How Texas Medicaid Pays for DAHS: The $18.59 Unit, STAR+PLUS, and What Changed in 2026

Texas is where ElderSuite lives, and Day Activity and Health Services is the program we know best. As of September 1, 2026, HHSC's directory lists 343 licensed traditional DAHS facilities plus 48 licensed for both DAHS and ISS — and every one of them is living with two dates right now. The first already happened: September 1, 2025, when the rate-enhancement ladder ended and one flat unit rate took its place. The second is coming: October 6, 2026, when HHSC starts surveying SEMARC employability checks.

Here is the full 2026 picture of how DAHS gets paid.

One service, two payment tracks

DAHS is a Texas Medicaid state-plan service — adult day health under Title XIX — with a Title XX counterpart for people who aren't on Medicaid but meet the community care income and resource limits. Which track pays for a given client decides where the authorization comes from and where the claim goes.

Most Medicaid adults 65 and older or with disabilities are in STAR+PLUS, where DAHS is delivered through the member's health plan and authorized by the plan's service coordinator. Seven MCOs hold the current STAR+PLUS contracts, operational since September 1, 2024: Wellpoint, Superior, UnitedHealthcare, Molina, Community First (Bexar), El Paso Health (El Paso), and Community Health Choice (Harris). The legacy fee-for-service track still runs alongside it: an HHSC caseworker authorizes the service on Form 2101, and the provider bills through TMHP. Title XX clients run through HHSC as well.

The unit, and the flat $18.59

The DAHS billing unit is a half day: three to under six hours of covered services is one unit, six or more hours is two units, and no client can be authorized for more than 10 units a week. Your attendance times are your units.

Since September 1, 2025, the payment is $18.59 per unit — the same for Title XIX and Title XX — per HHSC's current rate schedule. What makes that number bigger news than it looks: the same action, implementing the 2026–27 state budget's attendant-wage rider, discontinued the Attendant Compensation Rate Enhancement program, per HHSC Information Letter 2025-24. The old system paid $16.72 to $18.47 depending on your enhancement level; the new flat rate is above even the old top rung, and a facility that never participated in the enhancement program saw an increase of more than 11 percent. For fee-for-service claims, DAHS bills under Service Group 7 — service code 29 (bill code C0200) for Title XIX, 29A (C0202) for Title XX.

One thing to watch: HHSC's rate analysts held a provider engagement meeting on DAHS rates in July 2026, the usual first step toward a rate hearing in early state fiscal year 2027. The $18.59 may move again.

The forms chain that gets a client authorized

Medical eligibility, per the CCSE Handbook (medical criteria section effective June 1, 2026), takes two things: a chronic medical condition with a physician's orders certifying the need — Form 3055 — and at least one functional limitation with the potential to benefit therapeutically, documented in the health assessment and individual service plan — Form 3050.

Facilities can start the process themselves for Medicaid clients: obtain the physician's orders, notify HHSC intake verbally, and follow up within seven calendar days on Form 2067 — and the facility may begin serving the client at risk while the authorization is pending. For STAR+PLUS members, the plan's service coordinator owns the authorization instead, but the clinical paperwork is the same chain.

Billing: TMHP or the plan

Fee-for-service claims are built from the daily attendance record (Form 3683), submitted monthly to TMHP — and that is ElderSuite's home turf: ElderSuite submits Texas DAHS claims to TMHP directly, from the same attendance records the state audits. Texas Medicaid's timely filing window is 95 days from the date of service. STAR+PLUS claims go to the member's plan under the plan's provider contract.

The rule that ties it together is the payment-integrity provision in the DAHS program rules (26 TAC §211.211): payment is forfeited when monthly claims don't correspond to the service authorizations and the attendance records, when the facility exceeded its licensed capacity, or when required staffing wasn't maintained. Records are kept six years. In other words, the claim is only as strong as the attendance tracking behind it — the same principle federal auditors applied when they reviewed 20 Texas DAHS facilities in 2025 and found compliance gaps at 19. For the general workflow from attendance record to electronic claim, see ElderSuite's Medicaid billing guide.

Licensing — and the rule numbers that moved

DAHS facilities are licensed by HHSC Long-Term Care Regulation under 26 TAC Chapter 559, on a three-year license, with the renewal application due at least 45 days before expiration. Two housekeeping notes worth knowing. First, the program and contract rules moved in July 2024 — the old 40 TAC Chapter 98 provisions now live at 26 TAC Chapter 211, so older manuals citing 40 TAC are pointing at the previous address. Second, DAHS-ISS — Individualized Skills and Socialization, the hourly service that replaced day habilitation for the HCS, TxHmL, and DBMD waiver populations — is a separate license subcategory with its own rules (new licensing and enforcement provisions took effect February 9, 2026) and now counts 736 ISS-only licensees, more than traditional DAHS itself. Different service, different billing; nothing in this article applies to it.

October 6: SEMARC

The near-term deadline is the one we covered in depth in our SEMARC guide: as of August 3, 2026, DAHS employability checks run through SEMARC plus the Nurse Aide Registry in TULIP, the hold-harmless period ends October 5, and HHSC surveys for SEMARC compliance start October 6. If SEMARC isn't showing under TULIP's Other Actions tab yet, start the access request now.

Where to check

• HHSC's DAHS provider page (rules, directories, quarterly provider webinars)
• The current DAHS rate schedule and IL 2025-24
• The CCSE Handbook, DAHS chapter
• TMHP's Long-Term Care program page and PL 2026-10 on SEMARC