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Metrocare has been caring for people for 50 years.

1.9 million Texans live with a serious and persistent mental illness

6.4 million Texans have a mental illness and would benefit from treatment

Last year, nearly 50,000 adults received services from Metrocare

Last year, 15,000 children received care from Metrocare

70% to 80% of parents with a child with autism will get divorced

40% of children with autism do not talk at all

Autism impacts more children than childhood cancer, juvenile diabetes, Down syndrome, and cystic fibrosis combined

Early diagnosis and intervention of an individual with autism can reduce the lifetime support costs by 66%

ADULT FOSTER CARE (AFC)

Service Description: Adult Foster Care (AFC) provides 24-hour living arrangements with supervision in an adult foster home for persons who because of physical, mental, or emotional limitations are unable to continue independent functioning in their own homes.

Providers of AFC must live in the household and share a common living area with the clients. With the exception of family members, no more than three may live in the foster home unless it is licensed by the Texas Department of Human Services.

Services Provided: Services may include minimal help with personal care, help with activities of daily living, and provision of, or arrangement for, transportation. The client pays the provider for room and board.

Client Eligibility: The individual must be 18 years of age or older.

Financial Eligibility: The individual must be a Medicaid recipient or be determined financially eligible for Title XX services. The caseworker applies allowable exclusions to Income and Resources.

The countable income must not exceed:

  • $1,500 per month for an individual
  • $3,000 per month for a couple

The countable resources must not exceed:

  • $5,000 or less for an individual
  • $6,000 or less for a couple

Functional Assessment: The individual must meet functional need criteria. Level of impairment is measured in a client needs assessment interview by a DHS caseworker.

For more information, call the Texas Department of Human Services @ (972) 337-6100.

COMMUNITY BASED ALTERNATIVE (CBA)

Service Description: The Community Based Alternative (CBA) program will provide home- and community-based services to aged and disabled adults as cost-effective alternatives to institutional care in nursing facilities.

Funding Source: Title XIX (Medicaid 1915 C home and community based-services waiver). State Matching Funds.

Covered Services: Case Management is provided by TDHS staff.

Waiver services include:

  • Adaptive and Medical Supplies
  • Adult Foster Care
  • Assisted Living/Residential Care Services
  • Nursing Services
  • Minor Home Modifications ($7,500 cap)
  • Occupational Therapy
  • Personal Assistance Services
  • Physical Therapy
  • Respite Care
  • Speech Pathology
  • Client Eligibility: Age 21 or older

Income/Resources: Be Medicaid eligible in the community under SSI or MAO protected status or meet the income and resource requirements for Medicaid benefits in nursing facilities.

Income: Less than $1,500/month with resources of $2,000 for an individual. Spousal impoverishment provisions apply.

Medical Necessity: Meet the Medical Necessity determination for nursing facility care.

PASARR: Be determined appropriate for nursing facility care through PASARR process.

Waiver-specific criteria:

  • Have an Individual Plan of Care approved by TDHS;
  • Choose waiver services based on an informed choice;
  • Have ongoing needs for one of the following tasks that cannot be delivered adequately on an ongoing basis by friends, relatives, volunteers, other Medicaid reimbursed services, service agencies other than TDHS, or third-party resources, and which will be met by waiver services
    medication administration;
    • tube feeding through permanently placed tubes;
    • sterile procedures, which are those procedures involving a wound or an anatomical site which could potentially become infected;
    • non-sterile procedures, such as dressing or cleansing penetrating wounds and deep burns already contaminated;
    • invasive procedures, which involve inserting tubes in a body cavity or instilling or inserting substances into an indwelling tube, e.g,.
    • intermittent or indwelling catheterization;
    • care of broken skin other than minor abrasions or cuts generally classified as requiring only first aid treatments; or
    • twenty-four hour supervision
  • receive waiver services at least monthly
  • have ongoing needs for waiver services whose projected costs, as indicated on the Individual Plan of Care, do not exceed the maximum service ceiling set for those services listed below:
    • Adaptive Aids and Medical Supplies service category cannot exceed $10,000 per individual per Individual Plan of Care year;
    • Minor Home Modifications service category cannot exceed $7,500 per individual;
    • Respite Care cannot exceed thirty (30) days per individual per Individual Plan of Care year;
    • The protective supervision component of the Personal Assistance service category cannot exceed four (4) hours per week; and
    • Service Maximum: the participant’s Individual Plan of Care cannot exceed 95% of the individual’s actual Texas Index for Level of Effort payment rate.

