Texas Medicaid Home Care FAQ
PHC, FC & CAS — Answered in Plain Language

No — and this is one of the biggest misconceptions we hear. PHC, FC, and CAS are specifically designed to help people stay at home rather than move into a facility. You do not need to be in a nursing home, and you do not need to be homebound. The goal of these programs is to keep eligible Texans living independently in their own homes and communities.

Yes. Living with a spouse, adult children, or other family members does not disqualify someone from receiving Medicaid home care benefits. The assessment looks at the individual’s functional needs and financial situation — not who else lives in the home.

To qualify, your loved one generally needs to meet three requirements:

For CAS specifically, the person must also have a physical disability that causes the functional limitation.

Income limits vary by program and Medicaid pathway. As a general guideline for 2026:

Yes, in most cases. Medicare does not cover ongoing personal care like bathing, dressing, or companion services. Medicare covers short-term skilled nursing and therapy after a qualifying hospital stay — and once that period ends, it stops paying.

For ongoing, non-medical home care, Medicaid (PHC, FC, or CAS) is the primary public funding source. Many Houston seniors are dual-eligible — meaning they have both Medicare and Medicaid — and Medicaid covers the personal care that Medicare won’t.

Yes — dementia does not disqualify someone from PHC, FC, or CAS. In fact, many of our clients in Houston have Alzheimer’s or other memory conditions. What matters is whether they have a functional need for help with daily activities, which most people with dementia do.

CareWorks caregivers who serve memory care clients receive specialized training in dementia-specific communication, wandering prevention, and behavioral redirection.

Yes, through what Texas calls the Consumer Directed Services (CDS) option. Under CDS, the Medicaid recipient (or their authorized representative) becomes the employer of their own attendant — which can include a family member, neighbor, or other trusted person. A spouse cannot be hired as the paid attendant, but adult children, siblings, and other relatives typically can be.

A Financial Management Services Agency (FMSA) handles payroll, taxes, and paperwork on the family’s behalf. CareWorks can walk you through whether CDS is the right fit for your situation.

The starting point depends on whether your loved one is already on Medicaid:

For a full step-by-step walkthrough, see our How to Apply for Medicaid PHC/FC/CAS guide →

Once Medicaid is approved and a functional assessment is completed, most families can expect services to begin within 6 to 10 weeks. If your loved one already has Medicaid, the timeline is shorter — sometimes 2 to 4 weeks from the assessment to the first caregiver visit.

A state assessor — either from HHSC or your STAR+PLUS managed care plan — will visit your loved one’s home and evaluate how much help they need with daily activities: bathing, dressing, eating, mobility, continence, and household tasks. Based on that evaluation, they’ll authorize a set number of care hours per month.

Denials happen, and they can often be appealed successfully. Common reasons include incomplete paperwork, income documentation issues, or a functional assessment that didn’t fully capture the person’s needs. You have the right to request a fair hearing through HHSC.

If you receive a denial and aren’t sure what to do next, call us — we’ve helped families navigate appeals and we’re happy to point you in the right direction.

Hours are determined individually based on the functional assessment — there is no fixed number. Most clients receive anywhere from a few hours per week to several hours per day, depending on their level of need. If your loved one’s needs increase over time, a reassessment can be requested to authorize additional hours.

Yes — and many Houston families do exactly this. Medicaid covers a set number of authorized hours, and families add private-pay hours on top for evenings, weekends, or overnight coverage. CareWorks can coordinate both seamlessly so your loved one has consistent, uninterrupted care throughout the day and week.

Yes. CareWorks Houston is a licensed, HHSC-approved provider for PHC, FC, and CAS programs across the Greater Houston area — including Sugar Land, Katy, Pearland, Cypress, The Woodlands, Spring, League City, and surrounding communities.

We do. Our care coordinators regularly help families understand which program applies to their situation, what documentation they’ll need, and what to expect during the assessment. We don’t charge anything for this guidance — it’s part of how we support families in our community.