What is the difference between PHC, FC, and CAS in Texas?

All three are Texas Medicaid-funded home care programs. Primary Home Care (PHC) covers personal assistance for adults with a functional limitation who meet nursing facility level of care. Family Care (FC) is similar but for individuals who do NOT meet nursing facility level of care. Community Attendant Services (CAS) covers personal care for adults with physical disabilities who need help with Activities of Daily Living to remain living in the community.

Who qualifies for Medicaid CAS in Texas?

To qualify for CAS you must be enrolled in Texas Medicaid, be a Texas resident, be 21 or older, have a physical disability, and demonstrate a functional need for help with Activities of Daily Living through an HHSC assessment. Income must generally be at or below 100-138% of the Federal Poverty Level depending on your Medicaid category.

How do I apply for Medicaid CAS in Houston?

First apply for Texas Medicaid at YourTexasBenefits.com or by calling 2-1-1 if not already enrolled. Once on Medicaid, contact your managed care organization (MCO) such as Molina, Amerigroup, or UnitedHealthcare Community Plan and request a PHC or CAS functional assessment. CareWorks Houston can guide you through every step at no charge — call (832) 237-2273.

How long does the Medicaid CAS application process take in Texas?

The typical timeline is 6-10 weeks from start to first care visit. Medicaid enrollment alone takes 30-45 days. Once enrolled, your MCO schedules a functional assessment and then authorizes care hours. CareWorks Houston helps families navigate the process and avoid common delays.

Is CareWorks Houston a certified Medicaid CAS provider?

Yes. CareWorks Houston is a certified CAS provider serving Houston, Sugar Land, Katy, Pearland, Cypress, and surrounding communities. We are licensed by Texas HHSC and accept Medicaid CAS, PHC, and FC programs. Our care coordinators assist families with the full application and enrollment process at no additional cost.

What does Medicaid CAS not cover?

CAS does not cover skilled nursing tasks such as wound care, injections, or IV therapy. It also does not cover heavy housecleaning unrelated to the individual, yard work, home maintenance, childcare, medication administration, or companionship and supervision alone without an ADL need.

How to Apply for Medicaid PHC, FC & CAS Programs | CareWorks Houston

📋 Texas Medicaid Guide · Updated 2025

How to Apply for Medicaid
PHC, FC & CAS Programs
in Texas

Name: CareWorks Houston
Address: 1601 Industrial Blvd, Suite 3002, Sugar Land, TX, 77478, US
Telephone: (832) 237-2273

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.

📍 Houston · Sugar Land · Katy · Pearland · Cypress ✅ Free Medicaid-Funded Program ⭐ Reviewed by CareWorks Care Coordinators

Programs Covered

Steps to Apply

Cost if You Qualify

6–10 wks

Typical Timeline

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.

Medicaid home care programs help seniors and adults with disabilities remain safe and independent at home.

The Three Programs

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.

PHC

Primary Home Care

Personal assistance with bathing, dressing, grooming, and household tasks for eligible adults who have a functional limitation.

Most common

Family Care

Similar personal care services, specifically for individuals who do not meet the nursing facility level of care. Focuses on maintaining independence.

Lower acuity

CAS

Community Attendant Services

Personal care for adults with physical disabilities who need help with Activities of Daily Living to remain living in the community.

Disability-focused

🔍 CAS In Depth

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 and surrounding communities. CareWorks Houston is a certified CAS provider serving Houston, Sugar Land, Katy, Pearland, and Cypress.

What CAS Covers

CAS is a hands-on personal care benefit. It 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

Bathing, showering, and personal hygiene
Dressing and grooming
Eating and meal preparation assistance
Mobility support — transferring, positioning, walking
Toileting and continence care
Light housekeeping related to individual’s care
Escorting to medical appointments (attendant accompanies)
Medication reminders (not administration)

✗ Not Covered by CAS

Skilled nursing tasks (wound care, injections, IV therapy)
Heavy housecleaning unrelated to the individual
Yard work or home maintenance
Childcare or care for other household members
Medication administration
Driving or operating a vehicle for the client
Companionship or supervision alone (without ADL need)

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.

