4400, Family Care Services

Body

4410 Family Care

Revision 25-2; Effective March 31, 2025

Family Care (FC) provides in-home Personal Attendant Services (PAS) to people eligible under Title XX of the Federal Social Security Act relating to block grants to states for social services. Providers delivering PAS must meet all the requirements in Title 26 Texas Administrative Code Section 277.11, Contracting Requirements.

Review 4600, Primary Home Care and Community Attendant Services, for information on the Title XIX programs.

4411 Family Care Services Description

Revision 25-2; Effective March 31, 2025

Family Care (FC) provides help with activities of daily living to eligible people with functional limitations caused by age, disabilities or medical problems. Services are limited to 50 hours per week and 42 hours per week for a priority person. Services include help with personal care, household tasks, meal preparation and escort.

FC is a non-skilled, non-technical service delivered by an attendant employed by the provider. The attendant must be 18 or older. Providers must comply with the requirements in the contract with the Texas Health and Human Services Commission and in the Contracting to Provide Primary Home Care Services Handbook.

4412 Allowable Tasks

Revision 25-4; Effective Sept. 1, 2025

Personal attendant services (PAS) that may be delivered under Family Care (FC) include the tasks defined in 26 Texas Administrative Code (TAC) Section 277.41, Allowable Tasks.

For information on escort services, refer to 26 TAC Section 271.83(a) and (b), Time Allocation for Escort Services.

Refer to the examples given in 4621, Allowable Tasks, for more information on calculating time for escort. Escort may include accompanying the person on non-medical trips such as the grocery store, paying bills, pharmacy, hair stylist or barber, or social events. The time used to provide the escort task must not exceed the total time purchased for attendant care. No additional time for escort is allocated to the person’s service plan. The person may elect to receive escort in place of help with household or personal care on a day that best meets their needs. This service does not include the direct transportation of the person by the attendant.

Because shopping is an authorized task, it may entail the provider paying mileage to the attendant to perform the task. The person cannot be charged for transportation costs incurred when this task is performed by either the attendant or the provider.

Arranging furniture may be provided to improve mobility for people who use wheelchairs, walkers or crutches, or for blind people. The provider supervisor addresses this activity during orientation for an attendant who provides services to this type of person.

Refer to pages three and four of Form 2060, Needs Assessment Questionnaire, Task and Hour Guide, for more definition of activities that may be provided within each task.

4413 Excluded Services

Revision 25-3; Effective June 1, 2025

Family Care (FC) does not include services that must be provided by a person with professional or technical training. Examples include but are not limited to the following:

  • insertion and irrigation of catheters;
  • irrigation of body cavities;
  • application of sterile dressings involving prescription medications and aseptic techniques;
  • tube feedings;
  • injections;
  • administration of medication; and
  • any other skilled or technical services identified by the department.

Services that maintain an entire family or household are also excluded unless the entire household receives Community Care Services Eligibility services. Examples include:

  • cleaning floor and furniture in areas that the person does not occupy or use;
  • preparing meals for the entire family or household;
  • laundering clothing or bedding that the person does not use; and
  • shopping for groceries or household items the person does not need for health and maintenance.

An attendant may shop for items the person needs and that the rest of the household also uses.

4420 Eligibility

Revision 26-1; Effective March 1, 2026

To be eligible for family care, the applicant or person must:

  • meet the income and resource guidelines established by the Texas Health and Human Services Commission (HHSC) in 26 Texas Administrative Code Sections 271.53, 271.55, 271.89, 271.91 relating to Income and Income Eligibles, Determination of Countable Income, Resource Limits and Countable Resources;
  • meet the minimum functional need criteria set by HHSC:
    • HHSC uses a standardized assessment instrument to measure the person’s ability to perform activities of daily living;
    • this yields a score, which is a measure of the person’s level of functional need;
    • HHSC sets the minimum required score for a person to be eligible, which it may periodically adjust commensurate with available funding;
    • HHSC will seek stakeholder input before making any change in the minimum required score for functional eligibility; and
  • be ineligible to receive attendant care services funded through Medicaid.

