8624(f))
• Student financial assistance for attendance costs received from a program funded in whole or in part under Title IV of the Higher Education Act of 1965, as amended, or under Bureau of Indian Affairs student assistance programs if it is made available for tuition and fees normally assessed a student carrying the same academic workload, as determined by the institution, including:
  • costs for rental or purchase of any equipment;
  • materials or supplies required of all students in the same course of study; and
  • an allowance for books, supplies, transportation and miscellaneous personal expenses for a student attending the institution on at least a half-time basis, as determined by the institution, under Section 14(27) of Public Law 100-50, the Higher Education Technical Amendments Act of 1987 (20 U.S.C. 1087uu), or under Bureau of Indian Affairs student assistance programs.
• Amounts paid as restitution to certain individuals of Japanese ancestry and Aleuts under the Civil Liberties Act of 1988 and the Aleutian and Pribilof Islands Restitution Act, Sections 105(f) and 206(d) of Public Law 100-383 (50 U.S.C. app. 1989 b and c)
• Any matching funds and interest earned on matching funds from a demonstration project authorized by Public Law 105-285 that are retained in an Individual Development Account, pursuant to Section 415 of Public Law 105-285 (112 Stat. 2771)
• Any earnings, Temporary Assistance for Needy Families matching funds, and accrued interest retained in an Individual Development Account, pursuant to Section 103 of Public Law 104-193 (42 U.S.C. 604(h)(4))
• Payments made to individuals who were captured and interned by the Democratic Republic of Vietnam as a result of participation in certain military operations, pursuant to Section 606 of Public Law 105-78 and Section 657 of Public Law 104-201 (110 Stat. 2584)
• Payments made to the children of women Vietnam veterans who suffer from certain birth defects, pursuant to Section 401 of Public Law 106-419 (38 U.S.C. 1833(c))
• For the nine months following the month of receipt, any unspent portion of any refund of federal income taxes under Section 24 of the Internal Revenue Code of 1986 (relating to the child care tax credit), pursuant to section 431 of Public Law 108-203 (118 Stat. 539)
• Wages and salaries from Title V of the Older Americans Act, such as Green Thumb and the Senior Texan Employment Program (STEP), are not exempt income. See (15) in the section above.

In the income eligibility budget, do not count the hostile fire pay or imminent danger pay portion from military income. For the nine-month period following the month of receipt, exclude the unspent portion of any retroactive payment (see (23) above) of:

• hostile fire and imminent danger pay (pursuant to 37 U.S.C. 310) received by the ineligible spouse or parent from one of the uniformed services; and
• family separation allowance (pursuant to 37 U.S.C. 427) received by the ineligible spouse or parent from one of the uniformed services as a result of deployment to or while serving in a combat zone.

Other exemptions include:

1. Payments from the Remembrance, Responsibility and Future Foundation of Germany.
2. Interest or other earnings on any designated account established for Supplemental Security Income (SSI) individuals under age 18 for retroactive benefits, as required by Public Law 104-193, effective August 22, 1996.
3. Payments made in the class settlement of the Susan Walker vs. Bayer Corporation lawsuit, as required by Public Law 105-33, effective August 5, 1997.
4. Payments from the Department of Veterans Affairs made to or on behalf of certain Vietnam veterans' natural children regardless of their age or marital status, for any disability resulting from spina bifida suffered by such children as required by Public Law 104-204, effective October 1, 1997.
5. Gifts from tax-exempt organizations, such as the Make-A-Wish Foundation, to children with life-threatening conditions, as required by Public Law 105-306, effective retroactively to October 28, 1996. The exclusions apply to children under age 18. The gift must be from an organization described in Section 501(c)(3) of the Internal Revenue Code of 1986 and which is exempt from taxation under Section 501(c). The case manager documents the case record with an oral or written statement from the organization that the gift was made based on the child having a life-threatening condition. No additional verification of medical eligibility is necessary.
6. The following gifts to or for the benefit of a child described above are excluded from income:
   1. any in-kind gift, not converted to cash; and
   2. a cash gift to the extent that the cash excluded under this provision does not exceed $2,000 in any calendar year. Cash in excess of $2,000 received in a calendar year is included in the income eligibility budget.
7. Payments for foster care of a child if the child:
   1. is not eligible for SSI; and
   2. was placed in the individual's home by a public or private, non-profit child-placement or child-care agency.
8. Benefits received under Title III, Public Law 100-175, which amends the Older Americans Act of 1965 to authorize appropriations for the fiscal years 1988-1991.
9. Value of benefits provided under the Child Nutrition Act of 1966.

