Appendix XXXIII, Requests for Services from Individuals Under 21 Years of Age

Revision 17-1; Effective March 15, 2017

Since Sept. 1, 2007, Primary Home Care (PHC) has not been available for individuals under 21 years of age with full Medicaid benefits. Individuals requiring personal attendant services receive benefits through the Texas Health and Human Services Commission (HHSC) Personal Care Services (PCS).

Referring Requests for PCS Services

Any requests for services for Medicaid eligible individuals under age 21 must be referred to the appropriate Texas Department of State Health Services (DSHS) PCS regional office. A current list of regional offices and contact information follows.

For non-Medicaid eligible individuals under age 21:

  • refer to the Social Security Administration to apply for Supplemental Security Income (SSI), if the individual has not previously applied; and
  • begin the application process for Community Attendant Services (CAS) as outlined in the Community Care for Aged and Disabled Handbook, 2332, Requests for Services from Individuals Under Age 21.

If the individual subsequently becomes eligible for Medicaid, he must be referred to PCS and CAS services must be terminated.

Requests for Services from Individuals Turning 21 Years of Age

Individuals who will be turning 21 years of age within two months of the initial request for services should be given a choice to apply for either PCS or PHC services. If the individual chooses to apply for PCS, explain that two assessments will be required; one for PCS and one for PHC. If the individual decides to apply for PHC, begin the application process. All PHC policy and procedures apply. If eligible, services may begin as soon as the applicant is 21 years of age and certified for services.

PCS Eligible Individuals Turning 21 Years of Age

For individuals already receiving PCS who are interested in PHC, the regional PCS case worker will encourage the individual/family to contact the HHSC at least two months before the individual’s 21st birthday. Since there are differences in PCS and PHC services, the HHSC case worker will thoroughly explain the allowable PHC services at the time of the initial PHC assessment. PHC may not offer some of the services provided through the PCS program.

The applicant must meet all PHC eligibility criteria, including medical, functional and unmet need. If the applicant is eligible, PHC services are negotiated to begin on the individual’s 21st birthday. PCS services should end at midnight on the day before the individual’s birthday. Coordinate the transition with the PCS case worker and applicant to ensure there are no gaps in services.

DSHS PCS Regional Office Contact Numbers

DSHS RegionAddressTelephone NumberFax Number
Region 1PO Box 60968, WT AMU
Canyon, TX 79016
Region 2 or 31301 South Bowen Road, Suite 200
Arlington, TX 76013
Region 4 or 5 North1517 West Front Street
Tyler, TX 75702
Region 6 or 5 South5425 Polk Avenue, Suite J
Houston, TX 77023-1497
Region 72408 South 37th Street
Temple, TX 76504-7168
Region 87430 Louis Pasteur Drive
San Antonio, TX 78229
Region 9 or 10401 East Franklin, Suite 210
El Paso, Texas 79901-1206
Region 11601 West Sesame Drive
Harlingen, TX 78550