New document released in July 2013 to help explain the Medicaid Waiver Programs. Click here to download: Which Programs Do What?Financial Aid comes in two basic forms: private health insurance and government assistance. Your child may qualify for a number of programs offered by federal state or local government agencies. Many government programs have waiting lists that are many years long. It is very important to sign up as early as possible.
911 for Financial AssistanceTrying to understand how our Texas-based financial assistance programs work is not for the faint-hearted! But, in Williamson County we have access to a group that provide Case Management with Medicaid-related funding (through a large grant they received). Call Sylvia Calvillo or Bonnie Davis at the Williamson County and Cities Health District (WCCHD) Office, 512-248-3252 or 1-800-890-6296The HHSC Quick Resource Guide is intended to help community-based health workers make appropriate referrals to health and human service agencies.
Waiting Lists Parents Must Know About
Private Health InsuranceYour employers can provide information about your insurance coverage, or you can call your insurance provider directly. Ask about limits or "caps" on the amount your insurance will pay for the treatment of certain conditions. Some plans have lifetime limits, you can investigate other funding sources such as Early Childhood Intervention Programs ECI for therapy and equipment. Use Early Childhood Intervention Programs when you can. Save your insurance to pay for ongoing chronic health problems. In some cases, you can combine private insurance with other financial aid.
Texas Department of Insurance
Helps parent of children with disabilities, who have insurance problems. Offers "What Texans With Disabilities Should Know About Insurance," a free booklet explaining the rights of Texans with disabilities.
Health Insurance Premium Payment Reimbursement ProgramChoose the tab titled "Medicaid Programs" to get more information about the Health Insurance Premium Payment Reimbursement Program (HIPP).
Social Security ProgramsSupplemental Security Income (SSI)
SSI provides monthly assistance for children with disabilities. The amount paid is based on your family income, the number of people in your family, and the severity of the disability. Your child can receive up to approximately $550 a month. Even if your child receives as little as $1 of SSI, the child also qualifies for Medicaid.
SSI for Low-Weight and Premature InfantsMany very low birth-weight babies and premature infants can be eligible for SSI benefits and Medicaid from the date of “Intent to File” (Also referred to as the “protected filing date”) to the date of discharge from the hospital. The people answering the SSI 800 number may not be familiar with this program, so rely o your local Social Security Administration office for help. During your first call, state your “intent to file” for benefits. This will give you the earliest possible eligibility date.
Other Government Programs
Division of Blind Services, TxDARS
The Division of Blind Services provides an array of services to children with visual impairments. The services include eye restoration services, eye medical care, parent counseling, educational and training opportunities, and case management.
800-687-7008 or 512-533-7100
Deaf and Hard of Hearing Services, TxDARSThe mission of DHHS is to eliminate communication barriers and guarantee equal access. DHHS provides communication access, information and referral, and an early-intervention program.
CSD of Texas
877-744-1364 or 512-428-1813
In Home and Family Support (IH&FS), TxDADSIH&FS provides the funding for yearly grants of up to $2,500 (MHMRA) or $1,200 (CSS-TxDADS) to individuals or their families. The family may receive assistance to access services related to their child’s disability that maintains or improves their child’s ability to live at home/community. The grant monies can be used for specialized equipment, home modifications, medical services, personnel attendants, training and respite. There are income limits (much higher than Medicaid), and co-pays may apply. The two following departments under DADS have the IH&FS program. NOTE: Waiting lists.
IH&FS Mental Retardation Services Department (MRSD), TxDADSUnder contract to MHMRAs.
Serves children under age 4 who have one area of mental or physical developmental delay, age 4 or older, children and adults with intellectual disabilities, Rett’s, and autism spectrum disorders. If your child after age 4 does not have the above diagnoses, request MRSD transfer your child’s name with original application date to the IH&FS program under DADS Community Care Services. NOTE: Waiting list. (*This program could be eliminated and combined with IH&FS, CCS-DADS see below.)
Bluebonnet Trails Community Services (Williamson County MHMRA)
IH&FS Community Care Services, TxDADS*Serves people over age 4 with physical disabilities, with or without developmental delay.
NOTE: Short Waiting list.
Hays, Travis & Williamson Counties 512-908-9435
Primary Home Care (PHC) Community Care Programs TxDADS
PHC provides non-skilled non-technical, medically related personal care, household tasks, meal preparation, escort, shopping and assistance with self-administered medication. A physician must order the service and a nurse must supervise delivery. There is an income limit, and your child must be Medicaid-eligible. A case manager will assess the needs to determine eligibility and service delivery.
Hays, Travis & Williamson Counties – 512-908-9435
Non-educational Funding (Non-ed) Local School DistrictNon-educational funds are appropriated to school districts to provide non-educational community-based support services to certain students and their families. Funds are available for eligible students with disabilities who would have to be placed in or who would remain in resident facilities primarily for educational reasons without access to non-educational funds. Support services include in-home family support, respite care, attendant care and family dynamic training. Non-ed funds must be discussed outside the ARD process and cannot be used for educational purposes. Contact your special education department chairperson at the district level. Application required.