The applicant or person must require at least six hours of family care per week to be eligible, unless the applicant or person:

  • requires family care to provide caregiver support;
  • lives in the same household as another person receiving family care, community attendant services or primary home care;
  • receives one or more of the following services through HHSC or other resources:
    • congregate or home-delivered meals;
    • help with activities of daily living from a home health aide;
    • day activity and health services; or
    • special services to persons with disabilities in adult day care;
  • receives aids-and-attendance benefits from the Veterans Administration; or
  • is determined, based on the functional assessment, to be at high risk of institutionalization without family care.

Review the following for eligibility policy not contained in this section:

4421 Residence

Revision 25-4; Effective Sept. 1, 2025

To receive services, the person must live in a place other than:

  • a hospital;
  • a skilled nursing facility;
  • an intermediate care facility;
  • an assisted living facility;
  • a foster care setting;
  • a jail or prison;
  • a state school;
  • a state hospital; or
  • any other setting where sources outside the primary home care program are available to provide personal care.

Family Care (FC) cannot be authorized if the person lives in a home licensed as a personal care home by the Texas Department of State Health Services. If the home is not a licensed personal care home, services may be authorized if:

  • three or fewer people live in the home. The proprietor can be the personal attendant services (PAS) attendant for the people who live there. The person may not receive both PAS and Adult Foster Care.
  • the home provides only room and board to four or more people living in the home, it does not require licensure as a personal care home. PAS services can be authorized for people in this setting, but the proprietor, their agent or employee cannot be the attendant for people who live in the home. The caseworker must specify this on Form 2101, Authorization for Community Care Services.

FC can be provided to a private pay applicant or person living in a residential care facility if contracted with HHSC or not, under the following conditions.

  • The caseworker applies the unmet need policy on a task-by-task basis, not duplicating services.
  • Facilities provide varying degrees of assistance, and tasks purchased should not be tasks provided by the facility.
  • The caseworker must closely monitor the case to find out if the person is receiving other services from the facility. Service plans must be adjusted to avoid duplication of services or tasks.

If the person begins receiving residential care (RC) through HHSC, FC is terminated effective by the date RC services are started.

Related Policy

26 Texas Administrative Code Section 271.81(b)  

4430 Caseworker Procedures for Determining Eligibility

Revision 25-3; Effective June 1, 2025

Review 2200, Intake Procedures, for intake, screening criteria and interest list procedures.

Upon receipt of a Family Care intake or release from the interest list, the caseworker makes a home visit within the required time frames to begin the application process.

Conduct a home visit to determine if the person meets eligibility criteria outlined in 4420, Eligibility. The applicant must provide information to determine financial eligibility outlined in 3000, Eligibility for Services, and must be screened for eligibility for Community Attendant Services (CAS).

Give the following to all applicants:

Explain that the caseworker must approve increases in the number of hours of services the person receives. Also inform the person that they may select another provider if they are dissatisfied with the services or with the attendant providing the services.

4431 Family Care Financial Eligibility

Revision 25-4; Effective Sept. 1, 2025

To be eligible for family care, the person must:

The caseworker must determine that an applicant for Family Care is not eligible for services through Primary Home Care (PHC) or Community Attendant Services (CAS). Review 2340, The Initial Interview and Application Process, for information on the determination of financial eligibility and screening for eligibility for CAS.

Review 3000, Eligibility for Services, and Appendix XII, Examples of Methods to Verify Income and Resources, for specific information on determining financial eligibility.

4432 Family Care Functional Eligibility

Revision 25-4; Effective Sept. 1, 2025

Regardless of a person’s functional eligibility as determined by their score on the client needs assessment questionnaire, a person only receives CCSE services if there is an unmet need for those services.

Applicants and people must score at least 24 on Form 2060, Needs Assessment Questionnaire, Task and Hour Guide, to be eligible for Family Care.

