Texas Medicaid pays for in-home personal care and related services through 3 programs, including the STAR+PLUS Home and Community Based Services (HCBS) and the Community Living Assistance and Support Services (CLASS) Waiver. Texas HCBS waivers operate under different authorities — STAR+PLUS HCBS is a 1915(b)/(c) managed care waiver; CLASS is a non-capitated 1915(c) waiver; MDCP serves children. HCS, CLASS, and MDCP individuals are excluded from STAR+PLUS. The HCBS Settings Rule applies to all three programs.
Which Texas waivers can a home care agency bill?
Each waiver below lists who it covers, the services it pays for, and how providers bill.
STAR+PLUS Home and Community Based Services (HCBS)
Population
Adults with disabilities and elderly individuals who need a nursing facility level of care but want to live in the community
Services covered
personal assistance services
respite
adult foster care
adult day care
home-delivered meals
minor home modifications
nursing services
Billing format
Capitated managed care via STAR+PLUS MCOs; EVV via HHAeXchange (state-funded EVV system) or PSO; aggregator TMHP
To bill Medicaid for home care you need a state license, a Type 2 NPI, state Medicaid enrollment and screening, waiver or managed care contracts, EVV and authorizations.
Private pay means higher rates and fast payment; Medicaid means steady volume at state-set rates with authorizations and EVV. Compare rates, cash timing and admin before you mix them.
Track units remaining, the end date and the service code for every client, and check them before each schedule change. Hours over the cap are unbillable.
Four units equal one hour. How to convert units to hours, the common HCPCS codes, how states round partial units, and how to stay inside the authorization.
These free tools are made by the team behind Caregiver Scheduling,
caregiver scheduling software for home care agencies.
Simple pricing
From$199/month
Up to 10 caregivers on Starter, 50 on Growth.
More than 50 caregivers? We'll put together a custom Scale plan for your agency.