3100, Eligibility Determination Procedures

3110 Eligibility for CCSE Services

Revision 24-1; Effective March 1, 2024

To receive Community Care Services Eligibility (CCSE), a client must meet income, resource, age, and need criteria.

People who live in nursing homes are not eligible to receive CCSE services.

An applicant or person who lives in Texas may qualify to receive most CCSE services regardless of citizenship or the duration of residency. However, a person may not receive Community Attendant Services or waiver services without verification of citizenship and identity.

Provider agencies must accept HHSC's decision about which people are eligible. Visit Section 4000, Specific CCSE Services for eligibility requirements for specific CCSE services.

Note: Refer to Appendix XV, Services Available from Other State Agencies, for information about services that may benefit the applicant/individual.

Related Policy

26 TAC Section 271.51(a) 
26 TAC Section 271.51(b)

3111 Age Limits

Revision 24-1; Effective March 1, 2024

A person must be 18 years or older, or an emancipated minor, to receive Community Care Services Eligibility (CCSE) services, except:

  • a person of any age may receive CCSE Medicaid-funded day activity and health services;
  • a person of any age who is not eligible for the Texas Health Steps program may receive CCSE Medicaid-funded community attendant services.

Although age limits do not apply to Title XIX Day Activity and Health Services (DAHS), licensure prohibits service providers to deliver DAHS services in facilities that are not licensed to serve people under 18. There are currently no facilities licensed in Texas that can serve non-adults.

Related Policy

26 Texas Administrative Code Section 271.61 

3120 Loss of Eligibility

Revision 24-1; Effective March 1, 2024

A person is not eligible for CCSE services when the person:

  • dies;
  • is admitted to an institution;
  • physician requests service termination for Medicaid services only; or
  • requests service termination or repeatedly refuses to accept help, except in an involuntary protective services case, or they refuse to comply with his service plan. 

The case worker must notify the provider as soon as a person has died or is entering a nursing home. Terminate services effective the date of death or entry into the nursing home. The provider cannot bill for attempting to deliver services after the effective date of the termination.

Related Policy

26 Texas Administrative Code Section 271.155(c)