Review 2400, Assessment Process, 2500, Service Planning, and 2600, Authorizing and Reassessing Services, for caseworker procedures for full determination of functional eligibility and unmet need determination.

Related Policy

26 Texas Administrative Code Section 271.61
26 Texas Administrative Code Section 271.69  

4433 Time Frames

Revision 25-4; Effective Sept. 1, 2025

Eligibility for CCSE services for income-eligible applicants is determined within 30 calendar days after a signed application is received.

The caseworker must complete all eligibility determination within 30 calendar days from the assessment date and send the applicant Form 2065-A, Notification of Community Care Services, within two business days of the eligibility decision.

Related Policy

26 Texas Administrative Code Section 271.151(d) 

4440 Referral Process

Revision 21-4; Effective December 1, 2021

After completing the assessment, send the selected provider a referral packet.

The referral packet must include:

All Form 2101 referrals to the provider, both initial and ongoing, must include the:

  • authorized tasks;
  • total number of authorized hours;
  • number of days the applicant or recipient requests delivery of services; and
  • relationship and name of any person designated as ‘do not hire.’

Document any of the following information in the comments section of the Form 2101:

  • any special needs of the applicant or recipient that require a specific schedule and the reason;

    Example: “<Name of person> is diabetic and requires a specific eating schedule.” or “<Name of person> requires service delivery in the afternoon due to a sleeping condition.”
     
  • the number of service days requested by the applicant or recipient based on the Form 2060;

    Example: "<Name of person> requests a five-day plan."
     
  • the relationship and name of any person(s) designated as ‘do not hire;’

    Example: “Do not hire <spouse>, <name of spouse>, for any tasks.” or “Do not hire <daughter>, <name of daughter>, for shopping.”

Related Policy

Who Cannot Be Hired as the Paid Attendant, 2514
Referrals to the Provider, 2630
Content of Referral Packets, Appendix XIII

4440.1 Types of Referrals

Revision 25-3; Effective June 1, 2025

There are two methods of referral:

Routine Referrals

Within five business days of the eligibility decision, the caseworker mails the referral packet to the provider to authorize service delivery.

Expedited Referrals

Sometimes the person's need for services must have facilitated delivery of services. This is based on the caseworker's judgment. When weighing if an expedited referral is warranted, consider:

  • What was the person's assigned intake priority? In most situations, cases which required an expedited response to a request for services also require an expedited referral.
  • Is the applicant being authorized as having priority status? If so, that may indicate a need for an expedited referral.
  • Could a delay in starting services constitute a threat to the person's health, safety or well-being? If so, an expedited referral is needed.

The expedited referral process includes:

  • the caseworker makes a verbal referral to the selected provider and negotiates a start of care date which must be less than 14 calendar days once the eligibility decision is made; and
  • following up the verbal referral by sending a referral packet to the provider, including Form 2101, Authorization for Community Care Services, noting the time, date and staff person contacted, and the negotiated start date in the comments section.

4441 Provider Responsibilities after Receipt of Referral

Revision 25-4; Effective Sept. 1, 2025

Upon receipt of the referral packet, the provider must conduct pre-initiation activities, develop a service plan and assign an attendant to perform services for the individual in accordance with 26 Texas Administrative Code (TAC) Section 277.45. These activities must be completed within 14 days after one of the following dates, whichever is later:

For expedited referrals, the provider must document the date, time and the name of the caseworker who gives the verbal authorization. Provider staff contact the caseworker if the packet is not in their office by the seventh day after the verbal referral.

The provider can request a corrected authorization if the information, such as hours or dates of coverage, conflicts with what was given over the phone. In these situations, correct and initial Form 2101 and mail a copy of it to the provider.

Within 14 days after initiating services, the provider must send notice of service initiation to the caseworker. The provider may, but is not required, to use Form 2101 to notify the caseworker of service initiation.

