Texas Medicaid Community Based Alternatives Waiver
Waiver Description
Though not designed specifically for the elderly, this Medicaid waiver allows aged, blind and disabled individuals that require a nursing facility level of care to reside at home or in assisted living residences instead of in a nursing home. It should be noted that this is not a Medicaid entitlement program. Therefore even if individuals are qualified, there may not be space available in the program.
The types of service available under this waiver are non-medical in nature. Personal care is offered as well as coverage for home medical equipment and home modifications which enable the participant to better care for themselves.
Individuals receiving personal care under this waiver can choose to allow the state administrators to manage their care or they can choose to self-direct their care. This is referred to as the Consumer Directed Services Option or CDS. Under the CDS option, participants are given the flexibility to choose their own personal assistance and respite care providers. Usually personal assistance and respite care can be provided by non-medical professionals and participating individuals can hire certain family members to provide this services. Spouses and legal guardians are usually excluded, but siblings, ex-spouses, friends and the children of aging parents can all be hired as paid caregivers.
The CBA Waiver will pay for a broad range of services and supports to individuals that choose to live in their homes or in assisted living. These include:
• Environmental Adaptive Aids (to increase the independence of the individual in their home)
• Durable Medical Equipment and Supplies
• Home Modifications
• Personal Emergency Responses Services
• Personal Assistance
• Home Delivered Meals
• Respite Care
• Transition Assistance
It should be noted that Waiver programs, in addition to providing individuals with options, are designed to save the state money and therefore the overall services provided may be limited to not exceed the cost for those same services were they provided in a nursing home or a percentage thereof.
Community First Choice (CFC) Waiver Programs
What is Community First Choice? Community First Choice (CFC) provides certain services and supports to individuals … who are enrolled in the Medicaid program and meet CFC eligibility requirements. Services and supports may … their own attendants (support management). In Texas, CFC may be available to people enrolled in Medicaid, ..
What is Community First Choice?
Community First Choice (CFC) provides certain services and supports to individuals living in the community who are enrolled in the Medicaid program and meet CFC eligibility requirements. Services and supports may include:
• activities of daily living (eating, toileting, and grooming), activities related to living independently in the community, and health-related tasks (personal assistance services);
• acquisition, maintenance, and enhancement of skills necessary for the individuals to care for themselves and to live independently in the community (habilitation);
• providing a backup system or ways to ensure continuity of services and supports (emergency response services); and
• training people how to select, manage and dismiss their own attendants (support management).
In Texas, CFC may be available to people enrolled in Medicaid, including those served by:
• 1915 (c) waiver programs;
• Medicaid managed care; and
• personal care services for children.
Individuals may use the Consumer Directed Services (CDS) option for certain CFC services.
CFC as a state plan Medicaid service is available to individuals with a need for habilitation, personal assistance or emergency response services who receive services in the following HHS waiver programs:
• Community Living Assistance and Support Services (CLASS);
• Deaf Blind with Multiple Disabilities (DBMD);
• Home and Community-based Services (HCS); and
• Texas Home Living (TxHmL).
CFC is also available through managed care organizations for individuals who meet eligibility criteria. Information about eligibility for CFC is available at this link. Information about CFC for children in Traditional Medicaid can be found here
(link is external)
STAR Kids is a new Texas Medicaid managed care program that will provide Medicaid benefits, beginning November 1, 2016, to children and adults 20 and younger who have disabilities. Participation in the STAR Kids program is required for those who are 20 or younger, covered by Medicaid, and meet at least one of the following:
• Get Supplemental Security Income (SSI).
• Get SSI and Medicare.
• Get services through the Medically Dependent Children Program (MDCP) waiver.
• Get services through the Youth Empowerment Services (YES) waiver.
• Live in a community-based intermediate care facility for individuals with an intellectual disability or related condition (ICF/IID) or nursing facility.
• Get services through a Medicaid Buy-In program.
• Get services through any of the following Department of Aging and Disability Services (DADS) intellectual and developmental disability (IDD) waiver programs.
◦ Community Living Assistance and Support Services (CLASS)
◦ Deaf Blind with Multiple Disabilities (DBMD)
◦ Home and Community-based Services (HCS)
◦ Texas Home Living (TxHmL)
Managed care means that you will pick health plan that will provide the health services you need through a network of doctors, specialists, and other providers. Those enrolling in the STAR Kids program will choose a health plan, as well as a primary care physician or clinic who will provide basic medical services, like check-ups, and provide referrals to a specialist when needed.
