Home care in Texas is delivered by state-licensed agencies called Home and Community Support Services Agencies (HCSSAs), and it’s paid for through some combination of Texas Medicaid waivers, Medicare, VA benefits, private long-term care insurance, or out-of-pocket funds. Which of those pays depends on who needs care, what kind of care they need, and how long they’ll need it. Medicaid is the main funder for long-term personal assistance; Medicare covers only short-term skilled care; the VA has its own separate programs for enrolled veterans.
What Counts as Home Care
Texas puts three different kinds of care under the HCSSA license, and knowing which one you need shapes both who can legally provide it and who will pay for it.
Licensed home health services are skilled medical care ordered by a physician: intermittent nursing, physical therapy, occupational therapy, and speech-language pathology. This is short-term care aimed at recovery from surgery, illness, or injury. The workers are licensed clinicians.
Personal assistance services are non-medical help with everyday activities: bathing, dressing, grooming, eating, moving around the home. This is long-term custodial care, and it’s the type most often paid for through Medicaid waivers. The workers aren’t clinicians, though agencies still have to train and screen them.
Hospice care is comfort-focused care for someone with a terminal illness and a life expectancy of six months or less. Two physicians must certify the prognosis, and the patient agrees to palliative rather than curative treatment. Medicare covers hospice as a separate benefit, and eligibility can be recertified if the patient lives past the initial six months.1Medicare.gov. Hospice Care
An agency has to be licensed for the specific category you need. One licensed only for personal assistance can’t legally send a nurse.2Texas Health and Human Services. Home and Community Support Services Agencies
Paying With Texas Medicaid
Texas Medicaid pays for home care through Home and Community Based Services (HCBS) programs designed to keep people out of nursing facilities. Which program applies depends on the person’s age and disability status.3Texas Health and Human Services. Home and Community Based Services (HCBS)
STAR+PLUS for Adults 21 and Older
STAR+PLUS is the statewide Medicaid managed care program for adults 21 and older who are aged or have a disability. To get HCBS waiver services within STAR+PLUS, a clinical evaluation must find you meet a Nursing Facility Level of Care standard, meaning you’d otherwise need placement in a nursing home. Once you qualify, covered services can include attendant care, adaptive aids, minor home modifications, adult foster care, respite for family caregivers, nursing, and therapies.
STAR Kids for Children and Young Adults
Children and young adults 20 and under with disabilities receive Medicaid through STAR Kids, a separate managed care program. It covers prescriptions, hospital and specialty care, personal care services, private-duty nursing, and durable medical equipment. Children in waiver programs like the Medically Dependent Children Program get those services through STAR Kids as well.4Texas Health and Human Services. STAR Kids
Community First Choice
Community First Choice (CFC) is a Medicaid benefit layered onto whatever program you’re already in. It covers personal assistance, habilitation (skills training for independent living), emergency response services, and support management training for people directing their own care. It’s available through STAR+PLUS and through waiver programs including CLASS, DBMD, HCS, and TxHmL. You have to be enrolled in Medicaid and meet an institutional level of care.5Texas Health and Human Services. Community First Choice (CFC)
Other Waivers and the Waitlist Problem
Texas also runs specialized waiver programs for people with intellectual and developmental disabilities and other conditions: Community Living Assistance and Support Services (CLASS), Home and Community-based Services (HCS), Texas Home Living (TxHmL), and Deaf-Blind with Multiple Disabilities (DBMD). Enrollment is capped and the waitlists are severe. More than 170,000 Texans are currently waiting, with some programs carrying wait times over a decade. If a family member might ever need waiver services, get their name on the interest list through HHSC as early as possible, even if the need isn’t immediate.
Consumer Directed Services
Instead of taking whoever an agency sends, you can use the Consumer Directed Services (CDS) option to hire, train, and manage your own attendants. A financial management services agency handles payroll and tax compliance. CDS is available across multiple Medicaid programs.6Texas Health and Human Services. Consumer Directed Services (CDS)
Income and Asset Limits
Medicaid home care requires meeting both the functional need standard and financial limits. As of January 2026, the income limit for an individual seeking waiver or institutional-level services is $2,982 per month, and $5,964 per month for a couple. The resource limit is $2,000 for an individual and $3,000 for a couple.7Texas Health and Human Services. Appendix VIII, Income and Resource Limits
Your home is generally exempt from the asset count as long as you intend to return to it, but the home equity cap is $752,000, with exceptions when a spouse or dependent lives there. If your income exceeds the threshold, Texas allows a Qualified Income Trust (a Miller Trust), which routes excess income through the trust so it doesn’t count against eligibility.
Estate Recovery After Death
One cost families often don’t see coming: Texas is required by federal law to seek repayment of Medicaid long-term care costs from a deceased recipient’s estate.8Medicaid. Estate Recovery The Medicaid Estate Recovery Program (MERP) applies to anyone who received covered long-term care services after age 55 and first applied for those services after March 1, 2005. It covers not just nursing facility care but STAR+PLUS HCBS waiver services, CLASS, HCS, TxHmL, DBMD, and other home and community-based programs.9Texas Health and Human Services. Your Guide to the Medicaid Estate Recovery Program
The state will not pursue recovery if a surviving spouse is alive, if there’s a child under 21 or a child of any age who is blind or permanently disabled, if the estate is worth $10,000 or less, or if total Medicaid costs were $3,000 or less. Additional hardship protections exist for family farms or ranches that support the heirs, and for cases where recovery would push heirs onto public assistance. Because recovery claims can grow substantial after years of covered care, it’s worth talking to an elder law attorney before applying.