4441.1 Delay of Service Initiation

Revision 25-4; Effective Sept. 1, 2025

26 Texas Administrative Code Section 277.61 Service Initiation.

A provider may delay the start of service only if the reason is not directly caused by the provider or is beyond the provider’s control, such as natural or other disasters. The provider must continue efforts to begin services and set a date, if possible, for service initiation. The provider must document any failure to begin services by the relevant due date, including:

  • the reason for the delay, which must be beyond the provider's control;
  • either the date the provider thinks they will initiate services or specific reasons the provider cannot anticipate a service initiation date; and
  • a description of the provider's ongoing efforts to begin services.

The provider must maintain documentation of service initiation in the person's file.

4441.2 Initial Service Delivery Plan Variances

Revision 25-4; Effective Sept. 1, 2025

Providers must follow the rules as specified in 26 Texas Administrative Code Section 277.45(b), Pre-Initiation Activities.

4442 Resolution of Service Plan Disagreement

Revision 25-3; Effective June 1, 2025

If a disagreement exists about the appropriateness of a referral or about service delivery issues involving the person, the caseworker and the provider staff attempt to resolve the disagreement. If the disagreement is not resolved at this level, supervisory staff of the two agencies attempt to resolve it. If supervisory staff of both agencies cannot resolve a disagreement, the regional director or designee resolves it. Do not delay service initiation because of a disagreement. The regional nurse may always be consulted about health and safety issues or the appropriateness of the service plan.

4443 Change of Providers

Revision 25-3; Effective June 1, 2025

Monitor the person after services are initiated and at times after that to check on the adequacy of the service plan, the quality-of-service delivery and the person's condition. Report to the unit supervisor any apparent deficiencies in the provider's delivery of Family Care (FC) services.

When a person plans to change providers, they must first contact their caseworker, who will:

  • coordinate the transfer to prevent a gap in coverage; and
  • try to resolve any problems the person may have with their current provider before processing the transfer.

Within 14 calendar days of notification that an ongoing FC person is requesting a transfer to another provider, the caseworker contacts the person and the provider to determine:

  • the person's reason for dissatisfaction; and
  • if the person's satisfaction can happen without changing providers.

The caseworker may decide that an interdisciplinary team (IDT) meeting is fitting to discuss and find a solution to the service delivery issues. Review 4675, Interdisciplinary Team, for more information. The caseworker may terminate the person’s services for refusal to comply with the service delivery provisions. This would be because the person, more than three times repeatedly directly, or knowingly and passively, condoning the behavior of someone in their home.

The caseworker authorizes the transfer within three business days of the IDT decision if:

  • they determine that the person’s satisfaction cannot be met without the person changing providers and services do not have to be terminated based on failure to comply with the service plan; or
  • the person insists on transferring to another provider and the caseworker determines that services do not have to be terminated based on failure to comply the service plan.

Within those three business days, the caseworker also:

  • asks the person or the person’s representative to select a new provider and documents the person’s choice by:
  • sends the new provider the updated Form 2101 and Form 2059; and

sends the current provider a copy of the updated Form 2101 that includes the effective date the person changes to the new provider.

4443.1 Service Interruptions

Revision 25-4; Effective Sept. 1, 2025

Refer to 26 Texas Administrative Code (TAC) Section 277.63(a), Service interruptions.

A service interruption occurs anytime service delivery is discontinued for 14 days or more for a reason that is not covered in 4446, Suspension of Services and Interdisciplinary Team (IDT) Procedures. The provider should make every effort to make sure interruptions in service last less than 14 days, particularly if a break in service would jeopardize the person’s health or safety. When an interruption of services is unavoidable, the provider must document all service interruptions by the 30th day:

  • after the beginning of the service interruption for priority people, and
  • that exceeds 14 days after the service interruption for non-priority individuals.

4444 Reporting Significant Changes

Revision 25-3; Effective June 1, 2025

The provider notifies the caseworker or the caseworker's office by phone or in person about a change in the person's condition or circumstances that may require a service plan change or service termination.

