In Texas, home care helps with daily life like bathing and meals, while home health sends a nurse or therapist to treat a medical condition at home. The two serve different needs, cost different amounts, and get paid for in completely different ways. The difference is not just vocabulary: it decides who is allowed to do the work and who pays for it.

This guide breaks down what each service actually includes, what home care costs in Texas, when Medicaid and Medicare cover the bill, and how to find a licensed provider near you. Many Texas families end up using both at once.

In This Guide

Home Care vs Home Health in Texas at a Glance

Home Care (Non-Medical) Home Health Care (Medical)
What it is Personal assistance with daily living Skilled medical care at home
Who provides it Trained, non-licensed caregivers RNs, LVNs, PTs, OTs, speech therapists
Doctor's order needed? No Yes
Services Bathing, meals, housekeeping, companionship, errands, transportation Nursing care, wound care, physical therapy, occupational therapy, IV infusions
Cost (private pay) About $30/hour in Texas Usually covered by Medicare or Medicaid
Medicare coverage No Yes, at $0 if homebound and skilled care is needed
Medicaid coverage Yes, through STAR+PLUS Yes, through STAR+PLUS

The short version: home health is skilled, physician-ordered care that Medicare will pay for at $0 when someone is homebound; home care is the non-medical, day-to-day help that Medicare excludes when that is the only care needed, so it is private-pay or Medicaid (about $30 an hour in Texas).,,

What Home Care Covers

Home care (sometimes called "non-medical home care" or "personal care") is the kind of help that makes it possible for someone to stay at home safely without moving to a facility.

A home care aide typically helps with:

  • Personal care: bathing, dressing, grooming, toileting
  • Meal preparation and help with eating
  • Light housekeeping: laundry, dishes, vacuuming
  • Companionship: conversation, activities, preventing isolation
  • Errands and transportation: grocery shopping, rides to doctor's appointments
  • Medication reminders (but not administering medications)

Home care doesn't involve medical tasks like injections, wound care, or IV infusions. The caregivers are trained but don't hold nursing or therapy licenses, and you don't need a doctor's referral to start.

Most families begin with part-time home care, maybe 15 to 20 hours a week, and adjust from there. The companionship piece is often the biggest value. Isolation is a real problem for homebound seniors, and having someone to talk to a few hours a day makes a bigger difference than most families expect.

What Home Health Care in Texas Covers

Home health care is medical treatment brought to your loved one's home. It requires a health care provider's order and a face-to-face certification, and the people delivering it are licensed professionals working through a Medicare-certified agency.

Home health services include:

  • Skilled nursing: wound care, injections, IV therapy, medication management
  • Physical therapy: strength, balance, mobility exercises after surgery or illness
  • Occupational therapy: relearning daily tasks, adaptive equipment training
  • Speech-language therapy: swallowing therapy, speech rehabilitation
  • Medical social work: connecting families with community resources

Home health care is short-term by design. A patient typically receives services for a few weeks or months after a hospital stay, surgery, or change in condition. The goal is recovery or stabilization, not ongoing daily support.

Trying to figure out which type of care your parent needs? Chat with Brevy on brevy.com for a personalized recommendation based on your situation.

Home Care Costs in Texas

Non-medical home care in Texas runs a median of about $68,640 a year, according to the CareScout (formerly Genworth) 2025 Cost of Care Survey. On the survey's standard basis of 44 hours a week for 52 weeks, that works out to roughly $30 an hour, or about $5,720 a month. That sits below the national median of $80,080 a year, or about $35 an hour.

Basis Cost
Per hour About $30
Per month (44 hrs/week) About $5,720
Per year (median) $68,640

Beginning with the 2025 survey, CareScout reports a single "non-medical caregiver" category rather than separate homemaker and home health aide figures, so the older split you may see quoted elsewhere is out of date. Your actual rate depends on the agency, the city, and how many hours a week you book.