For more information, call the Texas Department of Human Services @ (972) 337-6100.

CHRONICALLY ILL and DISABLED CHILDREN’S SERVICES (CIDC)

Service Description: The Chronically Ill and Disabled Children’s Services (CIDC) helps arrange for medical care and helps pay the medical bills.

Funding Source: Texas Department of Health’s largest non-Medicaid program. CIDC uses state funds to pay for medical and related services for consumers whose families’ income are too high to qualify for Medicaid but not sufficient to cover extraordinary medical costs.

Covered Services: CIDC pays for the following services:

  • First visit to a doctor.
  • Tests or doctor visits to find out what is wrong and how to treat it
  • Up to 60 days in the hospital each year
  • Braces and artificial limbs
  • Medicine a doctor orders
  • Special equipment, such as wheelchairs, that a doctor orders
  • Medical supplies a doctor orders
  • Speech therapy
  • Physical/occupational therapy
  • Home health care
  • Travel costs to take a client to a place where he or she can be treated
  • Food and a place to stay on long trips to get treatment
  • Inpatient rehabilitation up to 90 days a year
  • Nutritional supplement that a doctor orders
  • Insurance premiums

Client Eligibility Age: Child must be younger than 21, unless there is a diagnosis of cystic fibrosis (then, clients over 21 years of age may qualify).

Income/Resources: Child must meet CIDC income/asset limit. Family income no more than 200% above the federal poverty line.

Medical Necessity: Child must have a CIDC coverable diagnosis.

Coverable Diagnosis: CIDC covers services for the following diagnoses:

  • AIDS & HIV
  • Bone, muscle, and joint problems
  • Severe burns
  • Cancer
  • Heart problems
  • Cerebral palsy and other neurological disorders
  • Cleft (split) lip, cleft palate (roof of mouth)
  • Other craniofacial anomalies (misshapen head and/or face)
  • Diabetes
  • Epilepsy
  • Certain ear and eye problems
  • Stomach and bowel problems that a child was born with
  • Spina bifida
  • Certain blood problems, such as hemophilia and sickle cell disease
  • Certain metabolic and genetic disorders
  • Cystic fibrosis – Note: CIDC can work with a person of any age with cystic fibrosis, if the family is within the CIDC income and asset limits.

For more information, call the Texas Department of Human Services @ (972) 337-6100.


COMMUNITY LIVING ASSISTANCE and SUPPORT SERVICES (CLASS)

Service Description: The Community Assistance and Support Services (CLASS) program provides home- and community-based services to people with related conditions as a cost-effective alternative to ICF-MR/RC institutional placement. People with related conditions are people who have a disability, other than metal retardation, which before the age of 22 affects their ability to function.

There are two service providers: one provides independent case management for CLASS; the other provides all other services. The CLASS service model focuses on client independence and integration of the client into everyday community life.

Services Provided: Services include the following:

  • Case Management
  • Habilitation
  • Respite Care
  • Nursing Services
  • Psychological Services
  • Physical Therapy

Client Eligibility: The individual must be 18 years of age or older.

Financial Eligibility: The individual must be a Medicaid recipient or be determined financially eligible for Title XX services. The caseworker applies allowable exclusions to Income and Resources. The countable income must not exceed:

  • $1,500 per month for an individual
  • $3,000 per month for a couple

The countable resources must not exceed:

  • $5,000 or less for an individual
  • $6,000 or less for a couple

Functional Assessment: The individual must meet functional need criteria. Level of impairment is measured in a client needs assessment interview by a DHS caseworker.

