Texas State Guide for Medicaid Home Care Coverage Benefits
Learn how Medicaid supports in-home dementia care in Texas, helping families ensure comfort, safety, and independence for their loved ones.
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Tendly Home Key Takeaways
Learn how Texas Medicaid supports in-home dementia care to help families maintain comfort, safety, and independence for loved ones:
- 🏠 Texas Medicaid provides home care benefits that allow dementia patients to remain in familiar surroundings, avoiding institutionalization and improving quality of life.
- 💰 Medicaid covers a range of support services including personal assistance, medical supplies, and respite care at little to no cost to eligible families.
- 🧓 The STAR+PLUS program is Texas’s main Medicaid initiative offering long-term in-home services tailored to adults with disabilities or chronic health conditions like dementia.
- 📋 Eligibility requirements include income, functional needs, and residency status; applications must go through the Texas Health and Human Services Commission.
- ❤️ Accessing Medicaid-covered home care empowers caregivers by providing structured support, reducing burnout, and promoting dignity for individuals living with dementia.
Caring for a loved one who’s aging or living with a disability is one of the most selfless and challenging roles a person can take on. Whether you're a spouse, a child, or another family member, your concern is the same: How can I make sure my loved one is getting the care they need without draining our financial resources or making them leave the comfort of home? Fortunately, in the state of Texas, Medicaid may offer life-changing assistance by covering home care services for eligible individuals. But navigating the complex Medicaid system can feel intimidating.
If you're trying to figure out how Texas Medicaid can help you or a family member access home care support—from personal hygiene assistance to help with meals or medication—you’re not alone. This guide is here to clarify the key facts, outline your options, and give you practical next steps so you can advocate with confidence.
Medicaid is a joint federal and state program that helps low-income individuals and families access medical and long-term care services. In Texas, Medicaid doesn’t just cover hospital visits and doctor’s appointments—it can also cover in-home assistance for seniors, individuals with disabilities, and those with chronic medical conditions who qualify.
The Texas Health and Human Services Commission (HHSC) administers Medicaid and a variety of community-based programs. These services help people remain at home instead of moving into a nursing home, making them especially vital for people who want to stay connected to family life and familiar surroundings.
Generally, Medicaid in Texas covers home care through two main pathways: the state Medicaid plan (also called traditional Medicaid), and Medicaid waiver programs. Traditional Medicaid typically covers limited home health services such as part-time nursing care, medical supplies, and physical therapy—for those who meet strict eligibility requirements. But the more robust and flexible form of home care coverage usually comes from Medicaid waiver programs, which are designed specifically to support people in non-institutional settings.
One of the most important waiver programs in Texas is STAR+PLUS. This managed care program serves elderly adults and people with disabilities by providing both healthcare and long-term support services—including personal attendants, nursing, respite care, and even minor home modifications. Another critical waiver is the Community First Choice (CFC) option, which offers attendant services for those with functional needs, without long waiting lists.
Understanding which program fits your loved one’s needs and circumstances is key. Each has its own rules regarding income, assets, medical necessity, and service availability. Thankfully, community organizations, Area Agencies on Aging, and elder law professionals can help guide you.
Eligibility for Medicaid home care in Texas hinges on several important factors: income, assets, medical condition, and sometimes, age or specific disability status. Let’s break each down to help you understand whether you or your loved one might qualify.
First and foremost, the individual must be a Texas resident and either a U.S. citizen or a qualified non-citizen. They must need care that can be appropriately provided in a home setting and meet financial and medical eligibility criteria.
Financial Criteria: For 2024, a single applicant applying for long-term care Medicaid must have an income no higher than $2,829 per month, and countable assets below $2,000 (not including primary residence, certain personal belongings, or one vehicle). If someone applies through a Medicaid waiver rather than nursing home Medicaid, these thresholds are generally the same. For married couples where one spouse needs care, the “community spouse” (the one who remains at home) can keep more resources—up to $154,140 in countable assets, according to federal allowances.
Texas also honors “Miller Trusts” (also called Qualified Income Trusts), which can help individuals who are over the income limit become eligible by legally sheltering a portion of their income for care-related expenses.
Medical Criteria: Applicants must require a "nursing facility level of care" to be approved for waiver programs like STAR+PLUS or CFC. This doesn’t mean they must live in a nursing home, just that their medical needs are serious enough that nursing facility care would otherwise be required. This determination is made during a medical assessment by Texas Health and Human Services or a managed care organization.