✅

Already on Medicaid? Many families don’t realize in-home personal care is a covered benefit. If your loved one is already enrolled in Medicaid or STAR+PLUS, contact us for a free benefits review — CAS may already be available to them with no additional enrollment required.

CAS vs. Other Texas Medicaid Personal Care Programs

Texas offers several personal care programs under Medicaid. Understanding the differences helps families choose the right pathway — and in Harris County, most personal care is delivered through STAR+PLUS managed care plans.

Program	Who It’s For	In Home?	Managed Care?
CAS (Community Attendant Services)	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 (Primary Home Care)	Adults meeting nursing facility level of care	✓ Yes	Varies
HCBS Waivers (CLASS, HCS, MDCP)	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.

🏠

Consumer Directed Services (CDS) Option

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.

🧠

CAS for Memory Care & Dementia in Houston

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. If you’re caring for a parent with memory loss in Houston, Sugar Land, Pearland, Katy, or Cypress — call us at (832) 237-2273 for a free conversation.

Who Qualifies

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.

⚠️

Not enrolled in Medicaid yet? You must first apply for Texas Medicaid through YourTexasBenefits.com or by calling 2-1-1 before applying for PHC/FC/CAS. Once enrolled, your MCO will facilitate the home care assessment.

The Application Process

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.

Nurse reviewing documents with an elderly patient at home

Healthcare professional filling out paperwork

1
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.
Houston Tip: Harris County HHSC offices are located across multiple areas. Call 2-1-1 to find your nearest office or apply online to save time.
2
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.
What to say: “I believe I need help with Activities of Daily Living at home and would like a functional assessment for Primary Home Care or Community Attendant Services.“
3
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.
What to ask: “Can you provide documentation of my functional limitations with ADLs — bathing, dressing, mobility, continence — so I can apply for Medicaid home care services?”
4
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.
Be thorough: Describe all difficulties honestly. Understating needs can result in fewer authorized hours. Mention all struggles with hygiene, medication, mobility, or meal prep. If hours feel insufficient, you have the right to request a reassessment or appeal.
5
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.
CareWorks advantage: Our care coordinators handle the paperwork with your MCO and ensure a smooth transition from approval to your first caregiver visit — all billed directly to Medicaid.
6
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.
Annual reviews: Your care plan is reassessed annually. If needs change, request a reassessment at any time by contacting your MCO.

What You’ll Need

Documents to Gather

Having these ready before you call your MCO will speed up the process significantly.

🪪

Photo IDDriver’s license, state ID, or passport for the applicant

📋

Medicaid Card / IDCurrent enrollment card with MCO plan name

🏥

Physician StatementWritten documentation of functional limitations and diagnoses

📄

Proof of ResidencyUtility bill, lease, or mortgage with Texas address

💊

Medication ListCurrent medications with dosages (for the assessment)

🩺

Medical RecordsRelevant diagnoses, hospital discharge paperwork if recent

👤

Social Security CardSSN for the Medicaid applicant

📞

Emergency Contact InfoNames and phone numbers for family members or guardians

Estimated Timeline

How Long Does It Take?

The process varies by MCO and current HHSC caseloads, but here is a typical Houston-area timeline:

Medicaid ApprovalApplying and getting approved for Texas Medicaid2–4 weeks

MCO ContactCalling MCO and requesting a PHC/CAS referral1–3 days

Functional AssessmentScheduling and completing the in-home assessment1–3 weeks

AuthorizationMCO reviews assessment and authorizes service hours5–15 business days

Agency SetupSelecting agency, creating care plan, caregiver match3–7 days

🏠 Care BeginsFirst caregiver visit at homeTotal: ~6–10 weeks

⚠️

Experiencing a crisis? If your family member had a recent hospitalization or sudden health change, ask your MCO for an expedited assessment — sometimes completed within 48–72 hours. CAS and PCS are entitlement benefits — if you are eligible, there is no waitlist, unlike some HCBS waiver programs.

