Texas awaits approval of enhanced FMAP HCBS spending plan

The Texas Health and Human Services Commission (HHSC) submitted its $287 million Home and Community-Based Services (HCBS) spending plan to the Centers for Medicare and Medicaid Services (CMS) on Monday, taking advantage of a temporary increase in Federal Matching Assistance Percentages (FMAP) provided through the American Rescue Plan Act.


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The state simultaneously sent a request for clarification on CMS’s requirements for the enhanced FMAP funds, asking whether it’s allowed to claim the enhanced funds for only a subset of eligible services. The letter also asks for clarifications related to sustainability expectations for items in this proposal, and whether the state may discontinue the enhanced support before the end of the public health crisis. HHSC won’t claim enhanced funding until these clarifications are received from CMS.

The plan lays out three broad goals: supporting providers, supporting recipients, and enhancing and strengthening Texas’s HCBS infrastructure. 

Here are some notable items in each category:

Provider supports

  • $181.41 million GF for provider retention through temporary bonuses and paid time off for providers’ direct care workforces. Funds will be used in both fee-for-service and managed care programs, and will be expended by the end of 2022.
  • $2.145 million GF for the development of an electronic data interface (EDI) between local IDD Authorities (LIDDAs) and the state’s long-term care portal. This will make data input for intellectual and developmental disabilities (IDD) more efficient for LIDDAs across the state. The project will be complete by the end of 2022.
  • $1.25 million GF to fund “critical functionality” for service delivery to those with IDD and prevent gaps in care for these individuals. The project will be complete by Aug. 31, 2022.

Recipient supports

  • $35 million GF to add an individualized skill and socialization (ISS) benefit to the HCBS, Texas Home Living (TxHml), Community Living and Assistance Support Services (CLASS), and Deaf-Blind with Multiple Disabilities (DBMD) waiver programs, per federal HCBS setting requirements. The ISS benefit will provide activities for these individuals to develop skills, be more independent, socialize, participate in community activities, and prepare for future careers. It will be implemented by Sept. 1, 2022.
  • $30.08 million GF to provide HCBS services to more Texans. This will fund additional slots in the following programs:

“Home and Community-based Services – 542  

Texas Home Living – 471

Community Living Assistance and Support Services – 381


Medically Dependent Children Program – 42

Deaf-Blind with Multiple Disabilities – 6”

  • $10.7 million GF for expanding and testing a one-year pilot program that increases outpatient mental health services for IDD individuals who are at risk of institutionalization. HHSC will evaluate this program to develop recommendations for similar programs in the future. It will conclude by Dec. 31, 2022.
  • $6.5 million GF to determine needs levels of individuals on waiver interest lists. This will fund a questionnaire for individuals on waiver eligibility waitlists, after which they will be referred to services while they wait to be placed in waiver programs. It will create a portal to allow individuals to see their place on the interest list. The project will be complete by the end of 2022.

Enhance and strengthen HCBS infrastructure

  • $5 million GF to fund a pilot program to inform the transition of future 1915(c) waivers to managed care. This program will test LTSS delivery through managed care for individuals with IDD, traumatic brain injury, or people with similar functional needs. Specifically, funds will be used for IT system changes needed to start the program and for the automation of certain services. The project will be complete by August 31, 2022.
  • $2.1 million GF to hire assistance for provider compliance monitoring. HHSC will hire contract employees to assist with on-site provider reviews that were temporarily halted due to COVID-19. HHSC plans to finish all reviews impacted by COVID by the end of 2022.
  • $1.5 million GF for general HCBS project management. The state will contract with a vendor to help implement items in this proposal.

See HHSC’s total proposed spending for each category below.


Image: Texas Health and Human Services Commission


The commission said it received confirmation of receipt from CMS on July 13 and awaits feedback. It invites stakeholders to send questions or recommendations concerning this spending plan to the HCBS Mailbox.