For more information, call the Texas Department of Human Services @ (972) 337-6100.

CHILDREN WITH SPECIAL HEALTH CARE NEEDS (CSHCN)

Service Description: Children with Special Health Care Needs (CSHCN) helps arrange for medical care and helps pay medical bills.

Funding Source: Texas Department of Health’s largest non-Medicaid program. CSHCN uses state funds to pay for medical and related services for consumers whose families’ income are too high to qualify for Medicaid but not sufficient to cover extraordinary medical costs.

Covered Services: CIDC pays for the following services:

  • First visit to a doctor
  • Tests or doctor visits to find out what is wrong and how to treat it
  • Up to 60 days in the hospital each year
  • Braces and artificial limbs
  • Medicine a doctor orders
  • Special equipment, such as wheelchairs, that a doctor orders
  • Medical supplies a doctor orders
  • Speech therapy
  • Physical/occupational therapy
  • Home health care
  • Travel costs to take a client to a place where he or she can be treated
  • Food and a place to stay on long trips to get treatment
  • Inpatient rehabilitation up to 90 days a year
  • Nutritional supplement that a doctor orders
  • Insurance premiums

Client Eligibility Age: Child must be younger than 21, unless there is a diagnosis of cystic fibrosis (then, clients over 21 years of age may qualify).

Income/Resources: Child must meet CSHCN income/asset limit. Family income no more than 200% above the federal poverty line.

Medical Necessity: Child must have a CSHCN coverable diagnosis.

Coverable Diagnosis: CSHCN covers services for the following diagnoses:

  • AIDS & HIV
  • Bone, muscle, and joint problems
  • Severe burns
  • Cancer
  • Heart problems
  • Cerebral palsy and other neurological disorders
  • Cleft (split) lip, cleft palate (roof of mouth)
  • Other craniofacial anomalies (misshapen head and/or face)
  • Diabetes
  • Epilepsy
  • Certain ear and eye problems
  • Stomach and bowel problems that a child was born with
  • Spina bifida
  • Certain blood problems, such as hemophilia and sickle cell disease
  • Certain metabolic and genetic disorders
  • Cystic fibrosis – Note: CSHCN can work with a person of any age with cystic fibrosis, if the family is within the
  • CIDC income and asset limits.

For more information, call the Texas Department of Human Services @ (972) 337-6100.


DAY ACTIVITY and HEALTH SERVICES (DAHS)

Service Description: Day Activity and Health Services (DAHS) facilities provide daytime services Monday through Friday. These services are provided to clients residing in the community in order to provide an alternative to placement in nursing homes or other institutions. Services are designed to address the physical, mental, medical, and social needs of clients.

Services Provided: Services may include the following:

  • Nursing and personal care
  • Physical rehabilitation
  • Noon meals and snacks
  • Transportation
  • Social, educational, and recreational activities
  • Client Eligibility: Age: no limit

Financial Eligibility: The individual must be a Medicaid recipient or be determined financially eligible for Title XX services. The caseworker applies allowable exclusions to Income and Resources. The countable income must not exceed:

  • $1,500 per month for an individual
  • $3,000 per month for a couple

The countable resources must not exceed:

  • $5,000 or less for an individual
  • $6,000 or less for a couple

For more information, call the Texas Department of Human Services @ (972) 337-6100.


EXTENDED REHABILITATION SERVICES

Service Description: The Extended Rehabilitation Services (ERS) program helps Texans with severe disabilities work by offering on-going support in their jobs. Services are long-term and extended to both the job site and away. Community Integrated Employment, a primary goal of the program, helps clients work in their communities. Alternative Sheltered Employment is also an option for some people who need more assistance and where the majority of co-workers are also disabled.

