May 3rd, 2021
Information Letter No. 2021-19
Termination of Waiver Services during the Public Health Emergency was on hold for eligibility issues, but that is now back in effect as of May 10th, 2021.
This information letter is to notify you that, starting May 10, 2021, HHSC will resume ending waiver services of an individual who is not eligible for CLASS, DBMD, HCS, or TxHmL. This is being done in accordance with a rule promulgated by the federal Centers for Medicare and Medicaid Services (CMS).
During the federal public health emergency (PHE), HHSC has not terminated individuals’ IDD waiver services for most reasons related to eligibility. The only service terminations processed during the PHE have been due to an individual dying, moving out of state, or voluntarily withdrawing from a program.
In accordance with CMS’s Interim Final Rule CMS-9912-IFC, starting May 10, 2021, HHSC will resume processing CLASS, DBMD, HCS, and TxHmL program terminations for individuals who do not meet a program’s eligibility. The rules for program eligibility are:
● §9.155 for HCS,
● §9.556 for TxHmL,
● §42.201 for DBMD, and
● §45.201 for CLASS.
Individuals no longer eligible for a waiver program will have waiver services terminated, but may continue to receive Medicaid state plan services, such as primary care and pharmacy benefits, until the end of the federal PHE.
If there are any additional changes to Medicaid coverage, HHSC will notify individuals at the appropriate time.
To read more, here is Information Letter 2021-19
Contact the following with questions about termination of a person’s program:
HCS, TxHmL, CLASS Program Services:
IDD Program Enrollment and Support Message Line at 512-438-2484.
DBMD Program Services
IDD Utilization Review Message Line at 512-438-4896
