Some Texas caregivers could see hourly rate cut in June

Diane Kearns testifies against an HHSC proposed rule change that would cut hourly rates for some caregivers in the state (Courtesy The Arc Texas)
Diane Kearns testifies against an HHSC proposed rule change that would cut hourly rates for some caregivers in the state (Courtesy The Arc Texas)

AUSTIN (KXAN) — Tens of thousands of the state’s most vulnerable people, those with intellectual and developmental disabilities, rely on in-home caregivers. The state is looking to cut millions of dollars designated to fund at-home Medicaid services for these clients.

The two waiver programs that could see cuts are Texas Home Living (TxHmL) and Home and Community-based Services (HCS). The TxHmL waiver provides select services and support for people with an intellectual disability who qualify for intermediate care facility level of care and live in family homes or their own homes. The HCS waiver provides individualized services to those who qualify, like supported home living, respite, physical therapy and speech and language pathology.

On Thursday, dozens of people voiced their opposition to the proposed rule change during a public hearing with the Texas Health and Human Services Commission.

Diane Kearns was there with her son Dean Osterweil, who has cerebral palsy. Osterweil is visually impaired, cannot speak and needs care around the clock.

“He is a fantastic young man but he does have a lot of challenges due to his disability,” said Kearns. “You really have to get someone who really wants to make a difference in the life of someone with a disability. There’s not a huge pool of people to choose from.”

Kearns says the caregivers that work with her son are like family and have helped them for years. She worries the rate cuts would force them to quit.

“They need to pay their student loans, they need to pay for their groceries, their car payments, their rent. They just can’t afford to work for us as much, as they love our family, they will all be gone,” said Kearns.

Under the proposal, the rate would be reduced from $22.41/hr to $17.73/hr, a 21 percent decrease. The state says their current rate is significantly higher than similar services, and that the change would save the state over $70 million in the next two years, creating a savings within Medicaid.

The Arc Texas, which advocates for people with intellectual and developmental disabilities, says comparing TxHmL and HCS rates to other services like the Community Living Assistance and Support Services (CLASS) is like comparing apples to oranges. They say CLASS has a lower level of need individuals, easier documentation, less reporting, more flexibility regarding trained employees and less active care. The rate for CLASS is $13.85/hr.

The state says there are about 26,750 clients in HCS and 5,464 in TxHmL annually.

“This is yet another instance of the state of Texas picking on people with disabilities,” said Kearns.

A public hearing on the proposed rate change is scheduled for May 17. If the rule and rate change are adopted, it take effect July 1. provides commenting to allow for constructive discussion on the stories we cover. In order to comment here, you acknowledge you have read and agreed to our Terms of Service. Users who violate these terms, including use of vulgar language or racial slurs, will be banned. If you see an inappropriate comment, please flag it for our moderators to review.

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