Star+PLUS is available to adults aged 65 and older, and to individuals over 21 who have confirmed disabilities as determined by the Social Security Administration or the state. For Community First Choice services, individuals must require help with activities of daily living like bathing, dressing, moving around, or eating.
Most Medicaid waiver programs also have waiting lists due to high demand. However, CFC services usually do not. If your loved one qualifies, CFC may be the fastest route to accessing care.
Understanding the nuances of eligibility can be overwhelming. If you're unsure whether your family member qualifies for Medicaid home care, consider contacting a Medicaid planning specialist or a Texas senior services organization for guidance tailored to your specific circumstances.
Medicaid home care in Texas is not one-size-fits-all. Different programs offer different services, which can range from basic personal assistance to skilled medical care. Knowing what’s included—and what’s not—can help you make an informed decision about which program best fits your loved one’s needs.
Standard Home Health Services: Under traditional Medicaid, eligible individuals can receive limited home health services including intermittent skilled nursing, physical therapy, occupational therapy, and speech therapy. These are typically prescribed by a physician and provided for short periods after an illness or hospitalization. They’re helpful for someone recovering from surgery or undergoing medical treatment, but they’re not ongoing support for long-term care needs.
STAR+PLUS Waiver Services: This is where Texas Medicaid coverage becomes far more robust. STAR+PLUS provides a wide spectrum of long-term services and supports (LTSS) designed to help members live as independently as possible. Services can include:
- Personal assistance with daily activities like bathing, dressing, toileting, and meal prep
- Expanded home health services
- Nursing
- Physical and occupational therapy
- Emergency response systems
- Respite care for family caregivers
- Home-delivered meals
- Adaptive aids and minor home modifications (e.g., shower grab bars, ramps)
Because STAR+PLUS is administered through managed care health plans, individuals choose a Medicaid plan (e.g., UnitedHealthcare, Molina, or Amerigroup), and those plans coordinate the covered services.
Community First Choice (CFC): For individuals who meet the medical eligibility, this program provides personal care services and support management. Importantly, it does not have enrollment caps or waitlists like other waiver programs. CFC focuses primarily on basic daily activities and is available without needing to be enrolled in STAR+PLUS, though the programs can be used together.
Consumer Directed Services (CDS): One of the most empowering features in Texas Medicaid home care is the option to self-direct care. This means the individual or their authorized representative can hire and supervise their own caregivers, including friends or certain family members (though not spouses or guardians). For many families, this creates a sense of control and comfort that traditional agency-based care can’t always offer.
Understanding the scope of services allows you to better advocate for your loved one and make the most out of Medicaid’s offerings. Keep in mind that availability may depend on regional resources and managed care providers in your area.
Legal guardianship provides the authority to make vital healthcare and placement decisions for adults who can no longer make those choices themselves. This legal status ensures that home care arrangements, medical treatments, and financial matters can be managed in the best interest of the individual. Without guardianship, family members may face legal barriers when trying to secure care or services, even when acting with good intentions. For aging adults or those with cognitive decline, establishing guardianship proactively can help avoid delays in receiving necessary care at home.
Applying for Medicaid in Texas can feel complex, but with the right preparation, you can navigate the process successfully. Your eligibility and the specific Medicaid home care program you're applying for will determine the steps and required documentation.
Start by collecting essential documents such as proof of income (pay stubs, Social Security statements), asset information (bank and retirement account statements), proof of residence, ID, and medical records. Current health evaluations or details about cognitive or physical impairments will strengthen the case for a higher level of care.
Step 1: Apply for Medicaid: If the individual is not yet enrolled in Medicaid, the first step is submitting an application. You can do this online through the Your Texas Benefits website, by calling 2-1-1 (option 2), or by visiting your local Health and Human Services (HHS) office. Include as much detail as possible to avoid processing delays.
Step 2: Request Long-Term Services and Supports (LTSS): Once enrolled or as part of the application, indicate that you're seeking long-term services like in-home care. A nurse or social worker from HHS or your managed care provider will conduct an in-person assessment to determine whether the applicant meets the medical criteria for home care services.
Step 3: Choose a Managed Care Plan (for STAR+PLUS): If you're applying through STAR+PLUS, you’ll select from available health plans in your region. Each plan has a service coordinator who will help develop a personalized care plan and guide you through accessing services.