Eligibility: Eligibility criteria for ERS include, but are not limited to, the following:

  • Being capable of achieving an employment outcome;
  • 16 years of age or older;
  • Legal resident of Texas; and
  • Capable of earning at least 15% of minimum wage

Services: ERS clients are eligible for all Vocational Rehabilitation Services. In addition, there are services unique to ERS that are not time limited. All services are tailored to individual needs and may include:

  • Mobility assistance;
  • Job coaching;
  • Transportation to and from job;
  • Activities to improve daily living skills;
  • Assistance in developing self-help and adaptive skills; and
  • Assistive technology necessary for employment.


PRIMARY HOME CARE (PHC)

Service Description: Primary Home Care (PHC) is a non-technical, medically-related personal care service prescribed by a physician as part of a client’s plan of care. PHC is available to eligible clients, whose health problems cause them to be functionally limited in performing activities of daily living.

Services Provided: Services may include the following:

Personal Care: These services include assistance with activities related to the care of the client’s physical health. These activities include bathing, grooming, routine hair and skin care, preparing meals, feeding, exercising, helping with self-administered medication, toileting, and transferring/ambulating.
Home Management. These services include assistance with housekeeping activities that support the client’s health and safety. These activities include changing bed linens, housekeeping, laundering, shopping, storing purchased items, and washing dishes.

Escort: Accompanying the client on trips to obtain medical diagnosis or treatment or both. This service does not include the direct transportation of the client by the attendant.

Client Eligibility:

Age: There is no age limit.

Financial Eligibility: The individual must be a Medicaid recipient or be determined financially eligible for the program. The countable income must not exceed:

    • $1,500 per month for an individual
    • $3,000 per month for a couple

The countable resources must not exceed:

    • $5,000 or less for an individual
    • $6,000 or less for a couple

Functional Eligibility: The individual must meet functional need criteria. Level of impairment is measured in a client needs assessment interview by a DHS caseworker.

For more information, call the Texas Department of Human Services @ (972) 337-6100.


QUALIFIED MEDICARE BENEFICIARY (QMB)

Service Description: The Qualified Medicare Beneficiary (QMB) provides some medical-related financial assistance by paying for Medicare Part B premiums, deductibles, and co-pay amounts for eligible Medicare beneficiaries.

Client Eligibility: An individual must be enrolled in Medicare Part A, 65 years old or receiving disability benefits from social security for at least 24 months, and have an income below $707 for an individual and $942 for a couple. Assets may not exceed $4,000 for an individual and $6,000 for a couple; excluding homestead.


SPECIFIED LOW-INCOME MEDICARE BENEFICIARY

Service Description: The Specified Low-Income Medicare Beneficiary (SLMB) provides financial assistance by paying only for Part B Medicare premiums for individuals having slightly higher incomes than those qualifying for QMB.

Client Eligibility: An individual must be enrolled in Medicare Part A. 1999 monthly income limit: $844 for an individual and $1,126 for a couple. Assets may not exceed $4,000 for an individual and $6,000 for a couple.

For more information, call the Texas Department of Human Services @ (972) 337-6100.


RESIDENTIAL CARE

Service Description: The Residential Care (RC) program provides services to eligible adults who require access to care on a 24-hour basis but do not require daily nursing intervention. Services include, but are not limited to, personal care, home management, escort, 24-hour supervision, social and recreational activities, transportation, food, and room. Services provided under the RC program are delivered through one of the two arrangements: supervised living or emergency care.

Services Provided: Supervised living is a state-funded 24-hour living arrangement in which the client is expected, if able, to contribute to the total cost of his or her care. The client keeps a monthly allowance for personal and medical expenses, and the remainder of his or her income is contributed to the cost of care.

Emergency care is a state-funded or Title XX-funded living arrangement that provides services to eligible clients while caseworkers seek a permanent care arrangement. Emergency care clients do not contribute toward the cost of their care.

Client Eligibility: The individual must be 18 years of age or older.