The provider must notify the caseworker by the first Texas Health and Human Services Commission one business day after provider staff notice the change. They must follow up in writing, using Form 2067, Case Information, within seven calendar days after verbal notification.

Any of the following changes in the person's condition or circumstances may require a change in their service plan. These are examples only. This list is not all inclusive.

  • the person’s health improves or deteriorates;
  • the person no longer needs services;
  • the person is discharged from a hospital;
  • problems exist with family relationships;
  • the person is evicted or otherwise loses their housing;
  • the person relocates;
  • the person is referred for home health services; and
  • changes occur in the person's household composition.

If the caseworker receives a request for a change, respond to it within 14 calendar days from the date the request is received. Review the person's service plan to decide if the change is necessary. If the caseworker decides the change is not necessary, document the decision on Form 2067, send it to the provider and send Form 2065-A, Notification of Community Care Services to the person. Document the reason and related handbook reference for the denial of the requested change in Form 2065-A comments section.

A new assessment or revision of the service plan such as a change in priority status or a need for more hours may be necessary, depending on the person's new condition or situation. If appropriate, make changes to the service plan on Form 2101, Authorization for Community Care Services, per 2720, Changes Reported in the Individual's Condition or Status during the Certification Period. Consult with the supervisor about the requested change, if necessary. If the report meets the criteria for Adult Protective Services (APS), refer the individual to that service. Review 2220, Response to Requests for Service.

Related policy

Title I, Texas Administrative Code, Part 15, Chapter 357, Subchapter A
2910, Person’s Right to Appeal and Request a Fair Hearing

4445 Service Plan Changes

Revision 25-3; Effective June 1, 2025

Mail two copies of Form 2101, Authorization for Community Care Services, and one copy of Form 2059, Summary of Client's Need for Service, to the provider if a service plan change is authorized. If a service plan change increases hours, the beginning date of coverage is seven calendar days from the Form 2101 date, unless an earlier date is negotiated. Use verbal referral procedures for new priority recipients if a service plan change adds priority status.

For a service decrease or termination, the provider must abide by Community Care Services Eligibility (CCSE) staff's 12 calendar days prior notice provided to the recipient before implementing the change. CCSE staff must advise the provider using the comments section on Form 2101, if applicable, not to implement an adverse action until after the 12-calendar day notice. The recipient may appeal the decision and choose to continue to receive services pending the outcome of the appeal. These time frames apply only to those cases when the provider has a current authorization for the recipient.

When the recipient requires an immediate change to the service plan, approve the change by phone or in person. Respond by the next business day when any of the following situations occur:

  • The recipient has a major illness and no available caregiver.
  • The recipient loses their caregiver suddenly, has no other available caregiver, and
    • is totally bedridden or unable to transfer from bed to chair without help;
    • cannot manage toileting tasks without personal assistance; or
    • needs meal preparation or feeding to ensure that they receive daily nourishment.

If necessary:

Related Policy

Priority Status, 2540
Negotiated Referrals, 2631
Time Calculation, Appendix XVIII

4446 Suspension of Services and Interdisciplinary Team (IDT) Procedures

Revision 25-3; Effective June 1, 2025

The provider agency must suspend services if:

  • the person permanently leaves the state or moves to a county where the provider agency does not contract with the Texas Health and Human Services Commission (HHSC) to provide services under the Primary Home Care Program. Review 4677.1, Person Temporarily Leaving Service Area;
  • the person moves to a location where services cannot be provided under the Primary Home Care Program; or
  • the person dies;

Note: Complete and send Form SSA-1610-U2, Public Assistance Agency Information Request when notified of an active SSI or Medicaid person's death, to report the death of the person to the Social Security Administration. Keep a copy of Form SSA-1610-U2 and file in the case record.

