When authorized care still is not happening
Medicaid Approved the Hours, but No Caregiver Is Showing Up
Families can do everything they were told to do and still end up with uncovered shifts, repeated call-outs, or an agency that cannot consistently staff the authorized schedule. In Texas, the next question depends partly on whether the service is under STAR+PLUS, PAS, CFC, PHC, CAS, Agency Option, CDS, or SRO.
Planned Personal Assistance Services only; license pending.
First separate two problems
Authorization and staffing are not the same thing
The hours are authorized
The member may have an approved ISP, PAS authorization, CFC plan, or other service authorization. That establishes what the payer approved. It does not automatically guarantee that a specific agency has enough attendants to cover every shift.
The provider cannot staff them
Repeated vacancies, call-outs, turnover, or travel distance can create a service gap even when the hours exist on paper.
The delivery model matters
Agency Option, CDS, and SRO divide responsibility for recruiting, managing, and replacing attendants differently. The family needs to know which model applies before deciding who should solve the gap.
If the member has STAR+PLUS
Contact the MCO service coordinator, not just the agency
Texas STAR+PLUS service coordination is responsible for helping coordinate LTSS and the individual service plan. If authorized services are repeatedly not being delivered, document the missed coverage and ask the MCO service coordinator what steps are available to restore service.
Ask whether another contracted provider is available, whether the service-delivery model can be changed, or whether a service-planning meeting should be held.
Where AO, CDS and SRO fit
Who is responsible for the backup?
Agency Option (AO)
The provider employs attendants and handles workforce administration. Families should ask the agency how substitutes and uncovered shifts are handled, then involve the MCO or caseworker when the problem persists.
Consumer Directed Services (CDS)
The CDS employer recruits and manages attendants and must maintain a backup plan for critical authorized services. An FMSA handles specified financial-management functions, but the participant has significant employer responsibility.
Service Responsibility Option (SRO)
The member manages much of the attendant’s day-to-day work while the provider remains the employer of record. Texas guidance says the provider retains substitute-attendant responsibilities.
See the full comparison in our Texas CDS, Agency Option & SRO guide.
What to ask next
Questions for the agency, MCO, or case manager
- Are the hours still authorized on the current service plan?
- Which shifts or days are repeatedly uncovered?
- Does the current provider have a substitute or backup-attendant process?
- Are other contracted providers available in the member’s county or ZIP code?
- Would changing between Agency Option, CDS, or SRO solve the staffing problem?
- Who should the family contact when a missed shift creates an immediate health or safety concern?
If the problem is with a STAR+PLUS MCO and the MCO complaint process does not resolve it, Texas HHSC also has a managed-care complaint and Ombudsman pathway. This page is educational and is not legal advice.
The problem is not “Medicaid.” The problem is uncovered care.
Turn missed shifts into a documented staffing problem
Use the Texas care-navigation guides to identify the service, delivery model, responsible contact, and next question.