There are also a number of legislatively-mandated exemptions that apply to members of recognized Native American tribes.

§48.2908. Indian-related Exemptions.

(a) Type of payment. The following statutes provide that certain types of payments made to members of Indian tribes are exempt from income and resources as specified in paragraphs (1)-(4) of this subsection, or only from income as specified in paragraph (5) of this subsection.

(1) Indian Judgment Funds Distribution Act — Public Law 93-134. Effective October 19, 1973, per capita distribution payments to members of Indian tribes who are due judgment funds, according to a plan of the Secretary of the Interior (or legislation, when a plan cannot be prepared or is not approved by the Congress) are exempted from income and resources. This does not include payments of funds distributed or held in trust (i.e., in the possession or care of a trustee) according to public laws enacted before October 19, 1973.

(2) Distribution of Indian Judgment Funds — Public Law 97-458. Effective January 12, 1983, Indian judgment funds held in trust (i.e., in the possession or care of a trustee) or distributed per capita, pursuant to an approved plan, or their availability, are exempted from income and resources. Indian judgment funds include interest and investment income accrued while the funds are held in trust. Initial purchases made with distributed judgment funds are exempted from resources.

(3) Per Capita Act — Public Law 98-64.

(A) Effective August 2, 1983, per capita distributions of all funds held in trust by the Secretary of the Interior to members of an Indian tribe are exempted from income and resources.

(B) Any local tribal funds that a tribe distributes to individuals on a per capita basis, but which have not been held in trust by the Secretary of the Interior (e.g., tribally managed gaming revenues) are not exempted from income and resources under this provision.

(4) Alaska Native Claims Settlement Act (ANCSA) — Public Law 100-241.

(A) Effective February 3, 1988, the following items received from a native corporation are exempted from income and resources:

(i) cash received from a native corporation (including cash dividends on stock received from a native corporation) to the extent it does not exceed $2,000, per individual per year;

(ii) stock (including stock issued or distributed by a native corporation as a dividend or distribution on stock);

(iii) a partnership interest;

(iv) land or an interest in land (including land or an interest in land received from a native corporation as a dividend or distribution on stock); and

(v) an interest in a settlement trust.

(B) The ANCSA also provides that up to $2,000 in retained distributions from a native corporation may be exempted from resources for each year beginning with 1988.

(5) Payments from Individual Interests in Trust or Restricted Lands — Public Law 103-66.

(A) Effective January 1, 1994, up to $2,000 per year received by Indians that is derived from individual interests in trust or restricted lands is exempted from income.

(B) Interests of individual Indians in trust or restricted lands are exempted from resources.

(b) Payments to specific Indian tribes and groups. The following statutes provide that certain payments made to members of specified Indian tribes and groups are exempt from income and resources.

(1) Distribution of Per Capita Funds — Public Law 85-794. Effective August 28, 1958, per capita payments to members of the Red Lake Band of Chippewa Indians from the proceeds of the sale of timber and lumber on the Red Lake Reservation are exempted from income and resources.

(2) Distribution of Judgment Funds — Public Law 92-254. Effective March 18, 1972, per capita distribution payments by the Blackfeet and Gros Ventre tribal governments to members, which resulted from judgment funds to the tribes, are exempted from income and resources.

(3) Distribution of Claims Settlement Funds — Public Law 93-531 and Public Law 96-305. Effective December 22, 1974, settlement fund payments to members of the Hopi and Navajo Tribes, and the availability of such funds, are exempted from income and resources.

(4) Receipts from Lands Held in Trust for Indian Tribes — Public Law 94-114.

(A) Effective October 17, 1975, receipts derived from the following trust lands and distributed to members of designated Indian tribes are exempted from income and resources.

(B) The first four Indian groups had lands conveyed with mineral rights prior to Public Law 94-114; that law conveyed the rest of the land to the remaining Indian groups.

