How to Pay for Home Care in Texas (2026 Guide)

What Has Changed

• STAR+PLUS guidance changed. Revised HCBS operational rules took effect August 14, 2026, including current interest-list and upgrade pathways.
• Medicaid forms changed. H1200-EZ was updated in August 2026 for certain community-based programs, but not waivers. Current STAR+PLUS HCBS guidance uses H1200 for that pathway.
• Appeal timing was corrected. Managed-care cases generally allow 120 days after the plan’s internal appeal to request a state fair hearing. Keeping existing services can require much faster action.

Home Health and Nonmedical Home Care Are Different

Home health means skilled care such as nursing or therapy. Nonmedical home care means help with daily activities such as bathing, dressing, toileting, meals, supervision, and transfers. This difference often controls who may pay.

Medicare can pay for eligible skilled home health, but the Medicare home health rules say it does not pay for 24-hour care at home, unrelated homemaker services, or custodial personal care when that is the only care needed. If the main problem is daily hands-on help rather than skilled medical care, move quickly toward Texas Medicaid, VA, and aging-network options.

Our home care overview explains the main types of care. If you are deciding whether home care is still enough, compare home care and assisted living before committing to a large private-pay schedule.

What Medicare May Pay for at Home

Medicare is useful when the person needs part-time or intermittent skilled services and is homebound under Medicare’s rules. A qualifying health care provider must order the care, and a Medicare-certified home health agency must provide it.

Covered care can include skilled nursing, therapy, medical social services, and part-time or intermittent home health aide care when qualifying skilled care is also being provided. Medicare says covered home health has no patient charge, although Part B cost-sharing can apply to covered durable medical equipment.

If a home health agency says Medicare will not cover a service, ask what written notice applies and why. If you need help understanding Medicare or a Medicare Advantage plan, Texas HICAP provides free counseling through the aging network. The Texas Department of Insurance also lists long-term care resources and the statewide AAA line at 1-800-252-9240.

Texas Medicaid Paths for Long-Term Home Care

For ongoing personal care, Texas Medicaid is often the most important payer. The correct path depends on the person’s Medicaid status, care needs, income and resources, and whether the person meets a required level of care.

STAR+PLUS and STAR+PLUS HCBS

Texas’s current STAR+PLUS HCBS services are designed as a community alternative to Medicaid-certified nursing-facility care. Current eligibility guidance says an HCBS applicant must be at least 21, live in Texas, meet nursing-facility medical-necessity rules, have an unmet community-support need, choose HCBS instead of nursing-facility services, and meet Medicaid financial rules.

Texas’s August 2026 HCBS eligibility guidance says some people enter through an interest list. Existing STAR+PLUS members may be able to request an upgrade, and some people with full Medicaid may have another entry route. If needs have increased, ask the plan for an LTSS assessment and whether an HCBS upgrade applies.

Primary Home Care, CAS, and Family Care

Texas still operates Primary Home Care (PHC), Community Attendant Services (CAS), and Family Care. The state’s community-care program guide describes PHC and CAS as in-home attendant services for people who need help with personal care tasks. Family Care is a separate Title XX route for eligible adults and can matter when Medicaid attendant care does not fit.

These programs focus on personal care and home-management needs, not skilled nursing. Screening looks at financial eligibility, functional need, and unmet need. If one Medicaid route fails, ask whether PHC, CAS, Family Care, or another community-care program should be screened.

2026 financial screening numbers

Texas’s June 2026 income and resource chart lists a monthly income limit of $2,982 for an individual for CAS, waiver, and institutional pathways, with a $2,000 individual countable-resource limit. The same chart lists different resource limits for Title XX community-care programs.

Forms and application route

If Medicaid is not in place, use Your Texas Benefits or ask HHSC which paper form matches the program. Texas identifies Form H1200 for Medicaid for the Elderly and People with Disabilities and Medicare Savings Programs. Current STAR+PLUS HCBS instructions also identify H1200 for the waiver application process.

An updated H1200-EZ form took effect in August 2026 for certain aged and disabled community-based Medicaid programs, but HHSC says it is not used for waiver programs. If the goal is STAR+PLUS HCBS, confirm the form before submitting it.

Can a Family Member Get Paid in Texas?

Sometimes. There is no automatic statewide paycheck for every family caregiver. Payment depends on whether an approved program allows self-direction.

Consumer Directed Services (CDS) can give a member or representative more control over hiring workers. Texas’s current CDS relationship form shows that relationship rules differ by program, so a relative may be allowed in some situations but not others.