Financial Eligibility: The individual must be a Medicaid recipient or be determined financially eligible for Title XX services. The caseworker applies allowable exclusions to Income and Resources. The countable income must not exceed:

  • $1,500 per month for an individual
  • $3,000 per month for a couple

The countable resources must not exceed:

  • $5,000 or less for an individual
  • $6,000 or less for a couple

Functional Assessment: The individual must meet functional need criteria. Level of impairment is measured in a client needs assessment interview by a DHS caseworker.

Other Criterion: The individual must not have needs that exceed the facility’s capability under its licensed capacity.

For more information, call the Texas Department of Human Services @ (972) 337-6100.


RESPITE CARE

Service Description: The Respite Care program provides short-term services for adults who are elderly and adults who are disabled who require care and/or supervision while allowing their caregivers temporary relief. Services may be provided inside or outside the house.

Services Provided: Services may be provided:

  • In a nursing home or hospital, and include personal care, nursing intervention, supervision, meal preparation, and a room.
  • In an adult foster care home or personal care home, and include personal care, housekeeping, supervision, meal preparation, transportation, and a room.
  • In an adult day health care facility, and include personal care, nursing services, supervision, meal preparation, and transportation.
  • In the individual’s own home by a home care attendant, and include personal care, housekeeping, meal preparation, supervision, and transportation.
  • In the individual’s own home by a sitter, and include housekeeping, meal preparation, and supervision.

Client Eligibility: The individual must be 18 years of age or older.

Financial Eligibility: The individual must be a Medicaid recipient or be determined financially eligible for this program.

Other Criteria:

  • The individual must need care or supervision or both due to a physical disability or functional impairment.
  • The individual must have a caregiver who needs relief from care-giving responsibilities because of severe stress or who is temporarily unable to provide care.

Service Maximum: 336 hours (14 days) per year.

For more information, call the Texas Department of Human Services @ (972) 337-6100.


TEXAS REHABILITATION COMMISSION (TRC)

VOCATIONAL REHABILITATION PROGRAM

Service Description: The Vocational Rehabilitation Program helps Texans who have physical or mental disabilities prepare for, find, or keep employment. Vocational Rehabilitation counselors and clients work together to decide on an employment goal, and to develop a program of vocational rehabilitation services to achieve the goal. The counselor will provide the client with schools, colleges, doctors, hospitals, job coaches, and other resources to carry out services.

Eligibility: A person is eligible if the person has a disability, which results in:

Substantial problems in getting employment;

  • Vocational rehabilitation services are required by that person to prepare for, get and/or keep a job; and
  • That person is able to get and/or keep a job after receiving services.

Major Disability Groups Served: The Vocational Rehabilitation Program serves people with a wide variety of disabilities. Some of the major disability groups are:

  • Mental Illness
  • Hearing Impairment
  • Impaired Functioning of Arms or Legs
  • Back Injury
  • Alcoholism or Drug Addiction
  • Mental Retardation
  • Learning Disability
  • Traumatic Brain Injury
  • Other Physical or Mental Disabilities

Services: There are many services available to eligible clients. These services are provided based on each client’s individual need. Some of these services are:

  • Medical, psychological, and vocational evaluation to determine the nature and degree of the disability, and to help find the client’s job capabilities;
  • Counseling and guidance to help the client and family plan vocational goals and to adjust to the working world;
  • Hearing examinations, purchasing of hearing aids and other communication equipment, aural rehabilitation and interpreter services for the deaf and hearing-impaired;
  • Medical treatment, including hospitalization, surgery, and therapy to lessen or remove the disability;
  • Assistive devices such as artificial limbs, braces, wheelchairs, and hearing aids to stabilize or improve functions on the job or at home;
  • Rehabilitation technology devices and services to improve job functioning;
  • Training to learn job skills in trade school, college, university, on the job, or at home;
  • Training to learn appropriate work behaviors and other skills to find and keep jobs and to meet employer expectations;
  • Job placement assistance to find jobs compatible with the person’s physical and mental ability;
  • Follow-up after placement to ensure job success;
  • Assisting work-injured Texans in returning to work.