Education Service Center Region XIII
Title XIX of the Social Security Act provides certain medical benefits for families with low income or people with disabilities. To qualify for Medicaid in Texas, your child must meet at least one of the following criteria:
Receive SSI from Social Security
Qualify for benefits through the Temporary Assistance for Needy Families (TANF) based on low family income
Qualify under the Medically Needy Program (see below) or
Receive assistance from one of the three Medicaid Waiver Programs (see below): MDCP, CLASS, or HCS
These three programs are one type of Medicaid waiver program that waives the family-income requirement and counts the child’s income to qualify for Medicaid
800-252-8263 or 512-424-6500
STAR Program (Medicaid Managed Care)Mothers and children who qualify for TANF receive their Medicaid benefits through the Medicaid Managed Care program know as STAR. The STAR Program offers the choice of selecting one of the STAR health maintenance organizations (HMOs). From these choices, the member is required to select a primary care provider (PCP) who coordinates the member’s health care. The STAR program includes children with disabilities who are not on SSI.
STAR+PLUS (Medicaid Managed Care)Children with disabilities who receive SSI may participate in the STAR+PLUS HMOs or select traditional, fee-for-service Medicaid. The HCS, MDCP, and CLASS programs do not participate in STAR+PLUS. Children with disabilities who have primary insurance through a private insurance provider and secondary Medicaid coverage may choose not to participate in STAR+PLUS.
Texas Health Steps, TxDSHS Children and Pregnant WomenIf you child qualifies for Medicaid, the child also qualifies for Texas Health Steps, which provides free medical screening exams, dental services, and case management.
For help finding a provider call: 877-847-8377 or 254-778-6744 ext 2321
Comprehensive Care Program (CCP)The Comprehensive Care Program is an extension of Texas Health Steps for children under age 21. Services not normally covered by Medicaid can be covered if your medical provider obtains prior authorization or can document on the claim forma that a medical necessity requires the services or equipment. Examples of some covered services include unlimited prescriptions for children under age 21, RN or LVN services, medically necessary supplies, such as equipment for tube feeding, diapers for older children, and therapy services. NOTE: Medicaid and CSHCN (see below) pay for diapers and wipes if they are considered “medically necessary” for children over age 4 and sometimes for ages 2-4 depending on the type and severity of disability. Contact a local medical equipment supplier regarding ordering “incontinent supplies”. A letter of “medical necessity” will need to be acquired from the physician. In most cases the supplier will contact the physician and then submit paperwork to Medicaid.
Health Insurance Premium Payment Reimbursement Program (HIPP)HIPP is a Medicaid program that pays the cost of insurance premiums, co-insurance, deductibles and other cost sharing. HIPP will reimburse the health-insurance premiums of payroll deductions for Medicaid-eligible persons, but only when Medicaid determines it would be cost effective. The advantage of this program is that members of your family who are not eligible for Medicaid will be covered under your private health insurance plan. If your Medicaid benefits are provided through the STAR or STAR+PLUS program, you can apply for the HIPP program only if you are a member of the Texas Health Network.
Medically Needy Program (MNP), HHSCThe Medically Needy Program (MNP) is an option under Texas Medicaid. Families who meet Medicaid assets requirements, but whose income is too high for regular Medicaid, can “spend down” into Medicaid eligibility using the family medical bills. The spend-down amount works much like a deductible amount for a private health insurance policy. A spend-down amount is calculated for each month that you have medical expenses. A case can be set up for the month you apply or for the three months before the application month. You must renew MNP eligibility every 30 days. NOTE: this program can be complicated. If the case worker is not familiar with MNP, ask for a supervisor.
Children’s Health Insurance Plan, CHIP – HHSCThe Children’s Health Insurance Program (CHIP) is designed for families who earn too much money to qualify for Medicaid health care, yet cannot afford to buy private insurance. Families may pay monthly premiums and co-pays. There is an income limit and an assets test. NOTE: Also apply for CSHCN Program that will be secondary insurance with CHIP. See below.
Children with Special Health Care Needs Division (CSHCN), TxDSHSCSHCN provides health care benefits, family support services, and case management to children in Texas with special health care needs (chronic illness and/or medically-based disabilities). In addition, the family must meet specific income limits (except for case management, any income), assets, and residency requirements. The CSHCN income limits are slightly higher than Medicaid (SSI) and the same as CHIP. CSHCN can be used as secondary insurance with Medicaid, CHIP, and private insurance. There is a waiting list for health care benefits and family support services based on urgent need and severity, plus time spent on the waiting list. Once eligible for services, a child may receive treatment and obtain equipment or supplies through a group of physicians, therapists, and other providers enrolled in the CSHCN service program. CSHCN will require you to apply and obtain denial letters from Medicaid and the Medically Needy Program (see above) of TxDADS before CSHCN will pay for services. This process can be complicated, so be persistent and rely on the CSHCN medical social workers for help. If your family’s income is too high to qualify, ask about the “spend-down” program. If your child is on Medicaid, you may still want to apply for CSHCN because CSHCN may pay for a few services Medicaid will not cover. The Insurance Premium Payment Assistance (IPPA) is a program that allows CSHCN to reimburse families for insurance premiums paid to provide health insurance for a CSHCN client. To be eligible for IPPA, a client must have CSHCN eligibility and any type of third party resource. See note under CCP above.
