Project Background

The federal lawsuit, Alberto N., et al. v. Hawkins, et al., was originally filed on August 9, 1999, in the U.S. District Court for the Eastern District of Texas, Tyler Division. The plaintiffs were children with disabilities and chronic health conditions who alleged they had been denied medically necessary in-home Medicaid services. These services included private duty nursing, personal care services (PCS) and durable medical equipment (DME). Historically, Medicaid PCS was provided to beneficiaries through the Texas Department of Aging and Disability Services (DADS) and its legacy organization, Department of Human Services, through the Primary Home Care (PHC) program. As part of the agreement growing out of Alberto N, benefit administration of PCS for clients under 21 was transferred to the Texas Health and Human Services Commission (HHSC).

The Agreement also established a requirement for HHSC to implement a new comprehensive assessment as part of the PCS program for children. The HHSC entered into a contractual relationship in 2007 with The Texas A&M Health Science Center's School of Rural Public Health to develop and test this new assessment. The development effort at Texas A&M involved faculty in the School of Rural Public Health, in the College of Education and Human Development, and the College of Liberal Arts. The development was done in close collaboration with staff at the HHSC and at the Texas Department of State Health Services (DSHS), which is responsible for the assessment and case management of children receiving Medicaid PCS.

The assessment form(s) developed as part of this effort are closely focused on issues related to the determination of need for Medicaid PCS with some of the information needed to provide case management services to the children receiving PCS. This website contains the information about, and the products of, that development and testing. Two assessment instruments were developed: the PCAF 0-3 for children under four years of age and the PCAF 4-20 for children over three years of age. This development is discussed in project reports.

To protect the PCAF instruments from changes that might compromise their reliability or validity, these instruments and the training manual are copyrighted. The copyright in Texas is held by the Texas A&M Health Science Center. Copyright for the remainder of the United States and abroad are held by interRAI (see, a non-profit research and development organization with members from approximately 30 countries dedicated to developing systems that assist in the delivery of quality care to vulnerable populations.

For information about the project that is not available on this site contact:
Emily Naiser, MPH,
Texas A&M Public Policy Research Institute

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