Paying With Medicare
Medicare pays for home health under Part A and Part B, but the benefit is built for short-term skilled care, not ongoing personal assistance. You have to meet three conditions: a physician certifies you need intermittent skilled nursing or therapy, you are homebound, and a Medicare-certified home health agency provides the care.10Medicare.gov. Home Health Services
The homebound rule trips up a lot of families. You’re considered homebound if leaving requires help from another person or equipment like a walker or wheelchair, or if your physician believes leaving could worsen your condition. Leaving also has to be genuinely difficult and something you don’t typically do. Medical appointments, religious services, adult day care, and occasional outings like a haircut or family event don’t cost you homebound status.
Covered services include part-time or intermittent skilled nursing, physical therapy, speech-language pathology, occupational therapy, and home health aide care when you’re also getting a skilled service. Medicare defines “intermittent” as skilled nursing needed fewer than seven days per week, or daily care lasting less than eight hours per day for up to 21 days.11Medicare.gov. Medicare and Home Health Care
What Medicare does not pay for: 24-hour home care, meal delivery, housekeeping unrelated to your care plan, or custodial personal care when that’s the only care you need. If you need full-time skilled nursing over an extended period, you generally won’t qualify for the home health benefit either.10Medicare.gov. Home Health Services
VA Home Care for Veterans
Veterans enrolled in VA health care have access to a separate set of programs, distinct from both Medicare and Medicaid:12U.S. Department of Veterans Affairs. Home and Community Based Services – Geriatrics and Extended Care
- Homemaker and Home Health Aide Care, where a trained aide provides personal care and help with daily activities under RN supervision.
- Skilled Home Health Care, short-term clinical care through a community agency contracted with the VA, aimed at veterans who are homebound or live far from a VA facility.
- Home-Based Primary Care, where a VA physician supervises an ongoing care team in the home for veterans with complex conditions.
- Veteran-Directed Care, similar to Texas Medicaid’s CDS option, letting veterans choose and direct their own providers.
- Respite Care, temporary in-home or short-term placement so a family caregiver can take a break.
Veterans or surviving spouses who need regular help with daily activities may also qualify for the VA’s Aid and Attendance pension benefit, a monthly cash payment on top of the basic VA pension. The 2026 maximum rates are $2,424 per month for a single veteran, $2,874 for a married veteran, and $1,558 for a surviving spouse. Eligibility requires at least 90 days of active-duty service with at least one day during a recognized wartime period, a discharge other than dishonorable, a documented medical need for assistance with daily living, and meeting VA income and net worth limits.
Paying Out of Pocket and Private Insurance
Home care in Texas generally runs $24 to $26 per hour for a home health aide or personal care attendant, with regional variation and higher rates for skilled nursing. At 40 hours a week, even the low end of that range comes to roughly $50,000 a year, which is why most families exhaust the public benefit options first.
Private long-term care insurance can cover home care, but only if the policy was purchased before the need arose. Terms vary widely: daily benefit amounts, elimination periods (the days you pay before coverage kicks in), and maximum benefit periods. Standard health insurance rarely covers custodial home care unless the policy has a specific rider. If you already hold a long-term care policy, read it carefully, because many require the provider to be licensed and the care to be physician-prescribed.
Choosing an Agency
Start by verifying the agency’s HCSSA license through the HHSC online database. Confirm it’s active and that it covers the exact service type you need.2Texas Health and Human Services. Home and Community Support Services Agencies For Medicare-certified agencies, the CMS Care Compare tool at Medicare.gov shows star ratings based on eight care process and outcome measures and on patient survey results.13Medicare.gov. Find Healthcare Providers: Compare Care Near You
Ask about background checks. Texas requires licensed agencies to run criminal history checks on all direct-care employees and to search the HHSC Employee Misconduct Registry and the Nurse Aide Registry before hiring. A person listed as unemployable on the EMR, or whose nurse aide certification was revoked or suspended, cannot legally be hired for direct care.14Legal Information Institute. Texas Administrative Code 26-52.107 – Background Checks A reputable agency will explain its screening process without hesitation.
The agency has to provide a written care plan describing which services will be delivered, how often, and what the care aims to achieve. Texas law also requires the agency to go over your rights as a client, including the right to participate in decisions about your own care, refuse treatment, and be treated with dignity. If services aren’t matching the plan, or the agency isn’t respecting your preferences, that’s grounds for a complaint.
To file a complaint about abuse, neglect, exploitation, or substandard care from a licensed provider, call HHSC at 800-458-9858 (Monday through Friday, 7 a.m. to 7 p.m.), file online, or email the Complaint and Incident Intake division. After-hours callers can leave a message for a next-business-day callback.15Texas Health and Human Services. Complaint and Incident Intake
Hiring a Caregiver Directly
Some families skip agencies and hire privately, especially for non-medical personal assistance. It can lower costs and give you more say over who’s in the home, but it comes with legal obligations that catch many families off guard.
Once you hire someone to work in your home, you’re a household employer under the Fair Labor Standards Act. That means paying at least the federal minimum wage of $7.25 per hour (Texas follows the federal rate), tracking hours, and paying overtime at 1.5 times the regular rate for live-out workers who exceed 40 hours in a week. Live-in caregivers still have to be paid for all hours worked, though the overtime calculation differs. You’re also on the hook for employment taxes, including Social Security, Medicare, and federal unemployment tax withholding.
Private hires don’t go through the screening that licensed agencies must perform. You can run your own criminal background check through the Texas Department of Public Safety and search the HHSC Employee Misconduct Registry yourself, but the responsibility falls entirely on you. If a caregiver injures your family member through negligence, there’s no agency liability coverage to fall back on. Families going this route should consider talking to an elder law attorney and adding a homeowner’s insurance rider that covers household employees.