Texas Medicaid Home Care is the set of Medicaid programs that pay for care in a parent’s own home — or in assisted living — for someone who would otherwise qualify for a nursing home. This Texas medicaid home care guide names the program, gives the 2026 financial limits, explains the level-of-care test and the waitlist reality, and shows where the application starts.
The financial figures come from the state Medicaid agency and CMS and reset on their own calendars; where Texas has not published a figure we say so.
In This Texas Medicaid Home Care Guide:
Texas Medicaid Home Care at a Glance (2026)
| Program | In Texas the main Medicaid program that pays for care at home instead of a nursing home is called STAR+PLUS Home and Community Based Services, usually written STAR+PLUS HCBS. |
| 2026 income limit (single applicant) | $2,982 |
| 2026 asset limit (single applicant) | $2,000 |
| Assisted living covered? | Confirm with Start with the Texas Health and Human Services Commission. whether assisted living is covered. |
| Waitlist | This is the hard part for Texas families. STAR+PLUS HCBS is not an entitlement. |
| PACE available? | Yes, PACE operates in Texas, but only in a few places, so most families will not have it as an option. |
| Hire your own caregiver? | Yes. Texas calls this the Consumer Directed Services option, abbreviated CDS, and it is available within STAR+PLUS HCBS and other long-term services programs. |
The Texas Program Behind Texas Medicaid Home Care
Nursing home Medicaid is an entitlement: anyone who qualifies gets it. Home-based care is different. Texas delivers it through a waiver or a managed long-term care program with its own name, its own enrollment rules and, in many states, a cap on how many people it serves.
The program Texas runs for people 65 and over is In Texas the main Medicaid program that pays for care at home instead of a nursing home is called STAR+PLUS Home and Community Based Services, usually written STAR+PLUS HCBS..
STAR+PLUS HCBS is built to cover the everyday help that keeps someone at home. The state lists personal assistance services, in-home and out-of-home respite so a family caregiver can rest, nursing in the home, adult foster care, assisted living, home-delivered meals, and an emergency response system button.
It also covers minor home modifications such as ramps or grab bars, adaptive aids, medical equipment and supplies, dental services, cognitive rehabilitation, physical, occupational and speech therapy, transition assistance for someone leaving a facility, and financial management services. Adult day care is available through Day Activity and Health Services.
Who Qualifies for Texas Medicaid Home Care
Three tests, the same as a nursing home: a medical test, an income test and an asset test. Texas uses the nursing-facility level of care as the medical bar, which means the applicant needs hands-on help with daily activities or supervision because of dementia — not merely help with errands.
Texas asks whether the person would otherwise need nursing facility care. The test is the Medical Necessity and Level of Care Assessment, commonly called the MN/LOC, which looks at medical conditions and at how much help the person needs with daily activities like bathing, dressing, transferring and eating.
A nurse or service coordinator from the person’s managed care organization comes to the home and completes the assessment in person, a physician signs it, and it is submitted electronically to Texas Medicaid & Healthcare Partnership, which makes the final level-of-care decision.
Financially, the applicant’s own income is measured against the Texas medicaid home care limit of $2,982, and countable assets against $2,000. The spouse who stays home is protected by the same spousal impoverishment rules that apply in a nursing home: up to $162,660 in assets in 2026 and a guaranteed income floor.
Waitlists and Enrollment Caps
This is the hard part for Texas families. STAR+PLUS HCBS is not an entitlement. The state funds a limited number of enrollment slots, and when they are filled, people are placed on what Texas calls an interest list rather than a waiting list, and they are assessed only when their name reaches the top.
HHSC publishes an Interest List Reduction page describing efforts to move people off these lists faster, but the state does not publish a guaranteed wait time, and waits vary by region. Actual current wait length is UNVERIFIED.
Two facts hold everywhere: applying for the waiver does not stop you from applying for nursing home Medicaid later, and the level-of-care assessment for one is usually accepted for the other.
What Texas Medicaid Home Care Pays For
Personal care (bathing, dressing, transfers), homemaker help, adult day programs, respite so the family caregiver can rest, home modifications such as ramps and grab bars, delivered meals, a personal emergency response button, and in many states assisted living services. It does not pay rent, a mortgage or groceries.
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Assisted living: Confirm with Start with the Texas Health and Human Services Commission. whether assisted living is covered.
PACE: Yes, PACE operates in Texas, but only in a few places, so most families will not have it as an option. The Program of All-Inclusive Care for the Elderly serves frail older adults who qualify for nursing facility placement and combines Medicare and Medicaid funding into one comprehensive package of medical, functional and adult day services.
