Relating to the provision of residential services under the Medicaid home and community-based services (HCS) waiver program.

HB 4282 sets criteria for Medicaid residential facilities (like group homes) participating in Texas' home and community-based services waiver program. It allows facilities to refuse new residents who: (1) exceed capacity, (2) have a history of violent behavior or actions threatening others' safety, or (3) remain physically aggressive despite medical/behavioral treatment. For medically fragile residents or those with serious injuries, the Texas Health and Human Services Commission must confirm a facility can provide necessary care before placement - without requiring facility modifications. The bill takes effect September 1, 2025, and applies directly to Medicaid providers and waiver program participants.