What’s Covered

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.

🛁

Bathing & GroomingBathing, hair care, oral hygiene, nail care

👕

DressingHelp putting on and removing clothing and footwear

🍽️

Meal PreparationPlanning and preparing meals; feeding assistance if needed

🚶

Mobility & TransfersHelp moving around the home, getting in/out of bed or chairs

🏠

Light HousekeepingLaundry, dishes, vacuuming, and tidying living areas

🛒

Errands & ShoppingGrocery runs and essential errands (varies by authorization)

💬

CompanionshipSocial interaction and supervision for individuals who should not be left alone

🚌

Transportation AssistEscorting to medical appointments (attendant accompanies, does not drive)

ℹ️

Not covered: Skilled nursing, wound care, medication administration, and therapy services are covered under separate Medicaid programs. Ask your MCO about STAR+PLUS waiver programs if these are needed, or ask CareWorks about combining CAS with a Home Health benefit.

Common Questions

Frequently Asked Questions

Can a family member be paid to be my caregiver through CAS?

In most cases, yes — through the Consumer Directed Services (CDS) option. An eligible family member (other than a spouse in most situations) can be hired as the paid attendant. They must complete required attendant training, pass background checks, and be paid through an authorized Financial Management Services Agency (FMSA). CareWorks can help connect your family with an FMSA in the Houston area.

Is there a waitlist for CAS in Houston?

No. CAS (and its STAR+PLUS equivalent, PCS) are entitlement benefits — if you are eligible, there is no waitlist. You must receive services. This is different from some HCBS waiver programs (like CLASS or HCS) which can have long waitlists. If your loved one is eligible for Medicaid and has a documented need for personal care, CAS services should begin promptly after authorization.

Does my loved one have to be homebound to receive CAS?

No. Unlike Medicare home health benefits, CAS does not require the individual to be homebound. CAS can be provided at home, in the community, or even at an adult day program setting. The key requirement is a documented need for personal care assistance due to a physical or cognitive limitation.

What is the difference between CAS and Medicare home health?

Medicare home health covers skilled nursing and therapy services for homebound individuals and may include limited home health aide visits tied to skilled care. CAS (Medicaid) covers non-skilled personal care assistance — bathing, dressing, mobility — on an ongoing basis regardless of homebound status. Many individuals use both: Medicare for skilled nursing needs and Medicaid CAS for ongoing personal care.

What if I get denied or receive fewer hours than expected?

There is no fixed limit on authorized hours — some individuals receive a few hours per week while others with higher needs receive daily attendant support. If you believe the authorized hours are insufficient, you have the right to request a reassessment or appeal through your MCO’s internal appeals process, or request a State Fair Hearing within 90 days of the denial notice. CareWorks care coordinators can help you understand the denial and prepare for an appeal.

Does CAS cover memory care or dementia care?

Yes. CAS covers the personal care tasks that are often most challenging in dementia — bathing, dressing, meal preparation, and mobility assistance. While CAS does not cover supervision or companionship alone, many families use CAS-funded hours for essential ADL assistance and supplement with private-pay care for additional oversight. CareWorks Houston’s dementia-trained attendants provide specialized support for families in this situation across Houston, Sugar Land, Pearland, Katy, and Cypress.

I already have Medicaid. Can I add CAS without re-enrolling?

Yes. If your loved one is already enrolled in Medicaid or STAR+PLUS, you can request personal care services at any time by calling your MCO’s Member Services line. There is no deadline or re-enrollment required. Many Houston families don’t realize in-home personal care is already a covered benefit — contact us for a free benefits review.

Ready to Get Started?

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.

Get a Free Assessment 📞 (832) 237-2273

How to Apply for Medicaid
PHC, FC & CAS Programs
in Texas

Understanding PHC, FC & CAS