1300, CLASS Program Eligibility

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Revision 25-1; Effective Sept. 1, 2025

HHSC approves eligibility for the CLASS program for applicants and people with related conditions who meet all of the following eligibility requirements.

  • The person is financially eligible for Medicaid because the person receives Supplemental Security Income (SSI) cash benefits or HHSC determines the person to be financially eligible for Medicaid.
  • HHSC determines the person meets the diagnostic or functional eligibility criteria for the CLASS program — Intermediate Care Facility for Persons with Intellectual Disability (ICF/ID) Level of Care VIII criteria.
  • The person has been diagnosed before 22 with a related condition as described in the Texas Approved Diagnostic Codes for Persons with Related Conditions.
  • The person has a qualifying adaptive behavior level of II, III or IV such as moderate to extreme deficits in adaptive behavior obtained by administering the Inventory for Client and Agency Planning (ICAP), Vineland Adaptive Behavior Scales, Second Edition (Vineland-II), Scales of Independent Behavior – Revised (SIB-R), or American Association of Intellectual and Developmental Disabilities (AAIDD) Adaptive Behavior Scales (ABS).
  • The person exhibits a substantial functional limitation in at least three of the following areas of major life activities as documented on the Related Conditions Eligibility Screening Instrument:
    • learning;
    • mobility;
    • self-care;
    • language;
    • self-direction (10 and over); and
    • independent living (10 and over).
  • The person demonstrates a need for Community First Choice (CFC) PAS/HAB.
  • The person requires and receives at least one CLASS Program service per month, and one CLASS service per year (monthly monitoring of services by a case manager meets this requirement).
  • The person has an Individual Plan of Care (IPC) cost for CLASS program services at or below $149,774. Note: As provided in Section 259.51, 210 percent of the annualized cost of care in an Intermediate Care Facility for Individuals with an Intellectual Disability or Related Condition (ICF/IID) using the unweighted average of the current non-state operated small facility daily rates for Levels of Need (LONs) 1, 5, and 8, rounded to the nearest dollar, as of Sept. 1, 2025.
  • The person is not enrolled in another Medicaid waiver program.
  • The person resides in his or her own home or family home.