| (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. (2) Office on Services to
Persons with Disabilities (OSPD). (A) In January 1991, the Texas Board of Human Services adopted a proactive position statement on community-based services to persons with disabilities. The philosophy of DHS became "... people with disabilities of all ages can live in the community when provided appropriate services and supports." DHS committed itself to take all appropriate and necessary actions to ensure the development of a system of community-based services and supports for persons with disabilities, and committed itself to the development of specific plans and policies whereby this philosophy would be implemented in all areas of DHS. The OSPD is responsible for coordination of this effort. (B) To specify how OSPD would facilitate the implementation of this philosophy organization-wide, an OSPD strategic plan with specific goals, objectives, timeframes, and products was developed. Although it is located in the Health Care Services Division,
which is one major program area of DHS, the OSPD's scope is within all DHS programs and services for persons with disabilities. (C) OSPD staff have five major roles: (i) advocating for persons with disabilities within DHS and externally; (ii) advocating for the implementation of the DHS position statement organization-wide; (iii) facilitating and coordinating the development of community-based programs and supports for persons with disabilities; (iv) serving as a focal point for DHS staff, consumers, providers, advocates, and other agencies to raise issues and concerns; and (v) providing technical assistance and education on disability-related issues. (3) Client self-support services. Client self-support services is a group of DHS programs that provides basic maintenance services such as food stamps, AFDC, Medicaid coverage,
nutrition, and energy assistance for eligible individuals, as well as services aimed at making clients self-sufficient, such as education, job training, child care, and transportation. (4) Community care services for aged and disabled persons. Community care services are provided to low-income, elderly persons; persons with disabilities; and persons with chronic health conditions, to help these persons remain at home or in community settings. These services also provide a support system to families caring for their elderly or disabled members. Eligibility for community care services is based on age; income; financial resources; the degree of functional impairment; and, in some cases, medical need. The income eligibility ceiling for community care services is $1,302 per month and the resource limit is $5,000. (A) In-home community care services. (i) Primary home care (PHC) provides medically necessary personal care or
supportive care, supervised by a registered nurse, in the client's home. DHS contracts with licensed home health agencies to provide these services to individuals for up to 50 hours per week. (ii) Family care (FC) provides personal care, housekeeping, escort service, and meal preparation in the client's own home. These services are provided through contracts with home health agencies for up to 50 hours per week. (iii) Congregate and home-delivered meals provide nutritious meals in a central location or a client's home through community-based provider agencies. All menus are approved by a registered dietitian or nutritionist. (iv) The Emergency Response System (ERS) is a 24-hour electronic monitoring service that permits quick response to emergencies using a network of volunteers and remote telephone-calling capability to a base station. Services are available to functionally impaired elderly or disabled
adults who live alone or who are physically isolated from the community. (v) The In-home and Family Support Program (IHFSP) provides direct grant benefits to people with physical disabilities and their families who choose and purchase services which enable the person with the disability to remain in the community. Allowable services include pre-approved items and services that are directly related to the person's disability, such as special equipment; architectural modification of a home to improve access or facilitate the care of a person with a disability; medical services; counseling and training programs which help provide proper care for a person with a disability; attendant care; respite care; and transportation. (vi) Respite services up to 336 hours per year of short-term care to elderly or disabled adults whose caregivers need temporary relief. (B) Out-of-home community care services.
(i) Adult foster care (AFC) provides supervision and assistance with daily living to eligible adults in 24-hour living arrangements provided in enrolled foster homes, for up to four clients, and licensed group homes, for four to eight clients. Clients pay their own room and board costs, and DHS pays the caregiver for personal care and supervision. (ii) Day activity and health services (DAHS) provide personal care, nursing services, physical rehabilitation, and nutrition and supportive services in adult day-care facilities licensed by the Texas Department of Health (TDH) and certified by DHS. These services are available at least 10 hours per weekday and can provide respite for families. (iii) Special services for persons with disabilities provide counseling, personal care, help with independent living skills, and transportation. Cont'd... |
