Texas - Home Modification Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Texas Health and Human Services Commission (HHSC) authorizes Minor Home Modifications (MHM) through the STAR+PLUS managed care program and 1915(c) waivers like Home and Community-Based Services (HCS) and Community Living Assistance and Support Services (CLASS). Approval requires either securing a network contract with a regional STAR+PLUS Managed Care Organization (MCO) or completing the HHSC Open Enrollment process via the Contract Application and Management for Providers (CAMP) portal to become a waiver contractor.

Texas does not issue a distinct state-level facility or agency license for home modification providers. Instead, applicants must hold applicable local municipal building permits and trade licenses, enroll in the Texas Medicaid & Healthcare Partnership (TMHP) Provider Enrollment and Management System (PEMS), and pass the Provider Applicant Training (PAT) competency exam if applying under the HCS waiver.

1. Service Definition and Scope

Minor Home Modifications (MHM) in Texas encompass physical adaptations to a member's residence necessary to ensure health, welfare, and safety, or to enable greater independence. The service excludes modifications that add square footage or are considered general home maintenance.

The scope of work is strictly limited to the approved bid and must comply with all local building codes and Americans with Disabilities Act (ADA) guidelines where applicable.

• Covered Adaptations: Wheelchair ramps, widened doorways, grab bars, and accessible bathroom modifications.
• Excluded Items: Roof repair, central air conditioning, swimming pools, and square footage additions.
• Lifetime Limits: STAR+PLUS limits MHM to a $7,500 lifetime maximum per member.
• Repair Allowance: A $300 annual allowance is permitted for the repair and maintenance of previously approved modifications.
• Property Ownership: Written consent from the property owner or landlord is required before any structural modification begins.

2. Regulatory and Oversight Agencies

HHSC oversees the Medicaid waiver programs and manages the contracts for fee-for-service waiver providers. TMHP handles the actual Medicaid enrollment and revalidation processes.

For managed care members, regional MCOs handle the direct authorization, credentialing, and payment for MHM services.

• Texas Health and Human Services Commission (HHSC): Manages waiver policy and open enrollment contracts (https://www.hhs.texas.gov).
• Texas Medicaid & Healthcare Partnership (TMHP): Operates the Provider Enrollment and Management System (PEMS) (https://www.tmhp.com).
• Texas Department of Licensing and Regulation (TDLR): Issues required trade licenses for specific electrical or architectural barrier work (https://www.tdlr.texas.gov).
• STAR+PLUS MCOs: Entities like Community First Health Plans manage MHM authorizations and provider networks for managed care members (https://medicaid.communityfirsthealthplans.com).

3. Gatekeeping Prerequisites: Who Can Even Apply

Entry into the Texas MHM market depends entirely on the funding pathway. For STAR+PLUS, providers face closed or restricted MCO networks and must secure a contract directly with the health plan.

For waiver programs like HCS, providers must meet strict historical experience requirements before HHSC will accept an open enrollment application.

• MCO Network Contracting: STAR+PLUS providers must be accepted into the network of regional MCOs; MCOs may close networks if they have adequate MHM provider capacity.
• HCS Open Enrollment: HCS waiver applicants must apply through the HHSC CAMP portal, which accepts applications year-round on a noncompetitive basis.
• Experience Requirement: HCS applicants must prove at least three years of experience providing similar services to individuals with intellectual disabilities, verified by written statements.
• Trade Licensure: Applicants must hold active local building contractor licenses or state trade licenses (plumbing, electrical) required by the municipality where the work occurs.

4. Licensure and Certification Requirements

Because HHSC does not issue a specific "Home Modification Agency" license, certification is achieved through the Medicaid contracting process and adherence to local building codes.

Providers must prove their legal entity status and pass state-mandated competency exams depending on the waiver program they intend to serve.

• State Licensure Exemption: Texas does not have a distinct state license category for MHM providers under HHSC.
• Local Permits: Providers must pull municipal building permits for structural, electrical, or plumbing modifications prior to construction.
• HCS Competency Exam: HCS applicants must pass an in-person competency exam after completing the online Provider Applicant Training (PAT) per 26 TAC §52.31.
• Business Registration: Entities must register with the Texas Secretary of State and provide a Certificate of Formation and Assumed Name Certificate.

5. Medicaid Provider Enrollment

All MHM providers must enroll through TMHP's PEMS portal as a Medicaid provider before they can bill MCOs or HHSC.

The application requires specific HHSC forms to designate authority and agree to state data use policies.

