A Practical Guide to Navigating Medicaid Home Care Benefits
The cost of in-home care is a significant concern for many families. What many don't realize is that Medicaid — the joint federal and state health insurance program — may cover a substantial portion of home care costs for eligible individuals. Understanding what's available and how to access it can make a life-changing difference.
What is Medicaid home care?
Medicaid home care refers to personal care and supportive services provided in the home that are covered under Medicaid programs. In Texas, the primary program is STAR+PLUS, which provides Medicaid managed care for people who are elderly or have disabilities, including home and community-based services (HCBS).
Who qualifies?
Eligibility for Medicaid home care in Texas is based on two main criteria: financial eligibility and medical/functional need. Generally, you must meet income and asset limits AND be determined to need a nursing facility level of care to qualify for the full range of home care benefits.
- Be a Texas resident and a U.S. citizen or qualified non-citizen
- Meet income and asset limits set by the state
- Be age 65 or older, or have a qualifying disability
- Require a level of care that would otherwise require a nursing facility
- Apply through the Texas Health and Human Services Commission (HHSC)
What services are covered?
Under Texas Medicaid HCBS waiver programs, covered services may include personal care assistance, homemaker services, adult day care, respite care, emergency response systems, and more. The specific services covered depend on your Medicaid plan and assessed level of need.
The STAR+PLUS waiver
STAR+PLUS is Texas's Medicaid managed care program for people who are 65 and older or have physical disabilities. Most members are enrolled in a health plan that coordinates both their medical and long-term services and supports. Home and community-based services (HCBS) available under STAR+PLUS include personal attendant services, which can cover help with bathing, dressing, grooming, and more.
Important: There is often a waiting list for some Medicaid waiver programs in Texas. Applying early — even before you immediately need services — is strongly advisable.
How to apply
- Contact Texas HHSC at 2-1-1 or visit hhs.texas.gov to begin the application
- Complete a needs assessment — a caseworker will evaluate functional limitations
- Provide documentation of income, assets, residency, and medical information
- If approved, work with a service coordinator to develop your care plan
- Choose a home care agency — Wellstead can walk you through this process
Other financial assistance options
Beyond Medicaid, other programs worth exploring include the Veterans' Aid & Attendance benefit for eligible veterans and their surviving spouses, long-term care insurance if the individual has a policy, and Area Agency on Aging programs which may provide limited assistance regardless of income.
Navigating these systems can feel overwhelming. Wellstead's care coordinators are familiar with the Texas Medicaid landscape and can help guide your family in the right direction. Reach out to us to learn more.
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