For more information, call the Texas Rehabilitation Commission @ (972) 337-6100.


SUPPLEMENT SECURITY INCOME

SSI: Supplemental Security Income is a program that pays monthly benefits to people with limited income and resources that are age 65 or older, blind, or disabled. Blind or disabled children, as well as adults, can get SSI.

How is SSI different from Social Security Benefits?
SSI benefits are not based on your prior work or a family member’s prior work. The SSI program is funded by General Revenue. To get SSI, you must have limited income and resources. By filing for SSI in most states, SSI beneficiaries also can get Medicaid (medical assistance) to pay for hospital stays, doctor bills, prescription drugs, and other health costs. SSI beneficiaries may also be eligible for food stamps.

Disabled – Child:
Under age 18, and

  • Has a physical or mental condition that can be medically proven and which results in marked and severe functional limitations, and
  • The condition must have lasted or be expected to last at least 12 months or end in death.

Disabled – Adult
For individuals age 18 and older, the law defines disability as the inability to engage in any substantial gainful activity as a result of any medically determinable physical or mental impairment, which can be expected to result in death, or has already lasted, or can be expected to last, for a continuous period of not less than 12 months.

How to apply for SSI:

  • You can call us and make an appointment to apply for SSI.
  • You can have an appointment on the telephone or in person at your local Social Security office.
  • Someone else can call for you.
  • You can visit our office to apply without making an appointment, but you may have to wait a while.
  • You will have to provide information and work with us to get documents concerning SSI eligibility.
  • You will have to sign an application.
  • Most of the forms to apply for SSI are not designed for self-completion. In fact, most claims are taken electronically. A claims representative interviews you and uses a personal computer to complete the forms with information you provide.

Documents you may need when you apply for SSI:

  • Social Security card or number \
  • Proof of age
  • A public birth record recorded before age 5
  • A religious birth record recorded before age 5
  • Any other documents showing your age or date of birth
  • Citizenship or Alien status record.
  • Proof of Income
  • Earned Income
  • Unearned Income
  • Proof of Living Arrangements
  • Medical Sources

If you are applying as a blind or disabled person, you need to give us:

  • Your medical reports, if you have them, and Names, addresses, and telephone numbers of doctors and other providers of medical services.

How long does the decision take? The decision usually takes about 3 to 4 months from the date of application. Sometimes a presumptive disability or blindness decision is made and Expedited Payments are made.

For additional information contact the Social Security Administration @ (800) 772-1213 from 7:00am to 7:00pm, Monday through Friday. If you are hearing impaired, you may call the toll free TTY-TDD number (800) 325-0778 from 7:00am to 7:00pm, Monday through Friday.

Or visit the Web site:
www.ssa.gov/notices/supplemental-security-income/text-understanding-ssi-htm

SOCIAL SECURITY ADMINISTRATION

Survivor Benefits: When a person who has worked and paid Social Security taxes dies, certain members of the family may be eligible for survivor’s benefits. Up to ten years of work is needed to be eligible for benefits, depending on the person’s age at time of death.

Who is eligible for Survivor Benefits:

  • A widow/widower - full benefits at full retirement age, or reduced benefits as early as age 60
  • A disabled widow/widower – as early as age 50
  • A widow/widower at any age if he or she takes care of the deceased’s child who is under age 16 or disabled, and receiving Social Security benefits
  • Unmarried children under age 18, or up to age 19 if they are attending high school full time.
  • Children at any age who were disabled before age 22 and remain disabled.

For additional information contact the Social Security Administration @ (800) 772-1213 from 7:00 am to 7:00 pm, Monday through Friday. If you are hearing impaired, you may call the toll free TTY-TDD number (800) 325-0778 from 7:00 am to 7:00 pm, Monday through Friday.

 

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