4900, Supported Employment and Employment Assistance

Revision 22-3; Effective Dec. 1, 2022

Texas Human Resources Code, Section 32.075 requires that all Medicaid waivers offer employment assistance (EA) and supported employment (SE). Employment services are intended to assist members to find employment and maintain employment. Employment services available for members in the Medically Dependent Children Program are EA and SE. STAR Kids managed care organizations may not require SE or EA providers to obtain a denial or explanation of benefits from a member's primary insurance before seeking reimbursement for SE or EA services.

4910 Employment Assistance

Revision 22-3; Effective Dec. 1, 2022

Employment assistance (EA) is provided to a member receiving Medically Dependent Children Program (MDCP) services to help the individual locate paid employment in the community and includes:

  • identifying a member's employment preferences, job skills, and requirements for a work setting and work conditions;
  • locating prospective employers offering employment compatible with a member's identified preferences, skills and requirements; and
  • contacting a prospective employer on behalf of a member and negotiating the member's employment.

For any MDCP member, the service coordinator must ensure and document that employment services are not available to the member from the member's school district or other available community resource before authorizing EA services.

The service coordinator refers the member to the Texas Workforce Solutions-Vocational Rehabilitation Services (TWS-VRS) within 30 days of meeting with a member and identifying an interest in obtaining employment. The service coordinator should contact the local TWC office to identify the referral process used by that office. Local TWC offices may be located at webp.twc.state.tx.us/services/VRLookup/.

A member who made contact with TWS-VRS is eligible to receive EA through MDCP until TRS-VRS has developed the Individualized Plan of Employment (IPE) and the member has signed it. If a member refuses to contact TWC, they may not receive waiver-funded EA. 

If the member has exhausted TRS-VRS services or been determined ineligible for TRS-VRS services, the service coordinator authorizes a minimum of 10 hours for employment on the member's individual service plan (ISP). EA can be authorized up to 180 days. The member or provider may request more hours for EA, if needed, and funds are available in the member's MDCP budget.

If, after making application with TWS-VRS, the member is determined ineligible for TWS-VRS services, EA through MDCP can continue until the member obtains competitive integrated employment.

4911 Coordination with Texas Workforce Solutions-Vocational Rehabilitation Services for Employment Assistance

Revision 22-3; Effective Dec. 1, 2022

Upon request and with proper authorization for disclosure, the service coordinator helps the member provide the Texas Workforce Solutions-Vocational Rehabilitation Services (TWS-VRS) Vocational Rehabilitation Counselor (VRC) with the following items from a member:

  • photo identification;
  • an original Social Security card;
  • member's home address and mailing address;
  • names and addresses of any doctors the member has seen recently;
  • names and addresses of any schools the member has attended;
  • information about the member's medical insurance;
  • a list of places the member has worked, including type of job, dates, the reason for leaving and salary;
  • proof of income for the member and their spouse, or parents (if the parents claim the member as a dependent on their income tax);
  • proof of expenses related to monthly mortgage or rental payments, debts imposed by court order, personal medical costs and other disability-related expenses;
  • names, addresses and phone numbers of two people who will know how to contact the member;
  • any reports of recent medical exams, school records or other information that may help the VRC understand the member's disability;
  • member's most recent service plan;
  • any current vocational assessments or person-directed plans that focus on employment opportunities;
  • any other available records pertaining to the member's disabilities, including but not limited to medical, psychological and psychiatric reports;
  • a copy of the member's court-ordered guardianship documents, if any guardian has been appointed; and
  • contact information for the member's service coordinator.

TWS-VRS will:

  • notify a member in writing if the member is determined to be eligible or ineligible for TWS-VRS services;
  • notify a member in writing when the member’s TWS-VRS case is closed;
  • develop with the eligible member an Individualized Plan for Employment (IPE) within 90 days of determination of eligibility for services;
  • After the IPE is completed, begin coordinating the provision of services as identified on the IPE; and
  • Upon request and with proper authorization for disclosure, provide copies of any of the member's records to the service coordinator, including the following documents:
    • a completed copy of the member's application statement;
    • a member's completed IPE;
    • written documentation specifying a member's eligibility status; and
    • the notification letter indicating TWS-VRS is completed.

If TWS-VRS has not notified the member of an eligibility decision within 60 days of the initial TWS-VRS appointment, the member's service coordinator attempts to contact the assigned TWS-VRS VRC to determine the status of the application and document the contact in the narrative notes.

The member's service coordinator will ensure that communication is maintained with the assigned TWS-VRS VRC about waiver-funded services provided between the Vocational Rehabilitation (VR) referral and the "start date" of TWS-VRS active services, as defined in the individual's TWS-VRS VR IPE.