(5) Distribution of Judgment Funds — Public Law 94-189. Effective December 31, 1975, judgment funds distributed per capita to, or held in trust for, members of the Sac and Fox Indian Nation, and the availability of such funds, are exempted from income and resources.

(6) Distribution of Judgment Funds — Public Law 94-540. Effective October 18, 1976, judgment funds distributed per capita to, or held in trust for, members of the Grand River Band of Ottawa Indians, and the availability of such funds, are exempted from income and resources.

(7) Distribution of Judgment Funds — Public Law 95-433. Effective October 10, 1978, any judgment funds distributed per capita to members of the Confederated Tribes and Bands of the Yakima Indian Nation or the Apache Tribe of the Mescalero Reservation are exempted from income and resources.

(8) Receipts from Lands Held in Trust — Public Law 95-498. Effective October 21, 1978, receipts derived from trust lands awarded to the Pueblo of Santa Ana and distributed to members of that tribe are exempted from income and resources.

(9) Receipts from Lands Held in Trust — Public Law 95-499. Effective October 21, 1978, receipts derived from trust lands awarded to the Pueblo of Zia and distributed to members of that tribe are exempted from income and resources.

(10) Distribution of Judgment Funds — Public Law 96-318. Effective August 1, 1980, any judgment funds distributed per capita or made available for programs for members of the Delaware Tribe of Indians and the absentee Delaware Tribe of Western Oklahoma are exempted from income and resources.

(11) Maine Indian Claims Settlement Act — Public Law 96-420. Effective October 10, 1980, all funds and distributions to members of the Passamaquoddy Tribe, the Penobscot Nation, and the Houlton Band of Maliseet Indians under the Maine Indian Claims Settlement Act, and the availability of such funds, are exempted from income and resources.

(12) Distribution of Judgment Funds — Public Law 97-95. Effective December 17, 1981, any distributions of judgment funds to members of the San Carlos Tribe of Arizona are exempted from income and resources.

(13) Distribution of Judgment Funds — Public Law 97-371. Effective December 20, 1982, any distributions of judgment funds to members of the Wyandot Tribe of Indians of Oklahoma are exempted from income and resources.

(14) Distribution of Judgment Funds — Public Law 97-372. Effective December 20, 1982, distributions of judgment funds to members of the Shawnee Tribe of Indians (Absentee Shawnee Tribe of Oklahoma, the Eastern Shawnee Tribe of Oklahoma, and the Cherokee Band of Shawnee descendants) are exempted from income and resources.

(15) Distribution of Judgment Funds — Public Law 97-376. Effective December 21, 1982, judgment funds distributed per capita or made available for programs for members of the Miami Tribe of Oklahoma and the Miami Indians of Indiana are exempted from income and resources.

(16) Distribution of Judgment Funds — Public Law 97-402. Effective December 31, 1982, distributions of judgment funds to members of the Clallam Tribe of Indians of the State of Washington (Port Gamble Indian Community, Lower Elwha Tribal Community, and the Jamestown Band of Clallam Indians) are exempted from income and resources.

(17) Distribution of Judgment of Funds — Public Law 97-403. Effective December 31, 1982, judgment funds distributed per capita or made available for programs for members of the Pembina Chippewa Indians (Turtle Mountain Band, Chippewa Cree Tribe, Minnesota Chippewa Tribe, and Little Shell Band of Chippewa Indians of Montana) are exempted from income and resources.

(18) Distribution of Judgment Funds — Public Law 97-408. Effective January 3, 1983, per capita distributions of judgment funds to members of the Gros Ventre and Assiniboine Tribes of Fort Belknap Indian Community, and the Papago Tribe of Arizona, are exempted from income and resources.

(19) Distribution of Judgment Funds — Public Law 97-436. Effective January 8, 1983, up to $2,000 of per capita distributions of judgment funds to members of the Confederated Tribes of the Warm Springs Reservation are exempted from income and resources.

(20) Distribution of Judgment Funds — Public Law 98-123. Effective October 13, 1983, judgment funds distributed to the Red Lake Band of Chippewa Indians are exempted from income and resources.

(21) Distribution of Judgment Funds — Public Law 98-124. Effective October 13, 1983, funds distributed per capita or family interest payments for members of the Assiniboine Tribe of the Fort Belknap Indian Community of Montana and the Assiniboine Tribe of the Fort Peck Indian Reservation of Montana are exempted from income and resources.

