Texas’ Medicaid Primary Home Care Services / Personal Assistance Services / Personal Attendant Services

Last updated: March 04, 2024


Overview of Texas’ Medicaid Primary Home Care

Texas’ Primary Home Care (PHC) provides seniors and persons with disabilities who have functional limitations with in-home “attendant services” (personal care assistance). Assistance may include help with daily living activities, such as bathing, dressing, personal hygiene, using the toilet, eating, cleaning the house, doing laundry, and making meals. The goal of this statewide program is to prevent and delay the need for nursing home care, and instead, allow eligible Texans to live in their home or the home of a loved one. Primary Home Care services cannot be provided for persons living in assisted living facilities or adult foster care homes.

There is flexibility of providers for people receiving services via Primary Home Care. While participants can receive services via a provider agency, services may also be participant-directed. This means that rather than receive services by a licensed care provider, a program participant can hire their own “care attendant”. The state offers two options of self-directed care: The Service Responsibility Option (SRO) and Consumer Directed Services (CDS). Via both SRO and CDS, program participants can choose, manage, supervise, and fire their own care attendants. This allows them to hire specific relatives, such as one’s adult child or grandchild. Spouses, unfortunately, are prohibited from filling this role. With SRO, the program participant is considered the “employer” and is responsible for finding substitute attendants, whereas with CDS, this is not the case. A Financial Management Services Agency handles the financial aspects of employment responsibilities such as background checks, tax withholding, and caregiver payments.

Primary Home Care, which may also be called Personal Attendant Services or Personal Assistance Services, is a Medicaid State Plan benefit. It is an entitlement for persons who meet the eligibility criteria. This means there is never a waitlist (interest list) for program participation.

 Medicaid Waivers versus State Plan / Regular Medicaid
While home and community based services (HCBS) can be provided via a Medicaid Waiver or a state’s Regular Medicaid Plan, HCBS through Medicaid State Plans are an entitlement. Put differently, meeting the program’s eligibility requirements guarantees an applicant will receive benefits. On the other hand, HCBS via Medicaid Waivers are not an entitlement. Waivers have a limited number of participant enrollment slots, and once they have been filled, a waitlist for benefits begins. Furthermore, HCBS Medicaid Waivers require a program participant require the level of care provided in a nursing home, while State Plan HCBS do not always require this level of care.


Benefits of Texas’ Medicaid Primary Home Care

Program participants can receive up to 50 hours of care services per week. The exact services and the amount of time with which one is provided assistance is based on an individual care plan. However, the following benefits may be provided.

– Escort Services – provides assistance to / from doctor appointments and other activities
– Home Management Tasks – housecleaning, laundry, shopping for essentials, preparing meals
– Personal Care – includes assistance with bathing, dressing, grooming, hair / skin care, toileting, eating, walking, transferring (i.e., moving from the bed to a chair), medication reminders

 Another Option: Texas has another Medicaid program, Community Attendant Services (CAS), that is very similar to Primary Home Care (PHC). The main difference is that CAS is available to persons of all ages who generally do not yet qualify for Medicaid, while PHC is limited to persons 21+ years old who receive SSI benefits.


Eligibility Requirements for Texas’ Medicaid Primary Home Care

PHC is for Texas residents who are 21+ years old and receive SSI (Supplemental Security Income). Texans who are eligible for SSI are automatically enrolled in Texas’ Regular State Plan Medicaid program. Additional eligibility criteria for PHC follows and is accurate for 2024.


Financial Criteria: Income, Assets & Home Ownership

To be eligible for SSI, and hence Texas’ Regular Medicaid program, an individual must have income under $943 / month. Married couples, regardless of if one or both spouses are applicants, must have income under $1,415 / month.

 Spousal Help: While many home and community based services Medicaid programs allow a non-applicant spouse to retain a larger portion of a couple’s income and assets, Primary Home Care does not. In contrast, Texas’ STAR+PLUS HCBS Program does allow a non-applicant spouse a Monthly Maintenance Needs Allowance from their applicant spouse and a Community Spouse Resource Allowance.

The asset limit for SSI (and Regular State Plan Medicaid in Texas) is $2,000 for a single applicant. For couples, the asset limit is $3,000 (regardless of whether one spouse or both are applicants).

Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.

While there is a 60-month Look-Back Rule in which Medicaid checks past asset transfers of those applying for Nursing Home Medicaid or home and community based services via a Medicaid Waiver, it is not relevant for Texas’ Regular State Plan Medicaid program.

Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. Applicants for Texas’ Regular State Medicaid program need not worry. For eligibility for this program, the home is exempt (non-countable) given the applicant (or their spouse) lives in it. Note that there are other Texas Medicaid programs, such as the STAR+PLUS HCBS Waiver and Nursing Home Medicaid, that have more rules when it comes to home exemption. Learn more.


Medical Criteria: Functional Need

While many long-term care Medicaid programs require an applicant need a Nursing Facility Level of Care (NFLOC), Primary Home Care does not. However, an applicant must have a medical need for the services provided via PHC. This is determined by an assessment of one’s ability / inability to complete their Activities of Daily Living (i.e., transferring from the bed to a chair, mobility, eating, toileting, dressing) that yields a functional impairment score. To be functionally eligible, an applicant must have a minimum score of 24, as well as require assistance with at least one personal care task. Furthermore, a statement from a physician indicating an applicant has a medical need for care is required.

While persons with Alzheimer’s disease or a related dementia often require assistance with such tasks due to cognitive decline, a diagnosis in and of itself does not mean one will meet the functional need.

  Learn more about long-term care Medicaid in Texas.


Qualifying When Over the Limits

For a senior to be eligible for Texas’ Regular State Plan Medicaid program, they must be eligible for SSI. Medicaid eligibility is automatically established when one is approved for SSI. While many Medicaid programs have alternative pathways to Medicaid eligibility, for seniors, the Regular State Plan Medicaid program does not. Therefore, if over the income and / or asset limit(s) for SSI, Medicaid planning strategies to help persons who would otherwise be ineligible for Medicaid to become eligible is not feasible. However, TX has another Medicaid program that provides long-term care for persons who require a Nursing Home Level of Care and does not limit eligibility to persons enrolled in SSI. Learn more about STAR+PLUS HCBS.


How to Apply for Texas’ Medicaid Primary Home Care

Application Process

Persons must be eligible for Texas’ Regular State Plan Medicaid program in order to access Primary Home Care. To be eligible, seniors must be eligible for SSI. Approval for SSI benefits is automatic approval for Medicaid; a Medicaid benefit card is automatically sent when one is approved for SSI. To be clear, seniors do not apply for the Regular Medicaid program via Texas Health and Human Services Commission. Persons can apply for SSI benefits (and hence, Medicaid) via the Social Security Administration. Learn how to apply for SSI here. Once enrolled in SSI (and hence, Medicaid), persons can inquire about PHC with the Medicaid agency. Persons already receiving SSI (and hence, Medicaid), should contact Texas Health and Human Services Commission to inquire about PHC.

More information about Primary Home Care can be found here.

The Texas Health and Human Services Commission (HHSC), an agency within Texas Health and Human Services (HHS), administers the Primary Home Care Program.


Approval Process & Timing

The SSI / Medicaid application process takes approximately 3 to 5 months. This includes the several weeks it generally takes one to complete the SSI application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process can be delayed even further.

Determine Your Medicaid Eligibility

Get Help Qualifying for Medicaid