Texas Administrative Code › Title 40 - SOCIAL SERVICES AND ASSISTANCE › Part 1 - DEPARTMENT OF AGING AND DISABILITY SERVICES › Chapter 72 - MEMORANDUM OF UNDERSTANDING WITH OTHER STATE AGENCIES › Subchapter B - MEMORANDUM OF UNDERSTANDING CONCERNING COORDINATION OF SERVICES TO PERSONS WITH DISABILITIES › Section 72.202 - Texas Department of Human Services (DHS)

Current through Reg. 49, No. 28; July 12, 2024
(a) Financial and service responsibilities to
				  persons with disabilities.
(1) Health care
				  services.
(A) One of the most important
				  Medicaid benefits provided to low-income individuals is comprehensive health
				  care services. In Texas, Medicaid services are funded by a combination of
				  approximately 40% state funds and 60% federal funds. The federal matching rate
				  is based upon the state's average per capita income.
(B) Medicaid eligibility is linked by federal
				  law to eligibility for supplemental security income (SSI), the financial
				  assistance program for low-income aged and blind persons, and persons with
				  disabilities; aid to families with dependent children (AFDC), the financial
				  assistance program for low-income families; and Medicaid for low-income
				  children and pregnant women. Eligibility for AFDC and Medicaid (low-income
				  families) is determined by client self-support services (CSS) eligibility
				  staff. Eligibility for SSI benefits is determined by the Social Security
				  Administration (SSA) based on income and resource requirements and a
				  determination of disability. The SSA contracts with the Texas Rehabilitation
				  Commission (TRC) to perform the disability determinations. Of the three million
				  Texans living in poverty, the Texas Medicaid program covers about 790,000
				  individuals. Of that number, more than 128,000 are persons with disabilities
				  under age 65.
(C) Federal
				  regulations specify which Medicaid services states must provide as well as a
				  range of optional services states may elect to cover.
(i) Mandatory Medicaid services. The
				  mandatory Medicaid services are long-term institutional care services in
				  nursing facilities.
(ii) Optional
				  Medicaid services. Optional Medicaid services include: day activity and health
				  services and long-term institutional care services in intermediate care
				  facilities (ICF); intermediate care facilities for the mentally retarded
				  (ICF-MR); and skilled nursing facilities (SNF) for children under age
				  21.
(iii) Medicaid waiver services.
				  Under the provisions of the Social Security Act, §1915(c), states have the
				  option to provide certain home and community-based services to individuals who
				  would otherwise require long-term institutional care. Pending approval of the
				  waiver requests by the Health Care Financing Administration (HCFA), states may
				  define the home and community-based services and make them available to a
				  limited number of individuals on less than a statewide basis. The cost of these
				  additional home and community-based services must be no greater than the cost
				  of Medicaid services without a waiver. Texas currently has four 1915(c)
				  Medicaid waiver programs which serve persons with disabilities.
(I) The waiver program for medically
				  dependent children provides Medicaid benefits and in-home skilled nursing
				  services to children under age 18 who would otherwise require nursing home care
				  in an ICF or an SNF. Currently, this waiver program serves 517 children
				  statewide. Eligible children are served on a first-come, first-served
				  basis.
(II) The 1915(c) waiver
				  program for mentally retarded individuals is designed to provide 11 different
				  home and community-based services to individuals living in their own home or
				  with family members, as alternatives to institutional care in an ICF-MR.
				  Eligible clients use their SSI to pay room and board costs. Home and
				  community-based services are delivered based on an individual plan of care.
				  This waiver program is in its 11th year of operation and can serve a maximum of
				  1,350 clients located in 31 geographic catchment areas. This waiver program is
				  administered through an inter-agency contract between DHS and the Texas
				  Department of Mental Health and Mental Retardation (TXMHMR). The state matching
				  funds are provided by TXMHMR.