(22) Distribution of Claims Settlement Funds — Public Law 98-432. Effective September 28, 1984, judgment funds and income therefrom distributed to members of the Shoalwater Bay Indian Tribe are exempted from income and resources.

(23) Distribution of Claims Settlement Funds — Public Law 98-500. Effective October 19, 1984, all distributions to heirs of certain deceased Indians under the Old Age Assistance Claims Settlement Act are exempted from income and resources.

(24) Distribution of Judgment Funds — Public Law 98-602. Effective October 30, 1984, judgment funds distributed per capita or made available for any tribal program, for members of the Wyandotte Tribe of Oklahoma and the Absentee Wyandottes, are exempted from income and resources.

(25) Distribution of Judgment Funds — Public Law 99-130. Effective October 28, 1985, per capita and dividend payment distributions of judgment funds to members of the Santee Sioux Tribe of Nebraska, the Flandreau Santee Sioux Tribe, and the Prairie Island Sioux, Lower Sioux, and Shakopee Mdewakanton Sioux Communities of Minnesota are exempted from income and resources.

(26) Distribution of Judgment funds — Public Law 99-146. Effective November 11, 1985, funds distributed per capita or held in trust for members of the Chippewas of Lake Superior and the Chippewas of the Mississippi are exempted from income and resources.

(27) Distribution of Claims Settlement Funds — Public Law 99-264. Effective March 24, 1986, distributions of claims settlement funds to members of the White Earth Band of Chippewa Indians as allottees, or their heirs, are exempted from income and resources.

(28) Distribution of Judgment Funds — Public Law 99-346. Effective June 30, 1986, payments or distributions of judgment funds, and the availability of any amount for such payments or distributions, to members of the Saginaw Chippewa Indian Tribe of Michigan are exempted from income and resources.

(29) Distribution of Judgment Funds — Public Law 99-377. Effective August 8, 1986, judgment funds distributed per capita or held in trust for members of the Chippewas of Lake Superior and the Chippewas of the Mississippi are exempted from income and resources.

(30) Distribution of Judgment Funds — Public Law 100-139. Effective October 26, 1987, judgment funds distributed to members of the Cow Creek Band of Umpqua Tribe of Indians are exempted from income and resources.

(31) Aleutian and Pribilof Islands Restitution Act — Public Law 100-383. Effective August 10, 1988, per capita restitution payments made to eligible Aleuts who were relocated or interned during World War II are exempted from income and resources.

(32) Distribution of Claims Settlement Funds — Public Law 100-411. Effective August 22, 1988, per capita payments of claims settlement funds to members of the Coushatta Tribe of are exempted from income and resources.

(33) Hoopa-Yurok Settlement Act — Public Law 100-580. Effective October 31, 1988, funds distributed per capita for members of the Hoopa Valley Indian Tribe and the Yurok Indian Tribe are exempted from income and resources.

(34) Distribution of Judgment Funds — Public Law 100-581. Effective November 1, 1988, judgment funds held in trust by the United States, including interest and investment income accruing on such funds, and judgment funds made available for programs or distributed to members of the Wisconsin Band of Potawatomi (Hannahville Indians Community and Forest County Potawatomi) are exempted from income and resources.

(35) Distribution of Money and Land — Public Law 101-41. Effective June 21, 1989, all funds, assets, and income from the trust fund transferred to the members of the Puyallup Tribe under the Puyallup Tribe of Indians Settlement Act of 1989 are exempted from income and resources.

(36) Distribution of Judgment Funds — Public Law 101-277. Effective April 30, 1990, judgment funds distributed per capita, or held in trust, or made available for programs, for members of the Seminole Nation of Oklahoma, the Seminole Tribe of Florida, the Miccosukee Tribe of Indians of Florida, and the independent Seminole Indians of Florida, (plus any interest and investment income accruing on the funds held in trust), and the availability of those funds, are exempted from income and resources.

(37) Distribution of Settlement Funds — Public Law 101-503. Effective November 3, 1990, payments, funds, distributions, or income derived from them under the Seneca Nation Settlement Act of 1990 are exempted from income and resources.

