Effective September 1, 2025, updates to the Texas Medicaid reimbursement structure will impact base wage requirements for Community First Health Plans’ Long-Term Services and Supports (LTSS) Providers. These changes are part of the implementation of the Patient-Driven Payment Model (PDPM) in Medicaid and affect the attendant base wage and rate enhancement program requirements for Providers contracted to deliver personal attendant service. These changes affect services delivered in Community First STAR+PLUS and STAR Kids programs.
Overview of Changes:
- Rate Increase for Attendant Services
Effective September 1, 2025, attendant reimbursement rates will increase to support an average wage of $13.00 per hour, as directed by the 2026-27 General Appropriations Act (Senate Bill 1, Rider 23). This rate increase also includes:
- An increase in allowable payroll taxes and benefits (PTB) to 15% for residential settings and 14% for non-residential settings.
- A $0.24 increase per attendant hour to the administrative rate for personal attendant services.
The updated rates apply to both fee-for-service and managed care programs, including:
- STAR Kids (MDCP Waiver and Non-MDCP)
- STAR+PLUS Home and Community-Based Services (HCBS) and Non-HCBS
The adopted rates are published on the HHSC Provider Finance Department (PFD) webpage.
Note: The attendant rate increases impact multiple direct care services.
Impacted Services and Payment Requirements:
- STAR Kids and STAR+PLUS: personal assistance services, Community First Choice, Day Activity and Health Services (DAHS), and personal care services.
- MDCP: employment assistance, supported employment, in-home respite, and flexible family support.
- STAR+PLUS HCBS: personal assistance services, employment assistance, supported employment, respite, and assisted living services.
For members in STAR+PLUS HCBS or MDCP using the agency model, Community First is not required to revise the ISP during the plan year to reflect the new rates. However, Community First will must ensure payments to providers include the new reimbursement rates for services provided on or after September 1, 2025, even if the ISP is not updated with the new amounts.
For members in STAR+PLUS or STAR Kids using the consumer directed services (CDS) model, Community First will ensure financial management services agencies (FMSAs) are provided the updated rates, service authorizations or ISPs, as needed, to facilitate updates to individual budgets and ensure providers are paid at the appropriate reimbursement rates.
If a rate increase causes total service costs to exceed the waiver cost limit and Community First determines the member’s subsequent ISP may exceed the cost limit, Community First will follow the high needs status process, as described in the following sections of the STAR+PLUS Handbook and the STAR Kids Handbook:
STAR+PLUS Handbook
- Section 3421.6, Individual Service Plan Cost Exceeds 202 Percent of the Resource Utilization Group Cost Limit
- Section 3532, Determination of High Needs Status for Ongoing Members
- Policy Updates, Medically Fragile Process Memo
STAR Kids Handbook
- Section 3324, Individual Service Plan Exceeding the Cost Limit for Medically Dependent Children Program Services
- Discontinuation of Rate Enhancement Programs
As required by Rider 23, Rider 25, and Senate Bill 457, HHSC will discontinue all direct care rate enhancement programs effective August 31, 2025, including:
- Attendant Care Enhancement Program (ACEP)
- Direct Care Staff Rate Enhancement Program
- STAR Kids Attendant Care Enhancement Program
Providers who are contracted with Community First and participate in a rate enhancement program must coordinate directly with Community First about those programs.
Network providers currently participating in a rate enhancement program will continue to
receive these add-on payments for dates of service through August 31, 2025.
HHSC Contact:
For questions about attendant rate changes and discontinuation of rate enhancement
programs referenced, please contact HHSC Provider Finance Department Longterm
Services and Supports Customer Information Team at PFD-LTSS@hhs.texas.gov
For questions or information about direction related to ISPs, notifying Providers, working with
FMSAs or updates to the cost limit tables please contact Medicaid and CHIP services policy
team: managed_care_initiatives@hhs.texas.gov
Providers are encouraged to share this information with their staff. If you have any questions about this notice, please email Provider Relations at ProviderRelations@cfhp.com or call 210-358-6030. You can also contact your Provider Relations Representative directly.
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- Log into the Community First Provider Portal
- Go to CommunityFirstHealthPlans.com/Provider-News
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