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Texas - Housing Stabilization — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Texas Health and Human Services Commission (HHSC) does not offer a standalone Medicaid State Plan benefit called "Housing Stabilization," but instead funds tenancy support, housing search, and retention planning as "Supported Housing" under the 1915(i) Home and Community-Based Services–Adult Mental Health (HCBS-AMH) program and as Transition Assistance Services under the STAR+PLUS waiver. Providers seeking to offer these services cannot simply enroll as housing providers; they must first apply through the HHSC Contract Application and Management for Providers (CAMP) portal to become an approved waiver contractor or secure a contract with a Local Mental Health Authority (LMHA).

Approval requires passing the Provider Applicant Training (PAT) competency exam and securing an HHSC approval letter before submitting a Medicaid enrollment application through the Texas Medicaid & Healthcare Partnership (TMHP) Provider Enrollment and Management System (PEMS). For STAR+PLUS delivery, providers must subsequently complete credentialing and contracting with the specific Managed Care Organizations (MCOs) operating in their Medicaid Rural Service Area (MRSA) or urban service area.

1. Service Definition and Scope

Because Texas lacks a universal Housing Stabilization service, tenancy supports are authorized under specific waiver definitions. In the HCBS-AMH program, "Supported Housing" includes assisting individuals in locating, securing, and maintaining integrated housing, negotiating leases, and mediating with landlords.

Under STAR+PLUS, similar supports are categorized under Transition Assistance Services (TAS) for individuals moving from nursing facilities to the community. These services do not pay for room and board, rent, or deposits directly, but fund the staff time required to help the Medicaid member secure and retain their housing.

2. Regulatory and Oversight Agencies

The Texas Health and Human Services Commission (HHSC) is the single state Medicaid agency responsible for waiver program design, provider contracting, and regulatory oversight. HHSC manages the open enrollment process for waiver programs and issues the required provider contracts.

The Texas Medicaid & Healthcare Partnership (TMHP) operates as the state's Medicaid Management Information System (MMIS) contractor. TMHP manages the Provider Enrollment and Management System (PEMS) where all approved waiver contractors must enroll to receive a Texas Provider Identifier (TPI).

3. Gatekeeping Prerequisites: Who Can Even Apply

Texas strictly gates entry into waiver services. To enroll in Texas Medicaid as an HCBS-AMH provider, the applicant must first obtain an approval letter and contract directly from HHSC; TMHP will reject any PEMS application lacking this specific HHSC approval documentation.

For STAR+PLUS, providers face a closed-network managed care environment. Even after obtaining a Medicaid TPI through TMHP, the provider cannot bill for services unless they successfully execute a network contract with the specific MCOs (e.g., Superior HealthPlan, Molina Healthcare) assigned to their service delivery area, which is subject to MCO network adequacy needs.

4. Licensure and Certification Requirements

Texas does not issue a specific "Housing Stabilization" license. Providers typically operate under a Home and Community Support Services Agency (HCSSA) license issued by HHSC if they provide personal assistance alongside housing supports, or they operate as unlicensed waiver-certified entities if providing only non-medical tenancy supports.

HCBS-AMH providers must adhere to the certification standards outlined in the Texas Administrative Code (TAC) Title 26, Part 1. They must maintain an active HHSC waiver contract and pass periodic HHSC contract monitoring reviews to retain their certification.

5. Medicaid Provider Enrollment

Once the HHSC waiver contract is secured, the agency must enroll through the TMHP PEMS portal. Applicants must select the specific provider type corresponding to their waiver (e.g., HCBS-AMH Facility or STAR+PLUS Waiver Provider) and upload their HHSC approval letter.

Providers must complete the Texas Medicaid Facility Enrollment Application (Form F00168 or its PEMS digital equivalent) and designate whether they are a public or private entity. A Medicare waiver request must be explicitly selected if the provider does not have a Medicare number, as housing supports are not Medicare-covered.

6. Staffing, Training and Background Checks

Staff delivering Supported Housing or TAS must meet the minimum qualifications defined in the respective waiver appendices. This generally requires a high school diploma or GED, a valid Texas driver's license, and specific training in person-centered planning and crisis intervention.

Agencies must conduct fingerprint-based criminal history checks through the Texas Department of Public Safety (DPS) and check the HHSC Employee Misconduct Registry (EMR) and Nurse Aide Registry (NAR) prior to hire and annually thereafter.

7. Documentation, Policies and Records

Providers must maintain comprehensive records demonstrating that housing supports were delivered in accordance with the member's Person-Directed Plan (PDP) or Individual Recovery Plan (IRP). Documentation must show the specific housing-related activities performed, the duration of the service, and the member's progress toward housing goals.

Agencies must have written policies covering critical incident reporting, grievance procedures, and compliance with the HCBS Settings Rule, ensuring that individuals have lease protections and privacy in their chosen housing.

8. Billing, Rates and Claims

Billing for waiver services is conducted through the TMHP LTC Online Portal or directly to the contracted MCO for STAR+PLUS members. Services are typically billed in 15-minute increments or as milestone payments, depending on the specific waiver's rate schedule published by the HHSC Provider Finance Department.

Providers must ensure that claims are filed within 95 days of the date of service for fee-for-service Medicaid, or within the specific timely filing window dictated by their MCO contract. Claims submitted before the TMHP welcome letter is received are at the provider's own financial risk.

9. Approval Sequence and Timeline

The approval process begins with creating an account in the HHSC CAMP portal and submitting the waiver contract application (Form 5873 checklist). HHSC review of the contract application and PAT competency exam completion typically takes 60 to 90 days.

Once the HHSC contract is awarded, the TMHP PEMS enrollment process takes an additional 45 to 60 days. If the provider intends to serve STAR+PLUS members, MCO credentialing adds another 90 to 120 days to the timeline before billing can commence.

10. Common Denials and Survey Findings

TMHP frequently denies PEMS applications because the applicant fails to attach the required HHSC approval letter or forgets to check the Medicare waiver request box for non-Medicare services. Name mismatches between the IRS W-9, the Secretary of State filing, and the NPPES NPI registry are also primary causes for application rejection.

During HHSC contract monitoring surveys, providers are commonly cited for failing to document how their housing search activities align with the specific goals in the member's Person-Directed Plan, or for missing annual Employee Misconduct Registry checks.

11. Key Contacts and Resources

Prospective providers should utilize the HHSC CAMP portal for initial contract applications and the TMHP website for Medicaid enrollment instructions. The HHSC Operations Mailbox is the primary contact for accessing the required Provider Applicant Training.

For STAR+PLUS contracting, providers must contact the provider relations departments of the specific MCOs operating in their region.

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