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

No — 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. This is one of the biggest misconceptions we hear from Houston families. 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 for Texas Medicaid home care, your loved one must meet three requirements: be a Texas resident enrolled in Texas Medicaid, have a functional need for help with at least one Activity of Daily Living such as bathing, dressing, eating, or mobility, and meet financial eligibility requirements. Income and asset limits vary by program — a CareWorks care coordinator can help verify this at no cost.

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 will not.

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 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.

To apply for Texas Medicaid home care, start at YourTexasBenefits.com or call 2-1-1 if your loved one is not yet on Medicaid. If they are already enrolled in Medicaid or STAR+PLUS, call your managed care organization and request a Personal Care Services assessment — you may already qualify with no additional enrollment required.

1. Already on Medicaid or STAR+PLUS? Contact your MCO and ask about Personal Care Services. You may already be eligible.
2. Not yet on Medicaid? Apply at YourTexasBenefits.com or call 2-1-1 for help. Once Medicaid is approved, the PHC/FC/CAS assessment can be scheduled.
3. Not sure where to start? Call us at (832) 237-2273. Our care coordinators help Houston families navigate this at no cost.

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 will authorize a set number of care hours per month.

If your Medicaid home care application is denied, you have the right to request a fair hearing through HHSC — and denials can often be successfully appealed. Common reasons for denial include incomplete paperwork, income documentation issues, or a functional assessment that did not fully capture the person’s needs.

If you receive a denial and are not sure what to do next, call us — we have helped families navigate appeals and we are happy to point you in the right direction.

Texas Medicaid home care covers personal care tasks that help individuals with daily living. It does not cover skilled nursing or medical procedures.

Texas Medicaid does not set a fixed number of care hours — hours are determined by a functional assessment and typically range from a few hours per week to several hours per day depending on the individual’s level of need. Most clients receive between 4 and 40 hours per month. 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, Tomball, League City, and surrounding communities.

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