Step 4: Explore Community First Choice (CFC): If there's urgency or the need seems less complex, ask specifically about Community First Choice services. This path typically offers a faster approval process since it has no waitlist.
Step 5: Consider Consumer Directed Services: If you want to hire a friend, adult child, or another trusted individual to provide care, tell your Medicaid service coordinator that you wish to pursue the Consumer Directed Services (CDS) option.
Keep in mind that Medicaid waiver programs like STAR+PLUS may have waitlists, though priority is often given to those transitioning out of a nursing facility. Persistence and regular follow-up can significantly improve the application outcome.
Working with a Medicaid planner, elder law attorney, or social worker can also improve your odds of a successful and expedited application—especially for complex cases involving income trust setup or asset divestment planning.
No one should have to choose between financial hardship and quality care for a loved one. Texas Medicaid’s home care programs offer a lifeline to families who want to preserve dignity, independence, and stability at home. Whether you’re caring for an aging parent, a spouse with a disability, or yourself, understanding your options is the first step toward confident decision-making.
Home care isn't just about physical tasks—it's about comfort, connection, and preserving the rhythm of daily life. With programs like STAR+PLUS, Community First Choice, and Consumer Directed Services, Medicaid empowers families to bring compassionate care into the living room rather than the nursing home.
If you're just starting your journey, don't be discouraged by the paperwork or policy lingo. Take your time, ask questions, and reach out to local resources for help. The support you need is often closer than you think.
Now is the moment to act. Begin the application, call your local HHSC office, and explore whether you qualify for life-changing support. Your family deserves care—and so do you.
Frequently Asked Questions
To qualify for Medicaid home care coverage in Texas, applicants must meet financial and medical criteria. Financially, income and asset limits apply and vary depending on the specific Medicaid program. Medically, individuals typically must demonstrate a need for assistance with activities of daily living or require a level of care similar to that provided in a nursing home. Eligibility also depends on citizenship or legal residency status and state residency. For the most accurate and updated requirements, it’s recommended to contact Texas Health and Human Services or a local Medicaid office.
To qualify for Medicaid home care in Texas, applicants must meet specific financial and medical criteria. Generally, individuals must have limited income and resources, often below certain thresholds. Additionally, they must demonstrate a medical need for assistance with daily activities, allowing them to receive home health services.
Medicaid home care in Texas covers a variety of services aimed at assisting individuals in managing their daily activities. These services include personal care assistance, nursing care, therapy services, and some medical equipment. Coverage may vary based on individual needs and the specific program under Medicaid.
To apply for Medicaid home care in Texas, begin by completing the application through the Texas Health and Human Services Commission website or your local office. Provide necessary documentation such as income statements and medical records. It's often helpful to seek assistance from caseworkers or advocates throughout this process to ensure a smooth application experience.
In Texas, some Medicaid home care programs may require cost-sharing through copayments or premiums based on income. However, many low-income individuals will not have to pay out-of-pocket expenses. It's important to review your specific circumstances and program guidelines to understand any potential costs you may face.
To find approved Medicaid home care providers in Texas, you can use the Texas Health and Human Services website, where you can search for service providers by location and type of care needed. Additionally, reaching out to local Area Agencies on Aging can provide valuable referrals and assistance in locating qualified providers tailored to your specific needs.
Dr. Alan Lee is a board-certified geriatrician specializing in neurodegenerative conditions including Alzheimer’s disease, Parkinson’s, and Lewy Body dementia. With more than two decades in clinical practice and research, Dr. Lee is a trusted authority in personalized care planning for aging adults. He serves as a medical reviewer for several national caregiving organizations and frequently lectures on aging in place and ethical dementia care.
Emily Sanders is a Dementia Practitioner and educator who trains in-home caregivers and family members in person-centered dementia care. With a background in occupational therapy and caregiver training, Emily creates practical tools and care plans that improve everyday life for people living with Alzheimer’s and related conditions. She is passionate about preserving identity, dignity, and connection in home-based settings.
Maria Torres is a social worker with a focus on elder care, family systems, and caregiver mental health. She has worked in both hospice and community health settings and currently supports family caregivers navigating long-term care decisions. Maria brings an empathetic lens to her writing and advocates for proactive planning, emotional resilience, and equitable access to home care resources.
