Your child likely qualifies for Texas PPECC if they're 20 or under, have Texas Medicaid, and need daily skilled nursing for a chronic condition.
This guide covers Texas requirements, how to check eligibility, and how Spark Pediatrics can help. Schedule a free eligibility consultation to discuss your child's situation directly.
Quick Self-Assessment: Does Your Child Qualify for Texas PPECC?
Texas PPECC has five core requirements. Check each one that applies to your child:
Age: Birth through 20 years old
Insurance: Texas Medicaid
If your child has Texas Medicaid, they're automatically enrolled in Texas Health Steps Comprehensive Care Program (THSteps-CCP)—no separate application needed.
Medical Complexity: Chronic condition requiring daily skilled nursing
The condition must be ongoing (not resolving within 60 days) and require more than occasional home health visits.
Technology Dependence: Daily use of medical equipment
This includes feeding tubes, tracheostomy, ventilators, oxygen, medication ports, or apnea monitors.
Medical Stability: Stable enough for center-based care
Your child's condition can be safely managed in a daycare setting with skilled nursing support.
What Your Results Mean
3+ boxes checked: Your child likely qualifies. Contact us to confirm.
1-2 boxes checked: Your child may still qualify—each case is evaluated individually.
0 boxes checked: PPECC may not be the right fit, but other options exist.
For a broader overview covering all states, see our complete PPEC eligibility guide.
What "Medical Necessity" Means for Texas PPECC
Texas requires children to demonstrate "medical necessity" for PPECC services. This means your child needs daily skilled nursing care—not just occasional check-ins—for a chronic condition.
Specifically, Texas looks for:
- Daily skilled nursing interventions throughout the day
- A condition that won't resolve within 60 days
- Care needs beyond what typical caregivers can provide
- Routine dependence on medical equipment
For more on what daily PPECC care looks like, see what PPEC centers actually provide.
Texas PPECC Rules: Hours, Limits, and Requirements
Daily limit: Up to 12 hours (centers typically operate 5am-9pm)
Annual limit: 400 hours maximum—most families attend 2-5 days weekly
Physician requirement: All services must be prescribed by your child's doctor
Transportation: Doesn't count toward your 400-hour limit
Texas began licensing PPECC facilities January 1, 2015. House Bill 3550 has since strengthened quality standards.
Medical Conditions That Qualify for Texas PPECC
Texas Medicaid specifically names cerebral palsy, cystic fibrosis, and muscular dystrophy as qualifying conditions. Many other diagnoses qualify based on individual evaluation.
Other Conditions That Often Qualify
- Congenital heart defects
- Chronic respiratory disorders
- Seizure disorders requiring daily monitoring
- Genetic syndromes with medical complexity
If your child was recently diagnosed, our cerebral palsy guide for new parents may help.
Medical Equipment That Qualifies
Children using these technologies typically meet medical necessity:
- Respiratory: Tracheostomy, ventilators, oxygen therapy, suctioning
- Nutritional: Feeding tubes (G-tube, GJ-tube, NG-tube)
- Monitoring: Apnea monitors, medication ports (PICC lines, central lines)
Children using multiple devices almost always qualify.
What Doesn't Typically Qualify
- Well-managed conditions not requiring daily skilled nursing
- Short-term needs (under 60 days)
- Developmental delays without medical complexity
Unsure about your child? Contact us to talk through your situation.
Required Documentation for Texas PPECC
Your child's physician must provide a signed order after an exam within 30 days of PPECC admission. The PPECC provider creates additional documents including the Plan of Care.
What to Gather
- Recent medical records and specialist notes
- Current medication list with dosages
- Equipment prescriptions
- Texas Medicaid card and MCO information
Your PPECC enrollment specialist coordinates most documentation with your physician's office—you don't have to chase down every form yourself.
For step-by-step details, see our PPEC enrollment guide.
Texas PPECC Approval Timeline
Prior authorization decisions are required within 3 business days of receiving complete documentation. Most families complete enrollment in 1-2 weeks.
Typical Timeline
- Week 1: Contact PPECC, preliminary assessment, physician visit
- Week 2: Nursing assessment, authorization submitted, approval confirmed
Common Delays to Avoid
- Missing signatures on documentation
- Physician exam outside the 30-day window
- Conflicting home health services not yet discontinued
At Spark Pediatrics Houston, our enrollment team reviews documents before submission to catch issues early.
Been denied? Most denials result from paperwork issues—not eligibility. Reach out and we can help you understand next steps.
How Texas PPECC Compares to Other Care Options
PPECC offers center-based skilled nursing with peer interaction. Home health provides short-term intermittent visits. Private duty nursing offers one-on-one home coverage.
Many families combine PPECC (weekdays) with private duty nursing (evenings/weekends).
For information on Private Duty Nursing in Texas, visit Texas HHS.
Frequently Asked Questions
Can my child attend PPECC part-time?
Yes. Schedules are flexible—anywhere from a few hours to 12 hours daily, 2-5 days per week.
Does my child need a trach to qualify?
No. Many children qualify with feeding tubes, oxygen dependency, seizure disorders, or complex medication needs.
Does PPECC include transportation?
Medicaid provides free transportation for eligible children. Spark helps coordinate scheduling and logistics.
How often is eligibility reviewed?
Nursing assessments update every 30 days. Prior authorizations renew every 90-180 days. Physicians conduct annual evaluations.
How Spark Pediatrics Houston Can Help
Our enrollment specialists manage qualification paperwork, coordinate with physicians, and handle authorization details. Most families complete enrollment within 1-2 weeks.
Houston Center: 6440 Sands Point Drive, Houston, TX 77074
What families can expect:
- At least one nurse with pediatric critical care or NICU experience on-site at all times
- Staff-to-child ratios typically around 1:3
- Team members fluent in Spanish and Haitian Creole
- Families report fewer ER visits, better medication adherence, and more socialization
Meet our nursing team or read parent reviews.
"Excellent care and communication! Every member of staff has been so welcoming, helpful, and kind!"
—Lulu S., Spark family
All PPECC services are 100% covered by Medicaid with zero out-of-pocket costs. Our team helps with paperwork and keeps the authorization process moving smoothly.
Next Steps
Your child likely qualifies for Texas PPECC if they're 20 or under, have Texas Medicaid, and need daily skilled nursing for a chronic condition.
Schedule a free tour of our Houston center to meet our team and get your questions answered.
For what happens after qualification, see our PPEC enrollment guide.