• TMHP PEMS Portal: The central system for all Texas Medicaid provider enrollments and revalidations (https://www.tmhp.com/topics/provider-enrollment).
• Application Checklist: Form 5873 (Waiver and Community-based Programs and Services Contract Application Packet Checklist) guides the required document submissions.
• Governing Authority: Form 2031 (Governing Authority Resolution) must be signed and notarized to designate authorized individuals.
• Application Portal: HCS and CLASS contracts are submitted online via the Contract Application and Management for Providers (CAMP) portal (https://camp.hhs.texas.gov).

6. Staffing, Training and Background Checks

MHM providers must ensure that all personnel and subcontractors entering a member's home pass state-mandated background checks.

Training requirements focus on waiver rules, incident reporting, and billing compliance rather than clinical care.

• Criminal History Checks: Providers must submit receipts for criminal history record requests for all owners and direct-contact staff.
• Provider Applicant Training (PAT): Required online training for HCS applicants covering waiver rules, billing, and incident reporting.
• Subcontractor Qualifications: Any subcontracted tradesmen (plumbers, electricians) must hold valid Texas state licenses for their respective trades.
• OIG Exclusion Checks: Monthly checks against the Texas OIG and federal LEIE databases are required for all employees and contractors.

7. Documentation, Policies and Records

MHM providers must maintain detailed records of the modification process, from initial bids to final inspections.

Failure to maintain these records can result in immediate recoupment of funds during an HHSC or MCO audit.

• Written Bids: Providers must submit detailed, itemized bids for the proposed modification, including materials and labor costs.
• Property Owner Consent: Signed documentation from the homeowner or landlord approving the specific structural changes.
• Post-Modification Inspection: Signed statements from the member and the provider confirming the work was completed to specification and is functional.
• Data Use Agreement: Providers must sign the HHS Data Use Agreement and the Information Security and Privacy Initial Inquiry form.

8. Billing, Rates and Claims

MHM is billed based on the approved bid amount rather than a standardized fee schedule, up to the program's lifetime limits.

Providers must not begin work or bill for services until they receive a formal service authorization from the MCO or waiver case manager.

• Bid-Based Pricing: Reimbursement is authorized based on the lowest of three competitive bids submitted to the MCO or waiver case manager.
• Lifetime Maximum: Claims cannot exceed the $7,500 lifetime limit per member across all Texas Medicaid programs.
• Repair Allowance: A separate $300 annual limit applies to the maintenance and repair of previously approved modifications.
• Claims Submission: STAR+PLUS claims are submitted directly to the authorizing MCO; HCS claims are submitted via the TMHP portal.

9. Approval Sequence and Timeline

The timeline to become an active MHM provider depends on the TMHP enrollment queue and MCO credentialing timelines.

Providers must complete state enrollment before they can finalize MCO contracts.

• Step 1: Register the business entity with the Texas Secretary of State and obtain local contractor licenses.
• Step 2: Complete the Provider Applicant Training (PAT) and pass the competency exam for HCS applicants.
• Step 3: Submit the Medicaid enrollment application via TMHP PEMS, which typically takes 60-90 days for processing.
• Step 4: Submit the contract application via the HHSC CAMP portal or apply for MCO network inclusion, adding 90-120 days.

10. Common Denials and Survey Findings

Contract applications and MHM authorizations are frequently delayed due to incomplete documentation or failure to meet bid requirements.

Auditors frequently target missing municipal permits or lack of property owner consent.

• Incomplete PEMS Applications: Missing ownership details or failure to upload the notarized Form 2031 causes immediate application return.
• Lack of Experience Documentation: HCS applications denied for failing to provide three years of verifiable written experience statements.
• Bid Rejections: MHM authorizations denied because the bid included non-covered items or exceeded the $7,500 lifetime cap.
• Permit Failures: Recoupment of funds if the provider fails to obtain or retain copies of required municipal building permits.

11. Key Contacts and Resources

Providers must utilize HHSC and TMHP resources for policy manuals, enrollment updates, and contract management.

The STAR+PLUS handbook and HHSC provider portals are the primary sources of truth for MHM rules.

• HHSC Long-Term Care Providers Page: Policy and contracting updates for waiver programs (https://www.hhs.texas.gov/providers/long-term-care-providers).
• TMHP Provider Enrollment: The PEMS portal and enrollment guides (https://www.tmhp.com/topics/provider-enrollment).
• CAMP Portal: The HHSC system for submitting waiver contract applications (https://camp.hhs.texas.gov).
• STAR+PLUS Handbook: Section 6600 details Minor Home Modifications rules and limits (https://fhb.hhs.texas.gov/handbooks/starplus-handbook/6600-minor-home-modifications).

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