HCBS Services

Home and Community-Based Services (HCBS) are intended to help participants who need nursing facility-level of care to stay in their least restrictive environment. Medicaid funded HCBS are available through either State Plan services or 1915(c) Home and Community-Based Waiver.

State Plan Services

DSDS administers state plan services under the authority of TXIX of the Social Security Act. There are two models of state plan services: the Agency Model and the Consumer-Directed Services Model.

AGENCY MODEL

The Agency Model for In-Home Services (IHS) refers to a system in which a home care agency provides and employs the caregivers and handles the administrative functions related to service delivery.

Basic Personal Care (PC) refers to hands-on tasks that assist a person with everyday activities that they are unable to perform on their own. Common tasks include bathing, dressing, toileting, grooming, mobility support, and household chores.

Advanced Personal Care (APC) addresses more complex medical needs involving devices and procedures for altered body functions. Examples include assistance with a transfer device, catheter maintenance, and ostomy hygiene. 

Authorized Nurse Visits (RN) are maintenance or preventive services provided to participants with stable, chronic conditions. They are generally not intended for treating acute health issues and are limited to once per week.  Examples include skin monitoring and medication setup. 

Participants of Residential Care Facilities (RCF) or Assisted Living Facilities (ALF) may be authorized for services to assist with personal care and nursing needs. These services are authorized for eligible residents when their needs exceed the facility's basic obligations as outlined in licensure standards. The services available include Personal Care (PC) services, Advanced Personal Care (APC) services, and Authorized Nurse Visits.

CONSUMER DIRECTED SERVICES

The Consumer Directed Services (CDS) program allows the participant to hire and manage their own caregivers, including family members, to assist with ADLs. This model shifts control from traditional home care agencies to the participant  receiving care. CDS is available to participants with a physical disability who can direct their own care and live independently.

CDS Personal Care provides both basic and advanced personal care related tasks to participants with physical disabilities.  CDS also supports transportation and essential correspondence needs. 

Waiver Services

DSDS oversees six (6) HCBS waivers, providing a wider range of services than the Medicaid state plan. These waivers have their own eligibility criteria, which differ from the state plan. A participant can only enroll in one waiver at a time, and because of enrollment limits, some waivers might have a waiting list.

Adult Day Care Waiver (ADCW) is the continuous care and supervision of a disabled adult aged 18 to 63 in a licensed adult day care setting.

The Aged and Disabled Waiver (ADW) offers in-home services to participants aged 63 or over who need assistance with their unmet needs to remain in the least restrictive environment. The services available include:

  • Adult Day Care
    Adult Day Care (ADC) is the continuous care and supervision of a disabled adult who is at least 63 years of age in a licensed adult day care setting.
  • Chore
    Chore services are designed to provide temporary assistance with specific household tasks in order to maintain a clean, sanitary, and safe home environment, which is crucial for protecting the participant’s health and safety.
  • Home Delivered Meals
    Home-delivered meals (HDM) are authorized for participants who are unable to prepare a balanced meal or who otherwise need HDM to meet their individual care needs.
  • Homemaker
    Homemaker (HC) services are designed to assist the participant with essential household tasks that the participant cannot perform due to their condition and functional ability.
  • Respite
    Respite Care (RC) services offer temporary relief to caregiver(s) by providing maintenance and supervisory care in the participant’s residence. RC can be authorized in two (2) categories: basic and advanced.

The Brain Injury Waiver (BIW) provides home and community based rehabilitation services and coordination to participants ages 21 to 65 who are living with a traumatic brain injury (TBI). The service is designed to be person centered, outcome oriented and relies on community inclusion.

The Independent Living Waiver (ILW) provides additional support to participants receiving Consumer Directed Services (CDS) who need additional assistance to remain independent in their home and community. The ILW has the same basic requirements as the CDS program.

The Medically Fragile Adult Waiver (MFAW) provides service coordination and authorization for medically necessary services to participants with serious and complex medical needs who have reached the age of 21 and are no longer eligible to receive services through the Healthy Children and Youth (HCY) Program. Participants must have been eligible for private duty nursing through the HCY Program. MFAW is Authorized through Special Health Care Needs.

The Structured Family Caregiving Waiver (SFCW) provides support for participants with Alzheimer’s disease or related dementia disease to receive care in their home, promoting independence and preserving dignity, self-respect and privacy.