1300, CLASS Program Eligibility

Revision 17-1; Effective November 1, 2017

HHSC approves eligibility for the CLASS program for applicants/individuals with related conditions who meet all of the following eligibility requirements.

  • The individual is financially eligible for Medicaid because the individual receives Supplemental Security Income (SSI) cash benefits or HHSC determines the individual  to be financially eligible for Medicaid.
  • HHSC determines the individual meets the diagnostic/functional eligibility criteria for the CLASS program — Intermediate Care Facility for Persons with Intellectual Disability (ICF/ID) Level of Care VIII criteria.
  • The individual has been diagnosed prior to age 22 with a related condition as described in the Texas Approved Diagnostic Codes for Persons with Related Conditions.
  • The individual has a qualifying adaptive behavior level of II, III or IV (i.e., moderate to extreme deficits in adaptive behavior) obtained by administering the Inventory for Client and Agency Planning (ICAP), Vineland Adaptive Behavior Scales, Second Edition (Vineland-II), Scales of Independent Behavior – Revised (SIB-R), or American Association of Intellectual and Developmental Disabilities (AAIDD) Adaptive Behavior Scales (ABS).
  • The individual exhibits a substantial functional limitation in at least three of the following areas of major life activities as documented on the Related Conditions Eligibility Screening Instrument:
    • learning;
    • mobility;
    • self-care;
    • language;
    • self-direction (age 10 and over); and
    • independent living (age 10 and over).
  • The individual demonstrates a need for Community First Choice (CFC) PAS/HAB.
  • The individual requires and receives at least one CLASS Program service per month, and one CLASS service per year (monthly monitoring of services by a case manager meets this requirement).
  • The individual has an Individual Plan of Care (IPC) cost for CLASS program services at or below $114,736.07.
  • The individual is not enrolled in another Medicaid waiver program.
  • The individual resides in his or her own home or family home.