Effective Date
Instructions
Updated: 9/2025
Purpose
Home and Community-based Services (HCS) or Texas Home Living (TxHmL) applicants, enrolled people and legally authorized representatives (LARs) will acknowledge an understanding of the waiver program eligibility and services for HCS, TxHmL or Community First Choice (CFC) services after receipt and an explanation of Form 8511 from their service coordinators.
Procedure
The service coordinator completes Form 8511 after an applicant or person has been offered a waiver slot from the HCS or TxHmL interest list, and annually thereafter. The service coordinator must provide an oral and written explanation of Form 8511 to the HCS or TxHmL applicant, enrolled person or LAR. The service coordinator can also provide the applicant or person the HCS Program brochure in English PDF or Spanish (PDF); or the TxHmL Program brochure in English (PDF) or Spanish (PDF).
Detail Instructions
Program Type — Check the box for HCS or TxHmL.
Person’s or Applicant’s Name — Enter the name of the person or applicant.
Medicaid No. — Enter the person’s or applicant’s Medicaid number, if applicable.
CARE ID — Enter the person’s or applicant’s Client Assignment and Registration (CARE) system identification number.
Section 1 — Eligibility for the HCS or TxHmL Program
The person who completes and signs this document initials the bottom of this section. If an LAR does not sign, a family member, if possible, initials next to the person’s or applicant’s initials.
The service coordinator must make sure the person, applicant or LAR acknowledges their understanding of program eligibility for the HCS or the TxHmL program by guiding the person, applicant or LAR to initial at the end of Section A.
Section 2 — Eligibility for Receiving CFC Services in the HCS or TxHmL Program
The person who completes this form initials the bottom of this section and signs this document. If an LAR does not sign, a family member, if possible, initials next to the person’s or applicant’s initials.
The service coordinator must make sure the person, applicant or LAR acknowledges their understanding of eligibility for CFC services in the HCS or TxHmL program by guiding the person, applicant or LAR to initial at the end of Section B.
Section 3 — Services Available in the HCS and TxHmL Programs
The person who completes this form initials the bottom of this section and signs this document. If an LAR does not sign, a family member, if possible, initials next to the person initials.
The service coordinator must make sure the person or LAR acknowledges their understanding of services available in the HCS and TxHmL programs by guiding the person or LAR to initial at the end of Section C.
Section 4 — Suspension of Services
The person who completes this form initials the bottom of this section and signs this document. If an LAR does not sign, a family member, if possible, initials next to the person’s initials.
The service coordinator must make sure the person or LAR acknowledges their understanding of suspension of services by guiding the person or LAR to initial at the end of Section D.
Section 5 — Termination of Services
The person who completes this form initials the bottom of this section and signs this document. If an LAR does not sign, a family member, if possible, initials next to the person’s initials.
The service coordinator must make sure the person or LAR acknowledges their understanding of termination of services by guiding the person or LAR to initial at the end of Section E.
Person, Applicant or LAR Printed Name, Signature and Date — The applicant, person or LAR must print, sign and enter the date they received Form 8511 from the service coordinator. By signing, the person, applicant or LAR acknowledges they have been provided an oral and written explanation of the eligibility criteria documented on this form.
Note: If the person or applicant requests added explanation of any portion of Form 8511, the service coordinator provides further explanation of the requested information until the applicant, person or LAR fully understands all sections of Form 8511.
Family Member Signature if LAR is not signing and Date — The family member signs and enters the date they received Form 8511 from the service coordinator.