(38) Distribution of Settlement Funds — Public Law 101-618. Effective November 16, 1990, per capita distributions of settlement funds under the Fallon Paiute Shoshone Indian Tribes Water Rights Settlement Act of 1990 are exempted from income and resources.

(39) Distribution of Settlement Funds — Public Law 103-116. Settlement funds, assets, income, payments or distributions from trust funds to members of the Catawba Indian Tribe under the Catawba Indian Tribe of South Carolina Land Claims Settlement Act of 1993 are exempted from income and resources.

(40) Distribution of Settlement Funds — Public Law 103-436. Effective November 2, 1994, settlement funds held in trust, including interest and investment income accruing on such funds, and payments made to members of the Confederated Tribes of the Colville Reservation under the Confederated Tribes of the Colville Reservation Grand Coulee Dam Settlement Act are exempted from income and resources.

If the total resources are not within $100 of the eligibility limit, no additional documentation is required in order for payments and benefits to be excluded from resources. If total resources are within $100 of the eligibility limit, then additional verification documentation of the funds is required in order for the payments and benefits to be excluded.

Revision 25-4; Effective Sept. 1, 2025

The information on the Consumer Directed Services webpage helps consumers compare available service delivery option features.

Revision 17-1; Effective March 15, 2017

Since Sept. 1, 2007, Primary Home Care (PHC) has not been available for individuals under 21 years of age with full Medicaid benefits. Individuals requiring personal attendant services receive benefits through the Texas Health and Human Services Commission (HHSC) Personal Care Services (PCS).

Referring Requests for PCS Services

Any requests for services for Medicaid eligible individuals under age 21 must be referred to the appropriate Texas Department of State Health Services (DSHS) PCS regional office. A current list of regional offices and contact information follows.

For non-Medicaid eligible individuals under age 21:

• refer to the Social Security Administration to apply for Supplemental Security Income (SSI), if the individual has not previously applied; and
• begin the application process for Community Attendant Services (CAS) as outlined in the Community Care for Aged and Disabled Handbook, 2332, Requests for Services from Individuals Under Age 21.

If the individual subsequently becomes eligible for Medicaid, he must be referred to PCS and CAS services must be terminated.

Requests for Services from Individuals Turning 21 Years of Age

Individuals who will be turning 21 years of age within two months of the initial request for services should be given a choice to apply for either PCS or PHC services. If the individual chooses to apply for PCS, explain that two assessments will be required; one for PCS and one for PHC. If the individual decides to apply for PHC, begin the application process. All PHC policy and procedures apply. If eligible, services may begin as soon as the applicant is 21 years of age and certified for services.

PCS Eligible Individuals Turning 21 Years of Age

For individuals already receiving PCS who are interested in PHC, the regional PCS case worker will encourage the individual/family to contact the HHSC at least two months before the individual’s 21st birthday. Since there are differences in PCS and PHC services, the HHSC case worker will thoroughly explain the allowable PHC services at the time of the initial PHC assessment. PHC may not offer some of the services provided through the PCS program.

The applicant must meet all PHC eligibility criteria, including medical, functional and unmet need. If the applicant is eligible, PHC services are negotiated to begin on the individual’s 21st birthday. PCS services should end at midnight on the day before the individual’s birthday. Coordinate the transition with the PCS case worker and applicant to ensure there are no gaps in services.

DSHS PCS Regional Office Contact Numbers

Revision 18-1; Effective June 15, 2018 

Comparison charts for the Texas Long-term Services and Supports (LTSS) programs.

Revision 18-1; Effective June 15, 2018

Community Care Services Eligibility (CCSE) asked each region to designate a complex needs coordinator. This appendix provides a description of the role and expectations of the designated complex needs coordinator.

While there are other situations which require the expertise of the coordinator, the primary responsibilities are in the coordination of high needs individuals transitioning from children's programs to adult programs. Due to the complexity of some of these situations, the skills of the complex needs coordinator are necessary.

Outlined below are the duties of the complex needs coordinator. Regional directors may assign additional staff to assist with these duties, but the designated coordinator will be the point of contact for issues and questions.

