Texas Considers Option to Expand Medicaid Attendant/Habilitation Services

Health Care

Centers for Medicare and Medicaid ServicesThe Centers for Medicare and Medicaid Services (CMS) issued a rule in May 2012 on the Community First Choice Option, which offers an incentive for states to provide community-based attendant services and supports to people with disabilities eligible for an institutional level of care. States that amend their Medicaid plan to include this option will receive a 6% increase in their federal Medicaid share for those services.

Initial drafts of the Department of Aging and Disability Services’ Legislative Appropriations Request include a placeholder for the CFC Option as an exceptional item. Exceptional items are basically a “wish list” beyond an agency’s base budget request. It is too soon to tell how many adults who are eligible for Supplemental Security Income and currently on an interest list for a Medicaid Waiver program might receive attendant/habilitation services if the CFC Option is implemented. The costs and benefits of the proposed CFC options will be debated during the 83rd Texas Legislative Session that convenes on Jan. 8, 2013.

If Texas implements this option, which is for individuals at or below 150% of the federal poverty level, it would:

  • Add a new population group – individuals with intellectual and developmental disabilities.
  • Add new services – habilitation, personal emergency response systems.
  • Allow some individuals on long term services and supports waiver interest lists to receive community-based attendant services.

The CFC option is a provision of the federal Affordable Care Act designed to assist eligible individuals with activities of daily living, instrumental activities of daily living (e.g., shopping and cleaning) and health-related tasks. Under the CFC, states must use written, person-centered service plans, and the services must be self-directed, either with a self-directed service budget or an agency-provider model.


The new rule requires states to provide CFC services only in a “home and community” setting; however, the definition for this term is still being finalized. Once completed, the definition will apply across all of the home and community programs, including Medicaid 1915(c) waivers, the 1915(i) State Plan option, and the 1915(k) CFC option.

Visit hhs.gov for more details on the CFC option.