In Texas, Medicaid / HHSC can now be applied to Congregate Care Facilities!

Many parents of adults with IDDs in Texas have been frustrated–I know I have!–that Medicaid Waiver / HCS funds cannot be used to pay for “congregate care” facilities or intentional communities (however you describe them). This has meant that parents have had to shoulder the cost, for the rest of their child’s life, if they wanted to place their child in anything other than a group home. Most of these private communities in Texas cost $3,500-$5,000 / month, and there are not many of them in Texas, fewer still any with vacancies, leaving parents with few placement options. 

SSI pays only $900 / month. That’s a huge gap for parents to try to fill on their own!

Texas has been reluctant to allow any Medicaid funds to be used for assisted living facilities, or intentional / congregate care communities, by classifying anything other than a private residential home an institution. I’m no expert on this, but I have heard from others and from Mark Olson, above, that the Texas Administrative Code made it impossible for HCS Medicaid waiver funds be used to fund “institutions,” or anything resembling them, which is why all of our private residential communities in Texas do not take HCS. For a long time, the idea was the philosophy was that institutions are bad, while homes “in the community” are good. Let me tell you, we have some rough communities in Houston, not safe for mentally impaired people or anyone else to be walking around “in the community.” They become easy marks. There was no allowance for setting like a campus or a facility which houses, cares for, and supports intellectually-disabled residents like an assisted living.

Most parents of an adult child with an IDD would prefer to place their child in a communal or congregate care setting on a campus where their adult child can be seen, walk around, talk to people, make friends and have needed supports and activities, instead of being placed into someone’s house, in a spare bedroom (often with another person with an IDD), in some sketchy part of town, to never seen by anyone.

Maybe that is not a fair assessment, but parents do not want their adult child warehoused inside a stranger’s home after they (parents) die. I’m sure there are good group homes out there, and I do not mean to be disparaging, but that is essentially an adult foster care model, and this model has proven in Texas and everywhere else to lead to abuse and neglect. It is a failed model.

I want to announce the good news that according to Mark Olson, founder and CEO of LTO Ventures, the regulations have recently changed.

Mark organized a large coalition of parents to pressure the Texas legislature to change the wording of this regulation so that Medicaid waiver funds can at least be applied to these often costlier private settings. Mark indicated it is still difficult to get HHS to pay, but maybe over time things will get easier.

I do not know how much they pay for residential care, but whatever it is, it is better than zero.

Thank you, Mark Olson, for fighting the good fight!