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Texas - I/DD Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Texas Health and Human Services Commission (HHSC) contracts with providers for the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Medicaid waiver programs through an open enrollment process. Under 26 TAC §52.31, an applicant cannot submit a provisional contract application without first completing the mandatory Provider Applicant Training (PAT) course and passing an in-person competency examination.

The approval sequence requires entities to first obtain a National Provider Identifier (NPI) and enroll as a Texas Medicaid provider through the Texas Medicaid & Healthcare Partnership (TMHP) Provider Enrollment and Management System (PEMS). Once Medicaid enrollment is active, prospective providers submit their waiver contract application through the Contract Application and Management for Providers (CAMP) portal to deliver services ranging from day habilitation to supported home living.

1. Service Definition and Scope

Texas operates two primary Medicaid 1915(c) waiver programs for individuals with intellectual and developmental disabilities: Home and Community-based Services (HCS) and Texas Home Living (TxHmL). HCS provides individualized services and supports to persons living in their own homes, family homes, or in small group home settings of up to four individuals.

TxHmL provides essential services and supports exclusively to individuals who live in their own homes or their family's homes. Both waivers offer a comprehensive array of services designed to prevent institutionalization in an Intermediate Care Facility for Individuals with an Intellectual Disability or Related Conditions (ICF/IID).

2. Regulatory and Oversight Agencies

The Texas Health and Human Services Commission (HHSC) serves as the state Medicaid agency and the operating agency for both the HCS and TxHmL waivers. HHSC manages provider contracting, regulatory compliance, and quality assurance surveys.

The Texas Medicaid & Healthcare Partnership (TMHP) acts as the state's Medicaid claims administrator and manages the initial Medicaid provider enrollment process. Local Intellectual and Developmental Disability Authorities (LIDDAs) serve as the front door for client eligibility, interest list management, and service coordination.

3. Gatekeeping Prerequisites: Who Can Even Apply

Texas utilizes an open enrollment process for HCS and TxHmL contracts, meaning there is no competitive procurement or Request for Proposals (RFP). However, HHSC enforces strict structural preconditions that block an application from being submitted or reviewed.

Under 26 TAC §52.31, an applicant cannot apply for a provisional contract without first completing the mandatory Provider Applicant Training (PAT) and passing the in-person competency examination. Additionally, the applicant must already be fully enrolled as a Texas Medicaid provider through TMHP and prove three years of specific IDD service experience.

4. Licensure and Certification Requirements

Texas does not issue a traditional facility license for HCS and TxHmL waiver providers; instead, HHSC issues a Medicaid waiver contract following a certification process. Providers operate under a provisional contract initially and must pass a certification survey to obtain a standard contract.

The certification standards are codified in the Texas Administrative Code (TAC) Title 26, Part 1. Providers must maintain compliance with all program rules, including physical environment standards for any operated group homes.

5. Medicaid Provider Enrollment

Medicaid enrollment is handled exclusively through the TMHP Provider Enrollment and Management System (PEMS). This step must be completed before submitting the HCS or TxHmL contract application to HHSC.

Applicants must pay an application fee unless they qualify for a waiver, such as being already enrolled in Medicare or another state's Medicaid program. The enrollment process requires detailed ownership disclosures and taxonomy code selection.

6. Staffing, Training and Background Checks

HCS and TxHmL providers must ensure all staff, contractors, and volunteers meet specific qualifications and pass rigorous background checks before having direct contact with individuals. The provider must designate a Program Provider who oversees daily operations.

Training requirements include initial orientation on abuse, neglect, and exploitation (ANE) reporting, individual rights, and specific needs outlined in the individual's Person-Directed Plan (PDP).

7. Documentation, Policies and Records

Providers must maintain comprehensive records that align with the individual's Implementation Plan (IP) and Person-Directed Plan (PDP). Documentation must justify all billed services and demonstrate progress toward identified goals.

HHSC requires providers to establish written policies covering emergency response, behavior support, grievance procedures, and medication administration. Records must be retained for a minimum of five years.

8. Billing, Rates and Claims

Claims for HCS and TxHmL services are submitted to TMHP, but service authorizations are managed through the HHSC Service Authorization System Online (SASO) and the Medicaid Client Portal (MCP). Providers must ensure the IPC is active and authorized before billing.

Rates are established by the HHSC Provider Finance Department. Providers are also required to submit periodic cost reports through the State of Texas Electronic Provider System (STEPS).

9. Approval Sequence and Timeline

The pathway to becoming an HCS or TxHmL provider is sequential and cannot be expedited. The applicant must first secure an NPI and complete the TMHP Medicaid enrollment, which can take several months.

Concurrently or subsequently, the applicant completes the PAT and competency exam. Finally, the contract application is submitted via the CAMP portal, leading to a provisional contract issuance.

10. Common Denials and Survey Findings

Applications are frequently rejected at the CAMP portal stage due to missing prerequisites, such as failing to complete the TMHP Medicaid enrollment first or lacking the required three years of verified IDD experience.

During initial certification surveys, HHSC Long-Term Care Regulation commonly cites providers for inadequate documentation in the Implementation Plan or failure to properly conduct and document background checks.

11. Key Contacts and Resources

Prospective providers must navigate multiple state systems and portals. The primary points of contact are TMHP for Medicaid enrollment and HHSC for waiver contracting and policy.

Technical assistance for the application process is available through the HHSC IDD Waiver Contract Enrollment email and the CAMP portal support desk.

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