Texas does not have IHSS. California’s In-Home Supportive Services program has no direct twin here, but Texas runs several state and federal programs that do the same job: paying for care at home so people don’t have to move into a nursing facility. The Texas Health and Human Services Commission (HHSC) administers them. The most important thing to know upfront is that many of these programs have interest lists, so getting your name on one early matters more than picking the “right” program on the first try.
The Texas Programs That Do What IHSS Does
There is no single door. Which program fits depends on your age, diagnosis, income, and whether you already have Medicaid.
STAR+PLUS Home and Community-Based Services
STAR+PLUS HCBS is the largest Texas program comparable to IHSS. It serves adults 21 and older who have a disability or chronic condition and need the level of care a nursing facility provides.1Cornell Law School. 1 Tex. Admin. Code 353.1153 – STAR+PLUS Home and Community Based Services (HCBS) Program Covered services include personal assistance, nursing, therapies, respite for family caregivers, home modifications like grab bars and ramps, home-delivered meals, and emergency response systems.2Texas Health and Human Services. STAR+PLUS It runs through Medicaid managed care, so you pick a health plan that coordinates both medical care and home services.
Community First Choice
Community First Choice (CFC) provides attendant services to Medicaid recipients of any age who need an institutional level of care. Because CFC is a Medicaid state plan option rather than a waiver, it has no enrollment cap and no interest list.3Texas Health and Human Services. Community First Choice (CFC) If you already have Medicaid and need help with daily activities, this is often the fastest route to services.
Primary Home Care and Community Attendant Services
Primary Home Care (PHC) and Community Attendant Services (CAS) send an attendant to help with bathing, dressing, grooming, meals, and light housekeeping.4Texas Health and Human Services. 4600, Primary Home Care and Community Attendant Services Both are delivered through licensed home and community support services agencies that contract with HHSC.5Texas Health and Human Services. Primary Home Care (PHC) Attendants can remind you to take medication and help open containers, but skilled tasks like injections or wound care require a licensed nurse.
Texas Home Living
Texas Home Living (TxHmL) is a Medicaid waiver for people with an intellectual disability or a related condition who live in their own or a family member’s home.6Texas Health and Human Services. Texas Home Living (TxHmL) Eligibility generally requires an IQ of 69 or below (or 75 or below with a related condition), deficits in adaptive behavior, and Medicaid eligibility.7Texas Health and Human Services. Texas Home Living (TxHmL) TxHmL supplements the support a person already gets from family or other programs rather than replacing it.
Community Care Services Eligibility (Non-Medicaid)
The Community Care Services Eligibility program, previously called Community Care for Aged and Disabled, serves older adults and people with disabilities who need help at home but don’t qualify for Medicaid.8BenefitsCheckUp. Texas Community Care for Aged/Disabled (CCAD) It’s the main fallback for Texans whose income or assets sit just above Medicaid limits.
Paying a Family Member to Provide Care
The IHSS feature Californians ask about most is paying a relative to be the caregiver. Texas allows this through the Consumer Directed Services (CDS) option. As the CDS employer, the participant or a legal representative recruits, hires, trains, schedules, and can terminate their own workers, including family and friends.9Texas Health and Human Services. 8200, Consumer Directed Services Spouses cannot generally serve as paid attendants, but adult children, siblings, and other relatives often can.
The trade-off is real employer responsibility. You set wages within your allocated budget, approve timesheets, and are legally responsible for payroll taxes owed to the IRS and the Texas Workforce Commission.10Texas Health and Human Services. 5200, Consumer Directed Services A Financial Management Services Agency (FMSA) handles withholding, payroll, and filings for you, but the liability stays with you. You also keep personnel files, build back-up plans for essential services, and retain records for at least five years. CDS is available in STAR+PLUS, STAR Kids, and several waivers.
Who Qualifies in 2026
Most of these programs use three tests: financial, functional, and residency.
On the financial side, a single applicant for Medicaid waiver or institutional programs in 2026 generally cannot have monthly income above $2,982 or countable assets above $2,000. For a couple where both spouses apply, the caps are $5,964 in monthly income and $3,000 in assets.11Texas Health and Human Services. Appendix XI, Income and Resource Limits A primary home is generally excluded from countable assets, subject to equity limits. Income slightly above the limit is not always disqualifying; HHSC applies certain deductions and alternative pathways, and where one spouse applies and the other stays home, federal spousal impoverishment rules protect a chunk of the couple’s assets and income for the spouse remaining in the community.12Centers for Medicare & Medicaid Services. 2026 SSI and Spousal Impoverishment Standards
Functional need is measured in a face-to-face assessment using Form H2060, which scores your ability to bathe, dress, eat, and move around your home.13Texas Health and Human Services. Form H2060, Needs Assessment Questionnaire and Task/Hour Guide For STAR+PLUS HCBS and other waivers, the assessment must show you need nursing-facility-level care.1Cornell Law School. 1 Tex. Admin. Code 353.1153 – STAR+PLUS Home and Community Based Services (HCBS) Program The same assessment sets how many service hours you’ll receive.
