Advocacy

ADVOCACY ALERT!

Protect the rights of Texas adults with intellectual or developmental disabilities (IDD)

Updated: September 26, 2022

ACTION REQUIRED! PLEASE READ CAREFULLY BELOW.

  • The proposed rules for the Home and Community-based Services (HCS), Texas Home Living (TxHmL), and Deaf, Blind and Multiple Disabilities (DBMD) waivers were published September 16th. The deadline for public comments is October 17th. You can download and read the rules here - https://www.sos.state.tx.us/texreg/pdf/backview/0916/0916prop.pdf.

    • DBMD waiver text starts on p. 5567; TxHmL waiver text starts on p. 5636; HCS waiver text stars on p. 5667.

  • The proposed rule for the Community Living Assistance & Support Services (CLASS) waiver was published September 2nd. The deadline for public comments is October 2nd. You can download and read it here - https://www.sos.state.tx.us/texreg/pdf/backview/0902/0902prop.pdf. The CLASS waiver text starts on p. 5236.

  • OUR OPINION ABOUT THE PROPOSED WAIVERS

    • We are very pleased that HHSC listened to hundreds of Texas voices and deleted the unnecessary and restrictive language that reduced housing options for Texans with IDD, and added important language about the heightened scrutiny process. We feel the public comment process worked fairly and effectively.

    • However, we believe there is important language missing that preserves choice for Texans with IDD and their families and we want your help to get added. We have detailed how to do that below.

    • In the next section on this page we explain how to write and submit your public comment.

  • HOW TO WRITE AND SUBMIT YOUR PUBLIC COMMENT

    • Choose the waiver on which you want to comment (please submit separate written comments to comment on more than 1 waiver…the number of comments submitted is counted by HHSC).

    • In your comment explain who you are and why this rule as proposed is important to you. Then, please add the entire suggested text for the waiver you have chosen [see SUGGESTED TEXT FOR YOUR PUBLIC COMMENT below].

    • SUGGESTED TEXT FOR YOUR PUBLIC COMMENT. The most effective public comments on a particular rule are when many commenters make the same request, combined with their personal story. Please click on the link below for the waiver you want to provide public comment. You will open a new webpage. We ask that you copy-and-paste the entire text into your public comment [see HOW TO WRITE AND SUBMIT YOUR PUBLIC COMMENT above].

    • Make sure that you clearly indicate on your comment and in your email Subject Line one of the following so HHSC knows which waiver your are commenting about.

      • HCS Waiver - “Comments on Proposed Rule 21R058”

      • TxHmL Waiver: “Comments on Proposed Rule 21R057”

      • DBMD Waiver: “Comments on Proposed Rule 21R134”

      • CLASS Waiver: “Comments on Proposed Rule 21R133”

    • Email as a PDF or word document to: HHSRulesCoordinationOffice@hhs.texas.gov. Don’t forget to put the right Subject Line (see above).

OTHER ACTIONS YOU CAN TAKE NOW

  • Get Notified! Visit This Page often or get on our Email List for Updates. Email molson@ltoventures.org to get on our email list.

  • Questions or comments, contact Mark Olson, President & CEO of LTO Ventures; molson@ltoventures.org; (702) 353-6540

BACKGROUND: THINGS YOU NEED TO KNOW ABOUT HOW WAIVERS WORK (OR DON’T) IN TEXAS

  1. Adults with IDD in Texas often need residential assistance paid with Medicaid Home and Community-Based Services (HCBS) Waivers to help them to live as independently as possible in a home or community-based setting. Adults with IDD apply to use waiver funds to pay for the supports they need, and the waiver funds can only be used in Medicaid-eligible settings.

  2. In Texas, the Home and Community-based Services program can provide 24-hour residential assistance for people with IDD or related conditions to live in these Medicaid-eligible settings: a group home where no more than four people receiving services live; a host home or companion care setting, their own home or their family’s home. For many adults with IDD these are their preferred settings.

  3. Many other adults with IDD, however, would prefer a different type of setting such as a farmstead, intentional community, or campus setting where they can enjoy a supportive community comprised largely of their peers. There are more than 300 intentional or planned communities for adults with IDD around the US, and about a dozen existing or planned in Texas.

  4. The disability community is very diverse. One size does not fit all. Adults with IDD want the right to live in the setting and manner they choose from the broadest range of options available.

  5. Unfortunately the Texas Health and Human Services Commission (HHSC) currently does not allow adults with IDD to use paid residential assistance in a farmstead, intentional community, or campus setting even if that is the preferred setting of the adult with IDD.

  6. Paid residential assistance can be very expensive for most adults with IDD. Medicaid HCBS waivers are the financial safety net that pay for those supports based on the needs and desires of the adult with IDD. The rules for how waivers can be used are governed at a federal level by the Centers for Medicare and Medicaid Services (CMS).

  7. Each state then uses the CMS rules to create waivers to address the needs of the disability community in their state. In Texas those waivers are: 1) Home and Community Services (HCS); 2) Texas Home Living (TxHmL); 3) Community Living Assistance and Support Services (CLASS); and, 4) Deaf Blind with Multiple Disabilities (DBMD). Did you know that almost 316,000 Texans with disabilities are on an Interest List to receive waiver funding? Did you know that an adult with IDD may have to wait up to 18 years to receive HCS waiver funding they need to live as independently as possible in the community?

  8. In January 2014 CMS issued its Final Settings Rule to bring consistency to what constituted a Medicaid-eligible home and community-based setting where you could use your waiver funds to pay for the supports you need to live in the community. The Setting Rule set a baseline with which states must comply, but allowed them to add restrictions. CMS gave states until March 2019 to bring their policies and regulations into minimum compliance with its Settings rule. That deadline was extended twice to March 2023.

  9. Each state was required by CMS to prepare a Statewide Transition Plan (STP) to show how they were going to bring their policies and regulations into minimum compliance, and give all interested citizens multiple opportunities to be heard. States are required to achieve Final Approval by March 2023. As of March 2022, Texas has not even gotten Initial Approval of its STP.

 

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