Can a Family Member Be the Paid Caregiver?
Yes. Texas calls this the Consumer Directed Services option, abbreviated CDS, and it is available within STAR+PLUS HCBS and other long-term services programs. Under CDS the member, or a legally authorized representative, recruits, hires, trains, supervises and can dismiss their own attendants, which means a trusted friend or certain family members can be paid to provide the care.
A Financial Management Services Agency handles payroll, taxes and paperwork on the member’s behalf. The person receiving services, their spouse, and their legally authorized representative generally cannot be hired as the paid attendant.
The full picture — who may be paid, how the pay is set and how to enroll — is in our companion guide to Texas family caregiver pay.
How to Apply for Texas Medicaid Home Care
Where: Start with the Texas Health and Human Services Commission. — start here.
Ask for two things on the first call: the functional assessment and a Medicaid financial application. Doing both at once shortens the timeline by weeks. Bring the same five years of financial records a nursing home application needs; the look-back rule applies to waivers too.
What Happens on Assessment Day
The assessment is a visit, usually at the parent’s home, by a nurse or social worker who walks through the day: getting out of bed, bathing, dressing, using the toilet, eating, moving from room to room, taking medication, and whether the person can be left alone safely. Answer for the worst day, not the best one. Families who describe a good morning talk their parent out of Texas medicaid home care without meaning to.
Bring the medication list, the diagnoses, recent hospital paperwork and any dementia evaluation. If a doctor has written that the person needs supervision or hands-on help, bring that letter; it is often the single document that tips the level-of-care decision.
The Care Plan That Follows
Approval produces a written care plan: which services, how many hours, and who delivers them. The plan is the budget. Hours outside it are not paid, and hours inside it that go unused are not banked. A plan can be revised when the parent’s condition changes — after a fall, a hospital stay or a new diagnosis — so keep the case manager’s number and call when something changes rather than waiting for the annual review.
Mistakes That Cost Families Months
- Waiting for the crisis. Waiver slots and assessments take weeks; the application should start when the family first notices the parent needs daily help.
- Giving money away first. The five-year look-back applies to the waiver as well as the nursing home, so a gift meant to “get under the limit” creates a penalty period instead.
- Spending the spouse’s protected share. Ask for the resource assessment before paying anything down.
- Assuming Medicare covers it. Medicare pays for short-term skilled care after a hospital stay, never for ongoing daily help. Texas Medicaid Home Care is the program that does.
Where to Get Help Free
Two free doors exist in every state: the Texas SHIP counselor for the Medicare side and the state’s Aging and Disability Resource Center for the Medicaid side. Neither sells anything. For a Texas medicaid home care question involving a house, a spouse at home or a recent gift, a local elder law attorney or legal aid office is the next call.
Key Takeaways: Texas Medicaid Home Care
- Same tests as a nursing home: Texas medicaid home care requires nursing-facility level of care plus the income and asset tests.
- Not an entitlement: Texas medicaid home care runs through a waiver that can have a waitlist, so apply before the crisis.
- The assessment travels: the level-of-care finding for Texas medicaid home care is usually accepted for nursing home coverage later.
- Room and board are never covered: Texas medicaid home care pays for care services, not rent, even in assisted living.
Official Sources
- In Texas the main Medicaid program that pays for care at home instead of a nursing home is called STAR+PLUS Home and Community Based Services, usually written STAR+PLUS HCBS.: https://www.hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-members/starplus is the single best official page for Texas’s home care program. Two other Texas HHS pages are worth bookmarking: the Interest List Reduction page at https://www.hhs.texas.gov/about/records-statistics/interest-list-reduction, which explains how the state manages the queue, and the Consumer Directed Services page at https://www.hhs.texas.gov/providers/long-term-care-providers/consumer-directed-services-cds, which explains hiring your own caregiver. The Medicaid for the Elderly and People with Disabilities Handbook section A-3300 covers the waiver programs in the state’s own technical language.
- Start with the Texas Health and Human Services Commission.
- Medicaid.gov spousal impoverishment standards: medicaid.gov
- Medicare.gov Medicare Savings Programs: medicare.gov
This Texas medicaid home care guide was checked against the state Medicaid agency, CMS and the statute cited above in September 2026. Figures reset on their own calendars (most on January 1); if a number here disagrees with a notice you received, the notice wins — and please tell us. This page is general information, not legal, financial or medical advice.