November 10th, 2025
HHSC Rider 23 from the 2026-2027 General Appropriations Act, Senate Bill 1, 89th Texas Legislature
HHSC has published the Information Letter IL 2025-25 regarding the Rider 23: Texas Administrative Code Rule Amendments, Personal Attendant Base Wage Discontinuation, Rate Enhancement Discontinuation, Established Average Hourly Wage Assumed in Methodology, and Established Direct Care Wage and Benefits Expense Ratio, effective September 1, 2025. Review the IL for more information.
At the bottom of page 4 and top of page 5, HHSC details its plan to align the definition of attendant cost component with the CMS rule related to Ensuring Access to Medicaid Services. This federal rule modified the definition of direct care to include nurses and other staff providing clinical supervision.
HHSC’s timeline for making this change:
HHSC says they are still evaluating the scope of this alignment. They do anticipate the change will align with a state fiscal year, in part because the cost reports are not collected on a state fiscal year time-period. Therefore, the earliest alignment would be effective 9/1/26. HHSC will be issuing public notices once the timeline is finalized the advising of the changes.
More information about the attendant programs and payment rates is available on the HHSC Provider Finance Department (PFD) webpage.
If you have questions, contact the HHSC PFD, Long-term Services and Supports (LTSS), Center for Information and Training at PFD-LTSS@hhs.texas.gov or (737) 867-7817.