What is the HCS program in Texas?

What is the HCS program?

HCS is a Medicaid waiver program run by the Texas Health and Human Services Commission (HHSC). It supplies services and supports to Texans with an intellectual disability or a related condition so they can live in the community.

HHSC describes HCS services as a supplement, not a replacement. They sit on top of other programs, such as Texas Health Steps, and on top of natural supports like family, neighbors, and community groups.

HHSC does not deliver the services itself. It contracts with public and private providers and monitors them for quality.

Who qualifies for HCS in Texas?

According to HHSC, HCS may be available to any Texas resident who does not live in an institutional setting and who meets four conditions: an IQ of 69 or below (or 75 or below with an approved related condition), mild to severe deficits in adaptive behavior, Medicaid eligibility, and no enrollment in another Medicaid waiver.

Eligibility also runs through a formal assessment. The Intellectual Disability/Related Condition Assessment (ID/RC, HHSC Form 8578) is used to determine the level of care, which decides program eligibility, and HHSC assigns a level of need (LON) from the ID/RC and the ICAP assessment. The LON sets how residential support, supervised living, host home/companion care, and ISS are reimbursed.

The LON also sets the yearly HCS individual cost limit. HHSC Information Letter 2025-21 lists these limits, effective Sept. 1, 2025. Each is 210 percent of the annualized ICF/IID cost of care at that level of need.

• Texas resident, not living in an institution
• IQ of 69 or below, or 75 or below with an approved related condition
• Mild to severe deficits in adaptive behavior
• Eligible for Medicaid
• Not enrolled in any other Medicaid waiver program
• Cost limit: $169,182 per year for Intermittent (LON 1), Limited (LON 5), and Extensive (LON 8); $211,822 for Pervasive (LON 6); $392,318 for Pervasive Plus (LON 9)

How does someone get into HCS?

To get on the HCS interest list, the person, their legally authorized representative, or an actively involved party calls the HHSC Community Services Interest List (CSIL) hotline at 877-438-5658. The local intellectual and developmental disability authority (LIDDA) keeps the person's interest list record in HHSC's CSIL system. An offer depends on need, the date the person was placed on the list, and available funding.

Once HHSC approves an offer, the LIDDA helps with the application and coordinates enrollment and ongoing services. The individual then chooses a provider from the list of providers in their area.

The wait is long. HHSC told the Texas House in May 2026 that HCS served 30,516 people and had 128,111 on its interest list, using August 2025 figures based on January 2026 reports. People still on the list as of Aug. 31, 2025, had waited 8.4 years on average. People removed from the list in fiscal year 2025, for any reason, had waited 16.7 years.

HCS slot releases are paused. HHSC announced on May 19, 2026, that it "will not release interest list reduction slots for the HCS program starting in May 2026," because biennial appropriations for HCS are insufficient to support more slot releases, based on data as of March 2026. HHSC says it will provide updates and has not given a date to resume.

Individuals can change providers at any time, even after moving to another part of Texas. People who live in their own home or a family home can also choose the Consumer Directed Services (CDS) option and hire, train, and manage some of their own service providers through a financial management services agency.

What services does HCS cover?

HCS covers residential services, day services, therapies, nursing, and supports for daily living. HHSC lists more than 20 service types, from group home and host home/companion care to individualized skills and socialization, nursing, behavioral support, and adaptive aids.

Residential services are the heart of HCS for group home providers. Residential support and supervised living are provided in a three-person or four-person residence that the provider owns or leases, and the provider may not live there. For residential support, a staff member must be present and awake whenever the individual is home. For supervised living, a staff member must be present during normal sleeping hours.

Host home/companion care is the other residential option. The individual lives in the home of a host home or companion care provider instead of a provider-run residence.

Individualized skills and socialization (ISS) is the HCS day service. It is delivered on-site at a licensed ISS location, off-site in the community, or in-home when the individual meets the criteria for it.

• Residential services: group home (residential support, supervised living) and host home/companion care
• Individualized skills and socialization
• Employment services
• Respite
• Nursing, dental, and dietary services
• Behavioral support and social work
• Occupational, physical, and speech therapy, audiology, and cognitive rehabilitation
• Supported home living (transportation)
• Adaptive aids, minor home modifications, and transition assistance

What do the LIDDA and the service coordinator do?

The LIDDA service coordinator leads person-directed planning. The coordinator gathers information about what matters to the individual, convenes the planning meeting, and develops the person-directed plan (PDP) with the individual, their legally authorized representative, the provider, and others the individual invites.

The PDP is recorded on HHSC Forms 8665-ID and 8665. HHSC describes person-directed planning as an ongoing process, and the PDP is treated as a new plan at each yearly IPC renewal. Within an IPC year it changes only when needed, and the coordinator documents what changed and when.

The service coordinator justifies which services an individual needs. The provider justifies how much of each service is needed, through its implementation plan.

How do the IPC and the PDP fit together?

The PDP says what the individual wants and needs. The Individual Plan of Care (IPC, HHSC Form 3608) lists the HCS and non-HCS services and amounts that deliver it. Every HCS service on the IPC must be supported by documentation in the PDP.

An IPC is completed at enrollment and is valid for 365 days, called the IPC year, as long as the individual stays eligible. It must be renewed before the current IPC ends and can be revised any time during the year.

Who enters it matters. The service coordinator enters the initial IPC in the HHSC data system, and the program provider enters renewals and revisions. When the IPC changes, the provider must also update its implementation plan (HHSC Form 2125) so the day-to-day plan matches.

What documentation does HHSC expect from HCS providers?

HHSC expects written, legible documentation behind every service claim. Under the HCS Program Billing Requirements, a service log must be written after the service, name the individual and the date, describe the billable activities, be signed with the staff member's title, and be made within 14 calendar days.

For residential support and supervised living, HHSC publishes Form 4119, the Service Delivery Log, as an example format. Providers may use it or any format that meets the same written documentation rules.

The stakes are real. In a provider fiscal compliance review, HHSC staff check the provider's written documentation, and HHSC recoups payment for any claim it cannot verify is supported. Vague entries such as "had a good day", ditto marks, and copied text are not accepted as descriptions of activities.

How does Sereniq support HCS providers?

Sereniq is the documentation system of record for HCS group home and host home providers. DSPs write notes on their phones, and those notes become the Form 4119 or Form 4122 service delivery log, the MAR, and the individual binder a surveyor asks for.

For the planning packet, Sereniq stores the LIDDA's finished PDP and reads it once with AI into goals, services, and contacts that a person reviews and confirms before anything is saved. Sereniq does not fill in Form 8665. From the confirmed rows it drafts the IPC (printed as Form 3608) and the Implementation Plan (Form 2125), and it keeps the ID/RC on Form 8578. These forms carry typed signature lines, and the IPC is still entered in the TMHP LTC Online Portal.

Sereniq was born in Texas on HHSC forms and adapts forms, terms, and time zones for other states. Texas is live today.