Quarterly Comprehensive Care Program (CCP) Transition Report

The designated complex needs coordinator is responsible for:

• completing the quarterly CCP Transition Report for the region and submitting it back to the state office Special Initiatives coordinator by the designated due date. The report includes all transitioning individuals, including Personal Care Services (PCS) to Primary Home Care (PHC) applicants;
• being the point of contact for any questions on the quarterly CCP Transition Report;
• ensuring the 12-month visit and contacts are made and reporting back to the state office CCSE contact any individuals who may potentially be over the cost limit based on current services;
• identifying the high needs individuals and ensuring all aging out assessments are started on time and remain on track; and
• submitting frequent progress reports to the state office CCSE contact on the individuals who have been identified as high needs.

Identification and Tracking of High Needs Aging Out Individuals

The complex needs coordinator is responsible for:

• identifying the aging out individuals who may be close to the cost limit or have other issues that may complicate the development of an acceptable individual service plan (ISP);
• coordinating the regional interdisciplinary team (IDT) meetings, as needed;
• being the regional contact person for state office staff for questions on pending applications or ongoing individuals with high needs;
• requesting and participating in the state office IDT, including assuring the chronology and other required documentation are submitted; and
• assisting with collecting and submitting the required medical and service documentation if a physician's clinical visit is required for the Rider 36 General Revenue (GR) process.

Providing Assistance and Overview of High Needs Assessments

The complex needs coordinator is responsible for:

• working with the assigned case worker and other regional staff on all high needs assessments;
• reviewing the draft ISP packet to check for the following;
  • Are the Medical Necessity/Level of Care (MN/LOC) and Resource Utilization Group (RUG) levels set correctly? Is the individual a ventilator patient and if so, is the RUG coded correctly for the 6 to 23-hour or 24-hour vent care?
  • Are the nursing hours calculated correctly? Are the registered nurse (RN) required hours included? Has the type of nursing (specialized or non-specialized) been discussed and set up correctly?
  • Do the nursing hours reflect the informal support hours the family has agreed to, and is this information reflected the same on Form 8598, Non-Waiver Services? Is the family in agreement with the plan and is Form 8598 signed in agreement with the overall plan?
• assisting regional staff in working with provider agencies and contract management to assure a cost effective ISP is developed that assures health and safety and is ready to be implemented on the age out date; and
• working with state office staff if the Rider 36 process is initiated.

Regional Complex Needs Coordinators Procedures for Individuals in the STAR+PLUS Program

The role of the complex needs coordinator is different in STAR+PLUS areas due to the differences in STAR+PLUS procedures. Listed below are the complex needs coordinator's responsibilities for individuals in STAR+PLUS.

Quarterly CCP Transition Report

The designated complex needs coordinator is responsible for:

• completing the quarterly CCP Transition Report for the region and submitting it back to the state office Special initiatives coordinator by the designated due date;
• being the point of contact for any questions on the quarterly CCP Transition Report; and
• ensuring all STAR+PLUS Home and Community Based Services (HCBS) aging out referrals (Form H3676, Managed Care Pre-Enrollment Home Health Assessment Authorization) are sent on time.

Identification and Tracking of High Needs Aging Out Individuals

The complex needs coordinator will be responsible for coordinating with the STAR+PLUS Support Unit (SPSU) supervisor for:

• identifying the aging out individuals who may be close to the cost limit or have other issues that may complicate the development of an acceptable ISP and reporting this information to HHSC-MCO and state office staff;
• being the regional contact person for state office and HHSC-MCO staff for questions on pending applications or ongoing individuals with high needs;
• assisting with collecting and submitting the required medical and service documentation for an IDT or for when a physician's clinical visit is required for the Rider 36 GR process;
• working with HHSC-MCO and state office staff if the Rider 36 process is initiated.

Revision 21-3; Effective September 1, 2021

Revision 17-1 Effective  March 15, 2017

As described in 2223, Caregiver Support Assessment Initiative, below are the forms for completing the caregiver support assessment.

• Form 1027, Caregiver Status Questionnaire, and Instructions (English PDF),
• Form 1027-S, Caregiver Status Questionnaire, and Instructions (Spanish PDF)

For assistance in completing the questionnaire, staff may use the Caregiver Status Questionnaire Script, provided in both English and Spanish.

• Attachment One, Caregiver Status Questionnaire Script (English PDF)
• Attachment Two, Caregiver Status Questionnaire Script (Spanish PDF)