You must also be a Texas resident with the intent to remain in the state.14Texas Health and Human Services. Medicaid for the Elderly and People with Disabilities Handbook D-3200, Eligibility Medicaid programs additionally require U.S. citizenship or a qualifying immigration status.
How to Apply
Pull your documents first: Social Security number, proof of Texas residency, bank statements and other financial records, proof of income, and medical documentation with your doctor’s contact information. Having them ready shortens the process.
You can apply online at YourTexasBenefits.com, by phone at 2-1-1 or 877-541-7905, or in person at a local HHSC office.15Texas Health and Human Services. Contact For the HCS and TxHmL waivers specifically, contact your Local Intellectual and Developmental Disability Authority (LIDDA) to be added to the interest list.16Texas Health and Human Services. Interest List Reduction Keep copies of everything you submit.
HHSC then verifies your finances and schedules the H2060 assessment in your home.17Texas Health and Human Services. 2400, Assessment Process Answer honestly about what you can and cannot do without help. The caseworker will observe you during the visit and may ask family members to fill in gaps. Respond quickly to any follow-up requests; delay on your end stalls the whole file.
Interest Lists and What to Do While You Wait
This is where Texas diverges most sharply from IHSS. Several waivers currently maintain interest lists because demand exceeds funded slots: Community Living Assistance and Support Services (CLASS), Deaf-Blind with Multiple Disabilities (DBMD), Home and Community-based Services (HCS), Texas Home Living (TxHmL), the Medically Dependent Children’s Program (MDCP), and STAR+PLUS HCBS.16Texas Health and Human Services. Interest List Reduction
Interest lists generally move on a first-come, first-served basis, though Texas has been exploring prioritization based on urgency.18Texas Health and Human Services. Overview of Texas Medicaid Waivers Eligibility itself is not decided until your name reaches the top and a slot opens. Wait times vary; nationally, the average wait for HCBS waiver services runs roughly 32 months, and some Texas lists have historically been longer.
Two practical points. First, being on an interest list does not stop you from getting other services you qualify for right now. You can enroll in regular Medicaid, Community First Choice, or non-waiver community programs while you wait, and it does not affect your spot.16Texas Health and Human Services. Interest List Reduction Second, apply for every program you might plausibly qualify for, not just the one you prefer. Getting on the list years before you actually need waiver services is often the difference between having help when you need it and not.
If You’re Denied
If HHSC denies your application, cuts your hours, or terminates services, you can request a fair hearing. You generally have 90 days from the effective date of the action.19Texas Health and Human Services. B-1020, Time Period for Requesting Fair Hearing For STAR+PLUS managed care decisions, the window can be up to 120 days after the plan issues its appeal resolution notice.
If the action reduces services you already have, you can ask that your current benefits continue during the appeal. That protection has a short fuse, sometimes as little as 10 days from the notice, so read the notice the day it arrives. If you’re appealing a denial of a service you were never receiving, benefits won’t be paid unless you win.
The hearing is run by an impartial hearing officer. You can bring evidence, witnesses, and a representative. Denials are often reversed at this stage when applicants come in with updated medical documentation that wasn’t in the original file.
Two Things to Know Before Transferring Assets
Before giving away money or property to try to qualify, understand two rules that don’t apply to IHSS-style state programs but do apply to Texas Medicaid waivers.
The first is the 60-month look-back. When you apply for a waiver or nursing facility Medicaid, HHSC reviews all asset transfers you and your spouse made in the five years before the application.20Texas Health and Human Services. I-5200, The Penalty Start Date Gifts and below-market transfers trigger a penalty period of ineligibility, calculated by dividing the uncompensated value by the average daily cost of nursing facility care. A common mistake is assuming the IRS annual gift tax exclusion protects you here. It does not. A gift that’s fine for tax purposes can still create a Medicaid penalty. The look-back does not apply to regular Aged, Blind, and Disabled Medicaid, only to nursing facility care and HCBS waivers.
The second is the Medicaid Estate Recovery Program. After a Medicaid recipient who was 55 or older dies, Texas can file a claim against the estate to recover what it paid for long-term care services received after that age.21Texas Health and Human Services. Your Guide to the Medicaid Estate Recovery Program Recovery applies to nursing facility care, STAR+PLUS long-term care services, HCS, TxHmL, CAS, and other waivers, plus related hospital and drug costs. Several exemptions apply, including when the person is survived by a spouse, a child under 21, or a blind or disabled child of any age, and when a claim would create undue hardship for heirs.22Medicaid.gov. Estate Recovery For families whose main asset is a home, this is worth reviewing with an elder law attorney before applying.