If your loved one receives Individualized Skills and Socialization through HCS or TxHmL, there is an important Texas update your family should know about.
Texas Health and Human Services Commission (HHSC) has clarified an important rule:
Program providers cannot charge individuals or their families additional fees for Individualized Skills and Socialization services that are being paid for through certain Medicaid waiver programs.
Let’s break down what that means.
What Is Individualized Skills and Socialization?
Individualized Skills and Socialization is a service that helps people with intellectual and developmental disabilities build skills, become more independent and participate in their communities.
Depending on the person’s individual plan and needs, activities can focus on areas such as:
- learning and practicing everyday skills;
- participating in community activities;
- developing greater independence;
- building social skills; and
- working toward personal goals.
You may also hear people refer to this service as ISS.
What Did Texas Clarify?
HHSC issued revised guidance explaining that providers cannot charge a person or their family an additional fee for Individualized Skills and Socialization when that service is already being reimbursed through:
- Home and Community-based Services (HCS);
- Texas Home Living (TxHmL); or
- Deaf Blind with Multiple Disabilities (DBMD).
In simple terms, imagine that Medicaid is paying an authorized provider for your loved one’s ISS service.
The provider cannot then turn around and charge your family an extra fee for that same covered service.
Why Is This Important?
Families already have many responsibilities.
Understanding which services Medicaid covers can be confusing, especially when a family receives a bill or is asked to pay an unexpected fee.
This clarification gives families an important question to ask:
“What exactly is this fee for?”
If you are being asked to pay for something connected with your family member’s Individualized Skills and Socialization services, ask the provider to explain the charge clearly.
Does This Mean Families Will Never Have Any Expenses?
The new guidance specifically addresses additional fees for Individualized Skills and Socialization services reimbursed through HCS, TxHmL or DBMD.
That distinction matters.
Families should avoid assuming that every possible expense connected with an activity is automatically covered.
If you are unsure about a charge, ask what the charge is for and whether it is part of the person’s authorized Medicaid service.
You can also speak with the appropriate service coordinator or other program representative when you need clarification.
What Should Families Do?
You do not need to panic or make changes simply because this guidance was issued.
Instead, be informed.
Know which services are included in your loved one’s plan. Ask questions when something is unclear. Keep copies of important service documents and notices. If someone asks you to pay an additional fee, find out exactly what the fee covers before paying it.
Families have an important role in understanding the services their loved ones receive.
The Bottom Line
The message from HHSC is straightforward:
Providers cannot charge individuals or families additional fees for Individualized Skills and Socialization services that are reimbursed through HCS, TxHmL or DBMD.
Knowing this information can help families ask better questions and understand what they should expect from their service providers.
At NUDO Homes, we believe families should have clear, understandable information about changes that may affect individuals with intellectual and developmental disabilities.
Check our News & Updates section for more important Texas IDD service updates.
Source: Texas Medicaid & Healthcare Partnership (TMHP), Revised Information Letter No. 2026-25.
Last reviewed: September 2026
This article is provided for general educational purposes. Medicaid rules and program guidance can change. Families should contact the appropriate Texas HHSC program representative or service coordinator regarding questions about an individual’s specific services or charges.
