How to Apply for Medicaid
PHC, FC & CAS Programs in Texas
A complete guide for Houston-area families navigating Texas Medicaid’s home care programs — Primary Home Care, Family Care, and Community Attendant Services — at little or no cost.
If your elderly parent, disabled adult, or medically fragile family member needs help with daily activities at home, Texas Medicaid offers three programs that can pay for in-home care at little or no cost to you. This guide explains each program, who qualifies, and exactly how to apply — whether you’re in Houston, Sugar Land, Katy, Pearland, or Cypress.
Understanding PHC, FC & CAS
Texas Health and Human Services Commission (HHSC) administers three closely related programs for home-based personal care. They share similar eligibility rules but serve slightly different populations.
Community Attendant Services (CAS) — A Complete Guide
Community Attendant Services is a Texas Medicaid program that pays for personal care assistance delivered in the home or community setting. Unlike nursing home care, CAS is designed so that eligible individuals can receive hands-on help while continuing to live where they choose — in their own home, with family, or in an assisted living facility.
The program is administered by Texas HHSC and is available through a network of certified home care agencies and independent attendants across the state — including the Greater Houston area. CareWorks Houston is a certified CAS provider serving Houston, Sugar Land, Katy, Pearland, and Cypress.
What CAS Covers
CAS covers assistance with Activities of Daily Living (ADLs) — the basic physical tasks a person needs help with due to age, illness, or disability. CAS does not cover skilled nursing or medical procedures.
✓ Covered by CAS
✗ Not Covered by CAS
Who Qualifies for CAS?
Eligibility for CAS has two components: a financial test (Medicaid eligibility) and a functional test (a demonstrated need for personal care assistance).
Financial Eligibility — Medicaid Pathways
You must be enrolled in Texas Medicaid (or eligible for enrollment). The main pathways for adults receiving CAS are:
- Aged, Blind, or Disabled (ABD) Medicaid — for individuals 65+ or those with qualifying disabilities; typically income at or below 100% federal poverty level
- STAR+PLUS Medicaid Managed Care — the most common pathway in Houston; same financial eligibility as ABD but services are delivered through a managed care plan
- Medically Needy (Spend-Down Program) — for individuals whose income is above standard limits; medical expenses can be used to “spend down” to the eligibility threshold
Functional Eligibility — The Assessment
An assessor from HHSC or your STAR+PLUS managed care organization will evaluate the individual’s ability to perform ADLs independently. The assessment determines the number of authorized care hours per month — typically ranging from a few hours per week to daily attendant care depending on the level of need.
CAS vs. Other Texas Medicaid Personal Care Programs
| Program | Who It’s For | In Home? | Managed Care? |
|---|---|---|---|
| CAS | ABD Medicaid recipients needing personal care | ✓ Yes | No — Fee-for-service |
| PCS via STAR+PLUS | Same as CAS — but through a managed care plan | ✓ Yes | ✓ Yes |
| PHC | Adults meeting nursing facility level of care | ✓ Yes | Varies |
| HCBS Waivers | Specific diagnoses or developmental disabilities | ✓ Yes | Some |
In Harris County and most of the Houston metro, CAS-equivalent services are typically delivered as Personal Care Services (PCS) through your STAR+PLUS managed care plan. The benefits are functionally similar; the administrative pathway differs.
Texas offers a CDS option within CAS and PCS programs, giving eligible individuals and families more control over their care. Under CDS, the Medicaid recipient (or their legally authorized representative) becomes the employer of their own attendant — meaning they can hire a family member, neighbor, or trusted person as the paid caregiver. A Financial Management Services Agency (FMSA) handles payroll, taxes, and compliance on behalf of the family. CareWorks Houston can help you understand whether CDS is a good fit and connect you with an FMSA in the Greater Houston area.
Families caring for a loved one with Alzheimer’s or another form of dementia often find that CAS provides essential daytime support for bathing, dressing, meal preparation, and safe mobility — reducing caregiver burnout and delaying or preventing a move to a memory care facility. CareWorks Houston attendants who work with memory care clients receive specialized training in dementia communication, wandering prevention, and behavioral redirection. CAS benefits can be paired with private-pay memory care services for extended evening or overnight coverage when needed. Call us at (832) 237-2273 for a free conversation.
