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Texas - Environmental Accessibility Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Texas Health and Human Services Commission (HHSC) funds physical adaptations to a member's home under the title Minor Home Modifications (MHM) through the STAR+PLUS HCBS and Home and Community-based Services (HCS) waiver programs. Approval to deliver and bill for these modifications requires either securing a direct network contract with a regional Managed Care Organization (MCO) for STAR+PLUS or completing the HHSC open enrollment process and Provider Applicant Training (PAT) for the HCS waiver.

Texas does not issue a distinct facility or agency license specifically for MHM providers; instead, contractors must enroll in Texas Medicaid through the Provider Enrollment and Management System (PEMS) as a waiver provider and meet the specific credentialing standards of the contracting MCO or the HCS program. Providers are bound by a $7,500 lifetime benefit limit per member and must obtain landlord approval for modifications in rented properties.

1. Service Definition and Scope

Minor Home Modifications (MHMs) in Texas are physical adaptations to a member's residence required by their Individual Service Plan (ISP) to ensure health, welfare, and safety, or to enable greater independence. The service covers the installation, maintenance, and repair of approved items not covered by warranty.

The scope of work is strictly limited to modifications that address assessed needs, and providers must adhere to state-defined financial caps for both initial installations and subsequent repairs.

2. Regulatory and Oversight Agencies

The Texas Health and Human Services Commission (HHSC) oversees the Medicaid waiver programs that fund MHMs, setting the overarching rules and lifetime limits. Day-to-day administration and provider credentialing are delegated either to regional Managed Care Organizations (MCOs) for STAR+PLUS or managed directly by HHSC's Contract Administration and Provider Monitoring division for HCS.

3. Gatekeeping Prerequisites: Who Can Even Apply

Texas does not utilize a Certificate of Need process for MHM providers, but structural gates depend on the target waiver. For STAR+PLUS, providers face a closed-network managed care gate and must successfully secure a subcontract with a regional MCO.

For the HCS waiver, HHSC utilizes an open enrollment process, meaning applications are accepted year-round without a competitive procurement, provided the applicant meets strict training and experience prerequisites.

4. Licensure and Certification Requirements

Texas does not issue a specific "Minor Home Modification License" through its health facility licensing division. Instead, providers are certified through their Medicaid enrollment and waiver contracting process, relying on local municipal building codes and standard contractor credentials.

5. Medicaid Provider Enrollment

Prospective MHM providers must enroll in Texas Medicaid using the Provider Enrollment and Management System (PEMS) operated by TMHP. For the HCS waiver, providers must also submit a contract application through the Contract Application and Management for Providers (CAMP) portal.

6. Staffing, Training and Background Checks

Because MHM providers operate in vulnerable members' homes, Texas requires background checks for personnel interacting with members. HCS program providers must also meet specific administrative experience and training mandates.

7. Documentation, Policies and Records

MHM providers must maintain rigorous documentation of the modifications performed, including proof of necessity, cost-effectiveness, and property owner consent. MCOs and HHSC require these records for authorization and audit purposes.

8. Billing, Rates and Claims

MHM services are billed based on the authorized bid amount rather than a standardized statewide fee schedule, up to the program's lifetime limits. Claims are processed either through the authorizing MCO or through TMHP for fee-for-service waiver participants.

9. Approval Sequence and Timeline

The timeline to become an active MHM provider varies significantly depending on the waiver program. HCS open enrollment is continuous but requires training, while STAR+PLUS depends on MCO credentialing cycles.

10. Common Denials and Survey Findings

Applications and authorizations are frequently delayed or denied due to incomplete documentation or failure to adhere to strict waiver limits. HHSC and MCOs monitor providers for compliance with cost-effectiveness and timely completion rules.

11. Key Contacts and Resources

Prospective MHM providers should utilize HHSC's official portals and handbooks to navigate the enrollment and contracting processes. The TMHP and CAMP portals are the primary technical interfaces for applications.

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