TX HHS Form H1204. Long Term Care Options

Form H1204 is an informational document used by the Texas Health and Human Services Commission (HHSC) to help individuals, families, and caregivers understand available long-term care services and supports across Texas. The form outlines a wide range of programs for people with medical, physical, intellectual, developmental, or age-related needs and is commonly used as a starting point when exploring care options or planning a transition from institutional care to community-based services.

Purpose of Form H1204

The purpose of Form H1204 is to present an overview of long-term services and supports that may be available depending on a person’s age, disability, medical condition, income, and geographic location. It does not function as an application by itself but serves as a guidance and education tool to help people make informed decisions before applying for specific programs.

The form is especially relevant for individuals currently living in nursing facilities who wish to return to the community, as well as families seeking alternatives to institutional care.

When This Form Is Used

Form H1204 is typically used in the following situations:

• When an individual or caregiver is exploring long-term care options for the first time
• When transitioning from a nursing facility to community-based services
• When comparing Medicaid and non-Medicaid long-term care programs
• When contacting HHSC to determine local service availability

The form is not required to be submitted on its own and does not replace formal applications for specific programs.

Who Uses This Form

Form H1204 may be used by:

• Individuals seeking long-term care services
• Family members and caregivers
• HHSC eligibility or intake staff
• Hospital discharge planners or social workers

No signature is required, and the form does not establish eligibility on its own.

Explanation of Key Sections

Programs and Services for Adults and Children with Medical or Physical Disabilities

This section lists community-based and residential programs designed to support individuals with physical or medical limitations. It includes services such as Adult Foster Care, Primary Home Care, Community Attendant Services, Emergency Response Services, hospice care, and residential options. Each program is briefly described to clarify the type of support provided.

Services for Adults Age 60+ and Caregivers

This section focuses on aging-related services, including caregiver support, nutrition services, in-home support, and access and assistance programs. These services aim to help older adults remain independent and support family caregivers.

Programs and Services for Individuals with Intellectual and Developmental Disabilities (IDD)

This section outlines programs such as Home and Community-based Services (HCS), Texas Home Living (TxHmL), State Supported Living Centers, and ICF/IID facilities. These options address residential, habilitative, and therapeutic needs for people with intellectual or developmental disabilities.

Additional Services

This section highlights other long-term care options, including Community First Choice, nursing facility care, relocation assistance, STAR+PLUS HCBS, and specialized Medicaid programs. These services may support transitions, institutional alternatives, or specialized medical needs.

Practical Tips for Using Form H1204

• Use the form as a reference when speaking with HHSC staff or calling 2-1-1.
• Identify programs that match both the individual’s needs and location.
• Understand that availability varies by county and funding limits.
• Follow up with the appropriate HHSC office for application steps.

Common Misunderstandings

• Assuming the form itself enrolls someone in services
• Believing all listed programs are available statewide
• Overlooking Medicaid eligibility requirements
• Not contacting HHSC for updated local availability

Legal and Regulatory Context

Form H1204 reflects programs authorized under Texas Medicaid rules, state plan services, and home and community-based waiver authorities. Many of the services listed are governed by federal Medicaid regulations, state statutes, and HHSC administrative rules that limit capacity, eligibility, and geographic availability.

The form exists to support informed decision-making before formal eligibility determinations are made.

Real-Life Examples of Use

• An older adult and caregiver compare in-home support services versus assisted living options.
• A nursing facility resident explores relocation assistance to return home.
• A parent reviews MDCP and CLASS services for a child with medical needs.
• A caregiver learns about respite and caregiver support programs.

Documents Often Needed After Reviewing This Form

• Medicaid eligibility documentation
• Medical or disability assessments
• Proof of income and residency
• Physician statements or evaluations

Frequently Asked Questions

Is Form H1204 an application?

No, it is an informational guide only.

Are all programs listed available everywhere?

No, availability depends on location and program capacity.

Does reviewing this form guarantee services?

No, eligibility and funding rules apply.

How do I find local services?

Call 2-1-1 to locate your HHSC office.

Is Medicaid required for all programs?

Many programs require Medicaid, but not all.

Can this form help with leaving a nursing facility?

Yes, it outlines community-based alternatives.

Related Forms and Resources

• Medicaid Long-Term Care Application Forms
• STAR+PLUS HCBS Program Materials
• Community First Choice Program Information
• HHSC Eligibility and Benefits Forms

Form Details

• Form Name: Long-Term Care Options
• Form Number: H1204
• Issued By: Texas Health and Human Services Commission
• State: Texas
• Revision Date: July 2019