Eligibility at a Glance — All Three Programs
You must meet three types of requirements: Medicaid financial eligibility, a clinical/functional need, and Texas residency.
| Requirement | PHC | FC | CAS |
|---|---|---|---|
| Texas Medicaid enrolled | ✓ Required | ✓ Required | ✓ Required |
| Texas resident | ✓ Yes | ✓ Yes | ✓ Yes |
| Age | 21+ or children with special needs | 21+ | 21+ |
| Functional limitation in ADLs | ✓ Required | ✓ Required | ✓ Required |
| Nursing facility level of care | ✓ Must meet | ✗ Must NOT meet | Varies |
| Physical disability required | No | No | ✓ Yes |
| Homebound requirement | No | No | No |
| Income limit (approx.) | Varies by Medicaid category; generally 100–138% Federal Poverty Level. Your MCO case manager can verify your specific situation. | ||
Step-by-Step: How to Apply
The process has two phases: first getting on Medicaid, then getting the home care benefit added to your plan.
Confirm or Apply for Texas Medicaid
If the person needing care is not already enrolled in Medicaid, start at YourTexasBenefits.com or call 211. You can also apply in person at your local HHSC office. Processing typically takes 30–45 days. For seniors, STAR+PLUS is the most common managed care pathway in Houston.
Contact Your Medicaid Managed Care Organization (MCO)
Once on Medicaid, you are assigned to a managed care plan. Common Houston-area MCOs include Molina Healthcare, Amerigroup, UnitedHealthcare Community Plan, and Texas Children’s Health Plan. Call Member Services on your Medicaid card and request a PHC/CAS referral.
Get a Physician’s Order / Medical Documentation
Your doctor must document the medical necessity for home care services. Ask your primary care physician for a written order or statement confirming functional limitations, which is submitted to your MCO and the home health agency.
Complete the Functional Assessment (In-Home Visit)
An HHSC representative or MCO nurse assessor will evaluate the individual’s ADLs and Instrumental ADLs. This determines the number of authorized care hours per month. Based on the assessment, you’ll receive written notice of the authorization.
Select a Medicaid-Certified Home Health Agency
After authorization, choose a licensed home care agency from your MCO’s network. You have the right to choose any HHSC-certified CAS provider in your area. CareWorks Houston is a certified provider serving Houston, Sugar Land, Katy, Pearland, and Cypress.
Care Plan Developed & Services Begin
Your selected agency develops a personalized care plan based on the assessment and physician orders. Caregivers are matched and services begin — typically bathing, grooming, dressing, light housekeeping, and meal preparation depending on authorization. There is typically no cost to the family for authorized hours.
Documents to Gather
Having these ready before you call your MCO will speed up the process significantly.
How Long Does It Take?
The process varies by MCO and current HHSC caseloads, but here is a typical Houston-area timeline:
Services Included Under PHC / FC / CAS
These programs cover personal care tasks that help individuals with daily living. Services are non-medical and focus on independence and safety at home.
Houston-Area Medicaid MCO Contact Numbers
CareWorks Houston holds a direct contract with Texas HHSC for PHC, FC, and CAS programs — which means we serve clients under these fee-for-service programs directly through the state, not through a managed care organization.
However, many Houston families are enrolled in a STAR+PLUS managed care plan, and your MCO is the starting point for requesting your functional assessment. The numbers below help you take that first step. Once your assessment is complete and services are authorized under PHC, FC, or CAS, CareWorks can serve you directly — call us at (832) 237-2273 and we will guide you through the rest.
Medicaid Eligibility FAQ — PHC, FC & CAS
Plain answers to the most common Houston family questions — income limits, whether your parent qualifies, family member pay, Medicare vs Medicaid, and more.
CareWorks Can Help You Navigate Every Step
Our Houston-based care coordinators are experienced with all three Texas Medicaid programs. We’ll help you understand your eligibility, work with your MCO, and match you with a qualified caregiver.
This guide is for informational purposes only and does not constitute legal or medical advice. Eligibility determinations are made by Texas HHSC and your Medicaid MCO. MCO phone numbers are subject to change — always verify on your Medicaid card or at hhs.texas.gov.