At the request of a member determined eligible for TWC, the service coordinator, will assist the member if possible, and:

  • participate in TWS-VRS planning meetings related to the member's employment, or ensure other individuals important to the member attend, as appropriate;
  • take an active role in providing input to the TWC IPE, or ensure other individuals important to the member provide input, as appropriate; and
  • if long-term services and supports are needed to maintain or advance in employment, supported employment will be incorporated in a revision to the member's service plan when the member reaches “Job Stability” status with TWS-VRS.

The member's provider must begin providing or subcontracting for those services and supports approved in the member's service plan without a gap between the provision of TWS-VRS and waiver services.

4912 Employment Assistance Providers

Revision 22-2; Effective September 1, 2022

Employment assistance providers are either employed by a licensed Home and Community Support Services Agency (HCSSA), also called a home health agency, or are employed by a member or their legally authorized representative under the Consumer Directed Services (CDS) option. At a minimum, the employment assistance provider must be at least 18 years of age, maintain a current driver license and insurance if transporting the individual, and satisfy one of these options:

Option 1:

  • A bachelor's degree in rehabilitation, business, marketing, or a related human services field; and
  • Six months of paid or unpaid experience providing services to people with disabilities.

Option 2:

  • An associate's degree in rehabilitation, business, marketing, or a related human services field; and
  • One year of paid or unpaid experience providing services to people with disabilities.

Option 3:

  • A high school diploma or Certificate of High School Equivalency (GED credentials); and
  • Two years of paid or unpaid experience providing services to people with disabilities.

Under the CDS option, the provider cannot be the member's legal guardian or the spouse of the legal guardian.

4920 Supported Employment

Revision 22-3; Effective Dec. 1, 2022

Supported employment (SE) services help a member receiving Medically Dependent Children Program (MDCP) services sustain competitive employment or self-employment.

SE services include:

  • assistance provided to a member to sustain competitive employment and who, because of a disability, requires intensive, ongoing support to be self-employed, work from home or perform in a work setting where individuals without disabilities are employed;
  • employment adaptations, supervision and training related to a member's assessed need; and
  • ensuring members earn at least minimum wage, if not self-employed.

Competitive employment is work:

  • in the competitive labor market where anyone may compete for employment that is performed on a full-time or part-time basis in an integrated setting; and
  • where a member is compensated at or above the minimum wage, but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities.

An integrated setting is a setting typically found in the community where members interact with people without disabilities, other than service providers, to the same extent that people without disabilities in comparable positions interact with other people without disabilities. An integrated setting does not include a setting where:

  • groups of people with disabilities work in an area not part of the general workplace where people without disabilities work; or
  • a mobile crew of people with disabilities work in the community.

An MDCP member may seek SE to aid the member in maintaining self-employment. Self-employment is work that the member:

  • solely owns, manages and operates a business;
  • is not an employee of another person, entity or business; and
  • actively markets a service or product to potential customers.

SE may only be authorized through the MDCP waiver if documentation is maintained in the member's record that the service is not available to the member under a program funded under the Individuals with Disabilities Education Act (20 U.S.C. Section 1401 et seq.).  In the state of Texas, this service is not available to individuals under a program funded under section 110 of the Rehabilitation Act of 1973.

4921 Coordination with Texas Workforce Commission for Supported Employment

Revision 19-1; Effective June 3, 2019

The service coordinator coordinates with the Texas Workforce Commission (TWC) and the local school districts, seeking third party resources before using Medically Dependent Children Program (MDCP) employment services, including school districts.

Activities include:

  • devoting time during a member's initial service planning meeting to discuss employment with the member and family and the process to obtain employment services and supports;
  • making a referral to TWC, assisting with completing the application form, and documenting the referral and outcome of the referral in the member's case record;
  • continuing to explore the possibility of employment at subsequent service planning meetings for a member who is not employed in the community;
  • affirming or explaining how a member can work and still maintain current medical benefits (e.g., through the Medicaid Buy-In program), and in most cases will have an increase in income;
  • explaining rights to appeal if services are denied, reduced or terminated; and
  • monitoring whether the member and family are satisfied with the employment supports.

4922 Supported Employment Providers

Revision 22-2; Effective September 1, 2022

Supported employment (SE) providers are either employed by a licensed Home and Community Support Services Agency (HCSSA), also called a home health agency, or are employed by a member or their legally authorized representative under the Consumer Directed Services (CDS) option. As a minimum, the SE provider must be at least 18 years of age, maintain a current driver license and insurance if transporting individual, and satisfy one of these options:

Option 1:

  • A bachelor's degree in rehabilitation, business, marketing, or a related human services field; and
  • Six months of paid or unpaid experience providing services to people with disabilities.

Option 2:

  • An associate's degree in rehabilitation, business, marketing, or a related human services field; and
  • One year of paid or unpaid experience providing services to people with disabilities.

Option 3:

  • A high school diploma or Certificate of High School Equivalency (GED credentials), and
  • Two years of paid or unpaid experience providing services to people with disabilities.

Under CDS, the provider cannot be the member's legal guardian or the spouse of the legal guardian.