Use our Texas caregiver pay guide, then ask the Medicaid plan or caseworker two exact questions: “Can these services use CDS?” and “Is this specific family member allowed to be the paid worker?”

Veterans and Surviving Spouses

VA Homemaker and Home Health Aide services can help with daily activities when clinical rules are met and the service is locally available. A copay may apply.

Veteran-Directed Care gives eligible veterans a budget and more control over hiring workers; a family member or neighbor may be hired. Availability varies by location.

VA Aid and Attendance adds money to VA pension for qualified veterans or survivors who meet added care rules. It is not a universal home-care benefit.

Ask a VA social worker about home and community services. For help with federal benefit claims, Texas veterans and survivors can also find a no-cost TVC claims advisor. The VA Caregiver Support Line is 1-855-260-3274.

Long-Term Care Insurance and Private Pay

If the person has long-term care insurance, review the policy now. The Texas Department of Insurance says coverage may include home health, adult day care, respite, and household help. Benefits can depend on a benefit trigger and elimination period.

Review the Texas insurance guide before paying large private-care bills. Ask the insurer whether home care is covered, what documentation is required, whether there is a waiting period, what daily or monthly maximum applies, and whether a licensed agency is required. Do not assume the policy pays a family caregiver; many policies do not.

If private pay is still necessary, compare an agency with an independent caregiver carefully. Our agency versus caregiver guide covers supervision, backup workers, payroll, and screening issues that can change the real cost.

How to Start Without Wasting Time

1. Write a task list. List each activity the person needs help with, how often, and any falls, wandering, unsafe transfers, or nighttime needs.
2. Call ADRC. Dial 1-855-937-2372 and ask which programs serve the county and which screening should come first.
3. Call the health plan. If the person has STAR+PLUS, ask for service coordination and an LTSS assessment. If needs have increased, ask whether an HCBS upgrade applies.
4. Apply for financial eligibility. If Medicaid is needed, use the correct Your Texas Benefits route or paper form. Keep copies of every page and document submitted.
5. Run parallel paths. Do not wait for one program before calling the VA, AAA, insurance company, or local services that could reduce the immediate care gap.

Document checklist

• Photo ID and Social Security number.
• Medicare, Medicaid, and STAR+PLUS plan cards.
• Recent medical records, discharge papers, therapy notes, and medication list.
• Names and phone numbers for doctors and current home-care providers.
• A written list of daily tasks the person cannot safely perform alone.
• Income records, bank statements, insurance policies, and other financial documents requested by HHSC.
• Veteran discharge documents and VA benefit information, if relevant.
• Name and relationship of a proposed family caregiver if asking about self-direction.

Reality Checks

STAR+PLUS HCBS can involve waiting. Texas uses an interest-list process for some applicants. Current Medicaid members may have other entry routes, including upgrades in some cases.

Approved hours still need workers. Staffing varies by area. If an agency cannot fill authorized hours, tell the plan service coordinator and ask about another provider or self-direction.

PACE is not statewide. Texas lists designated areas around El Paso, Amarillo/Canyon, and Lubbock. The PACE eligibility guide requires age 55+, nursing-facility medical necessity, financial eligibility, and residence in a PACE area.

Day care can reduce paid hours. Texas DAHS services can include nursing, personal care, meals, activities, and transportation in a licensed center.

Common Mistakes to Avoid

• Calling all daily help “home health” and waiting for Medicare to pay for custodial care.
• Waiting until a caregiver is exhausted before asking for Medicaid, respite, or adult day services.
• Giving the caseworker only diagnoses instead of describing the daily tasks that are unsafe.
• Assuming income above one published number means the person cannot qualify.
• Forgetting to ask whether a family member can be hired under a self-directed option.
• Throwing away a plan or HHSC notice. Appeal rights and continuation deadlines are tied to the notice.
• Buying full-time private care before checking benefits that could reduce the number of paid hours needed.

Backup Options When Full-Time Home Care Is Too Expensive

If full-time private care is unaffordable, combine smaller supports around the most important paid hours.

• Use adult day services for daytime supervision.
• Ask the AAA about respite, caregiver support, meals, and transportation.
• Use benefits screening to free money now spent on Medicare premiums and other basics. Our Texas Medicare Savings guide explains the 2026 programs.
• If care needs are becoming too high for the home setting, compare home care and nursing homes before a crisis move.
• Use our Texas benefits portals guide to check other official assistance that may reduce household costs.

Texas and Official Resources

To find the right local aging office, use the official Texas AAA directory. Our Texas AAA guide also explains what these agencies can and cannot do.

Phone Scripts