Beginning September 1, 2025, the Texas Health and Human Services Commission (HHSC) will implement significant changes to the way attendants in Medicaid and long-term services programs are compensated. The state is raising the base reimbursement rates paid to attendants, but at the same time it is discontinuing long-running enhancement programs that had previously boosted wages beyond the base level. The change is the result of directives outlined in the 2026-27 General Appropriations Act, passed by the 89th Texas Legislature through Senate Bill 1.
The most immediate impact is the end of the Attendant Care Enhancement Program (ACEP) and the Direct Care Staff Rate Enhancement Program, both of which officially concluded on August 31, 2025. These programs were designed to incentivize providers to raise wages for attendants by offering additional funding on top of standard Medicaid reimbursement rates. In practice, many attendants and providers relied heavily on these enhancements to make compensation competitive in a tight labor market. Without them, some workers may see a reduction in their overall earnings, depending on how the new base rates compare to the enhanced levels they had been receiving.
To offset the loss of enhancements, HHSC is implementing higher standard rates for attendant services across multiple programs, including STAR+PLUS, Home and Community-based Services (HCS), and other waiver programs serving individuals with disabilities and long-term care needs. According to agency announcements, the new base structure includes adjustments meant to ensure that attendants earn at least $13 per hour, with provisions for payroll costs such as benefits and payroll taxes. By building the increases into the base rather than through optional enhancements, the state aims to provide more stability and predictability in how attendants are paid.
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The policy change reflects a broader shift in how Texas funds long-term services and supports. While enhancements gave flexibility to providers, they also created disparities between agencies that chose to participate and those that did not. Some attendants benefited from significantly higher wages, while others performing the same work received only the base rate. By eliminating the enhancement programs and raising the base, the state hopes to create a more uniform system. However, critics argue that the enhancements served as critical tools for recruitment and retention in a workforce that already faces high turnover and chronic staffing shortages.
Attendant care has long been one of the most challenging sectors in Texas’s healthcare system. Workers provide essential daily assistance to older adults, individuals with disabilities, and those with complex medical needs in both home and community settings. Yet wages have historically been among the lowest in healthcare, leading to persistent recruitment struggles. In recent years, inflation and rising costs of living have intensified these challenges, making it increasingly difficult for providers to keep positions filled. By embedding a higher wage floor into the base Medicaid rate, HHSC is responding to years of advocacy from families, providers, and lawmakers calling for stronger financial support for attendants.
Still, concerns remain about the unintended consequences of this transition. Many providers had structured their operations around enhancement payments and invested in staff based on those higher funding levels. Without enhancements, agencies may struggle to cover the difference if the new base does not fully match what was previously provided. Attendants themselves may also notice that their take-home pay does not stretch as far as before, particularly if the enhancements they relied on had pushed their wages well above the new statewide minimum. This could lead some workers to leave the field altogether, further straining a system already under pressure.
For the individuals receiving services, the changes could affect both access and quality. Families who depend on reliable attendant care may encounter disruptions if agencies reduce staff or if workers leave for higher-paying opportunities in other industries. For those who receive support in home- and community-based programs, stability in staffing is especially critical. Turnover not only disrupts care but can also affect relationships and trust built between attendants and the people they serve. HHSC has acknowledged these challenges and has said it will monitor the impact of the new rate system closely.
The broader financial context is also important. The Texas Legislature allocated funding for these changes as part of its biennial budget, which included significant investments in health and human services. By eliminating enhancement programs, lawmakers have sought to streamline reimbursement while still ensuring that the workforce sees a raise. At the same time, HHSC has introduced a new measure known as the Patient Care Expense Ratio, which requires providers to dedicate a portion of their income directly to wages and care costs. This mechanism is designed to ensure that money earmarked for attendants truly reaches the workforce, even without the older enhancement framework.
As the new system takes effect, providers, attendants, and families across Texas will be watching closely to see how the policy plays out in practice. Supporters hope that higher base pay will stabilize the workforce and reduce disparities. Skeptics caution that losing enhancements could undermine recruitment efforts and risk further shortages. The outcome will have significant implications not just for the thousands of attendants employed across the state, but also for the many Texans who depend on their daily support.
For now, the shift represents one of the most consequential changes to Texas’s long-term care funding in decades, signaling a move toward standardized wages and away from incentive-based pay enhancements. Whether that shift ultimately strengthens or weakens the system will become clearer in the months and years ahead.