  • the person is admitted to an institution. An institution is defined as a:
    • hospital;
    • nursing facility;
    • state school;
    • state hospital; or
    • intermediate care facility serving people with an intellectual disability or related conditions;
  • the person requests that services or specific tasks end;
  • HHSC denies the person’s Medicaid eligibility not applicable to family care services; or
  • the person or someone in the person’s home exhibits reckless behavior, which may result in imminent danger to the health and safety of the person, the attendant, or another person;
  • if this reckless behavior occurs, the provider agency must make an immediate referral to:
    • the Texas Department of Protective and Regulatory Services or other appropriate protective services agency;
    • local law enforcement, if appropriate; and
    • the person’s case worker.

Services may be suspended indefinitely if the person is admitted to a rehabilitation hospital or to a rehabilitation floor or wing of a medical hospital.

The provider agency may also suspend services if:

  • the person or someone in the person’s home engages in discrimination against a provider agency or HHSC employee in violation of applicable law; or
  • the person refuses services for more than 30 consecutive days.

The provider agency must notify the caseworker by fax of any suspension by the next working day. The faxed notice of a suspension must include:

  • the date of service suspension;
  • the reason(s) for the suspension;
  • the duration of the suspension, if known; and
  • an explanation of the provider agency's attempts to resolve the problem that caused the suspension, including the reasons why the problem was not resolved.

The provider agency must convene an interdisciplinary team (IDT) meeting to resume services.

The provider agency must resume services after suspension:

  • once the person returns home, or the date the provider agency becomes aware of the person returning home, if applicable;
  • on the date specified in writing by the caseworker;
  • because of a recommendation by the IDT; or
  • upon the provider agency's receipt of notification from the caseworker that the provider agency must resume services pending the outcome of the appeal.

The provider agency must notify the caseworker in writing of the date services resume and must send the notice within seven calendar days of that date.

4447 Reassessment

Revision 26-1; Effective March 1, 2026

Functional Assessment

Functional eligibility must be redetermined for Family Care (FC) at least every 12 months. At each annual functional reassessment, review the screening exception criteria and determine if the recipient’s circumstances have changed.

For example, refer the person to Primary Home Care (PHC) or Community Attendant Services (CAS) if they were placed on FC because of no personal care tasks, but at the annual reassessment now require a personal care task.

Apply the screening exception criteria at the next annual review if the recipient or provider report interim changes between annual reassessments.

If a recipient requests a change at the annual reassessment, the change must be worked within five business days or by the annual reassessment due date, whichever is earlier.

Financial Assessment

Determine financial eligibility for FC at least every 24 months. If the person was previously determined ineligible for CAS because of resources, review the recipient’s current financial information.

If the recipient appears to meet the financial requirements for CAS, send Form H1200, Application for Assistance – Your Texas Benefits, along with verifications of income and resources to Medicaid for the Elderly and People with Disabilities (MEPD) for a CAS financial determination.

If a recipient was determined eligible for FC because of receipt of QI-1 benefits, reverify QI-1 benefits at each financial reassessment.

Note: If the person is referred to MEPD for CAS and is denied because of income or resources, the caseworker must review the reason for denial and make sure the person continues to meet financial eligibility requirements for Title XX. If the countable income or resources are over the Title XX limits the FC case must be denied. Refer to 3200, Resource Eligibility Criteria and 3300, Income Eligibility.

Related Policy

Exception Criteria for Referrals to PHC or CAS, 2342.2
Exceptions to Verification Requirements, 3422
Content of Referral Packets, Appendix XIII

4448 Complaints

Revision 25-3; Effective June 1, 2025

A person has the right to:

  • voice grievances or complaints about the Texas Health and Human Services Commission (HHSC) staff or purchased services without discrimination or retaliation; and
  • report service delivery issues to the Texas Health and Human Services (HHS) Office of Ombudsman at 877-787-8999.

If the caseworker is aware of the issue, the caseworker must work to resolve the person's issues. Review policy outlined in 2736.1, Reporting Service Delivery Issues, for detailed procedures in handling service delivery issues.