512-458-7355 or 800-252-8023
Medicaid Waiver ProgramsMedically Dependent Children Program (MDCP)This Medicaid waiver program provides qualified children with a variety of services that all the children to live at home. MDCP provides respite, adaptive aids, and supports to enable eligible children to participate in child care. To qualify, on the child’s income is considered. A physician must agree that your child meets medical necessity criteria for admission to a nursing home. MDCP is limited to a certain number of children on a first-come, first-served basis. Once accepted, your child also qualifies for Medicaid benefits. NOTE: long waiting list.
A number of MDCP slots are reserved for children who reside in Texas nursing homes, enabling them to return home with support.
Telephone number for information and to place a name on the waiting/interest list: 877-438-5658
Community Care Services, TxDADS
NOTE: The MDCP ends when a child reaches age 21. After that the Community Based Alternative (CBA) continues most services, but the change from MDCP to CBA is not automatic. You must apply for CBA separately, but the eligible child will access CBA services directly without being placed on a waiting list. State that the child is reaching 21 and on the MDCP.
For more information, call 877-438-3436 (intake line).
Community Living Assistance and Support Services (CLASS)CLASS provides home and community services such as therapies and personal-attendant care, limited nursing care, job training, daily living skills, adaptive aids, psychological counseling, home medication and respite care for persons with disabilities other than the primary diagnosis of intellectual disabilities. CLASS is funded by Medicaid through a waiver that allows participants to live in the community with a degree of freedom and choice. Qualification is based on approved needs. Applicants for CLASS services must have demonstrated needs for, and be able to benefit from, habilitation assistance and support services. Once accepted, the child also qualifies for regular Medicaid benefits. NOTE: Several year-long waiting list.
Telephone number to place a name on the waiting/interest list: 877-438-5658
Community Care Services, TxDADS
Home and Community-Based Services (HCS)Mental Retardation Services Department (MRSD),
TxDADS (under contract to MHMRAs)
The HCS program is a Medicaid waiver program that provides services to individuals with intellectual disabilities who either live with their families, in their own home, in a foster/companion care setting or in a residence with not more than four individuals who receive services. HSC services include residential assistance, day habilitation, respite, nursing, attendant care, adaptive aids, counseling, therapy, minor home modification, and supported employment. Call for eligibility.
Bluebonnet Trails Community Services (MHMRA for Williamson County)
Texas Home Living Waiver (TxHmL)Mental Retardation Services Department (MRSD)
TxDADS (under contract to MHMRAs)
The TxHmL program is one type of Medicaid waiver that waives a Medicaid requirement so that a list of services such as respite can be delivered by someone other than a licensed practitioner (doctor, etc.), and paid by Medicaid. Therefore, the family’s income must meet eligibility for Medicaid to qualify. The TxHmL program provides essential services and support so that Texans with intellectual disabilities can continue to live with their families or in their homes in the community. TxHmL services are intended to supplement. TxHmL is limited to an annual cost $10,000 per participant. This is a new program and MHMRAs contacts families from the HCS waiting list.
Bluebonnet Trails Community Services (MHMRA for Williamson County)
Estate & Financial PlanningTrust funds are private arrangements made by the families of children with disabilities. Trust funds may take many different forms. Parent support groups can usually provide information and sources of help in establishing trust funds.
Advocacy, IncProvides handouts on estate planning and guardianship.
78000 Shoal Creek #171 E
Austin, TX 78757
512-454-4816 or 1-800-252-9180
Arc of the Capital AreaAssists families who qualify with guardianship of a family member with disabilities.
2818 San Gabriel
Austin, TX 78705
Georgetown Independent School Districtdoes not discriminate on the basis of race, sex, age, religion, color, nationalorigin, or disability in providing education services, activities or programs.It is the intent and policy of this District to conduct its activities incompliance with all Federal and State laws prohibiting discrimination on thebasis of race, sex, age, religion, color, national origin, or disability.
ElDistrito Independiente Escolar de Georgetown no discrimina a base de raza,sexo, edad, religion, color, origen nacional, o incapacidad en proveerservicios educacionales, actividades, o programas. Es la intencion y norma delDistrito de conducir sus actividades de acuerdo con todas las leyes Federales yEstatales prohibiendo discriminacion a base de raza, sexo, edad, religion,color, origen nacional o incapacida.