Skilled home health care, by contrast, is usually covered by insurance. If your loved one qualifies for Medicare home health or Texas Medicaid, the medical side typically costs nothing out of pocket. That means families mainly pay out of pocket for the non-medical home care hours.

One thing families often discover too late: you can sometimes reduce your out-of-pocket costs by combining a few hours of Medicaid-covered attendant care (through STAR+PLUS) with private-pay home care hours for the rest. Your managed care organization (MCO) service coordinator can help you figure out what Medicaid will cover first.

How Texas Medicaid Covers In-Home Care

If your loved one has Texas Medicaid through STAR+PLUS, both home care and home health can be covered. Here's how each works.

Community Attendant Services (CAS)

STAR+PLUS members who qualify can receive Community Attendant Services, which covers personal care tasks like bathing, dressing, meal prep, and light housekeeping. Your MCO assigns a service coordinator who assesses what your family member needs and authorizes a specific number of hours per week.

Hours vary based on the assessment. Some members get 15 to 20 hours per week; others with higher needs get more. If you feel the authorized hours aren't enough, you can request a reassessment through your MCO service coordinator. Many families don't realize they can ask for more hours when conditions change.

Consumer Directed Services (CDS)

Here's where it gets interesting for families. The Consumer Directed Services option lets the person receiving care (or their representative) hire, train, and manage their own caregiver. That caregiver can be a family member such as an adult child, sibling, or other relative. Spouses can't be hired and paid as the attendant under CDS.

Under CDS, you work with a Financial Management Services Agency (FMSA) that acts as your employer agent and handles payroll, taxes, and reporting. The caregiver is hired as a W-2 employee, not an independent contractor, so taxes are withheld from each paycheck. CDS is available through STAR+PLUS, CAS, Community First Choice, and several other Medicaid programs.

STAR+PLUS Home Health Services

For the medical side, STAR+PLUS covers skilled home health services such as nursing visits, physical therapy, and occupational therapy at no cost to the member. Your doctor orders the services, and your MCO coordinates the home health agency.

PACE

Texas has three PACE (Program of All-Inclusive Care for the Elderly) providers, in El Paso, Amarillo, and Lubbock. PACE wraps everything together (medical care, home care, adult day care, prescriptions, transportation) into one program. If you live in one of those service areas and qualify, PACE can be a good all-in-one option. But it's only available in those three areas right now.

How Medicare Covers Home Health Care

Medicare covers home health care at $0 cost to the patient when three conditions are met: a doctor or allowed practitioner orders the services, the patient is "homebound" (needs help leaving home due to illness or injury), and the patient needs part-time or intermittent skilled services such as nursing or physical therapy.

Covered services include skilled nursing care, physical therapy, speech-language pathology, occupational therapy, medical social work, and part-time home health aide care (but the aide care is covered only while the patient is also receiving skilled care). You can read the rule directly at Medicare.gov.

"Part-time or intermittent" generally means combined skilled nursing and home health aide services furnished less than 8 hours a day and 28 or fewer hours a week (up to 35 hours a week on a case-by-case review).

What Medicare doesn't cover:

  • 24-hour-a-day care at home
  • Meals delivered to the home
  • Homemaker services (housekeeping only)
  • Personal care if that's the only care needed

So if your parent needs both medical care and help around the house, Medicare handles the medical part while you'll need Medicaid or private pay for the non-medical support.

How to Find a Licensed Provider in Texas

Finding Home Care Agencies

Texas licenses and regulates long-term care providers through the Health and Human Services Commission (HHSC). You can look up licensed agencies and review their survey and inspection history through the HHSC Long-Term Care Provider Search at apps.hhs.texas.gov/LTCSearch.

When comparing agencies, ask about:

  • Caregiver screening and training procedures
  • Backup plans when your regular caregiver is sick
  • Minimum hour requirements (some agencies require 4-hour shifts)
  • Whether they accept Medicaid or only private pay

Finding Home Health Agencies

For Medicare-certified home health agencies, use Medicare's Care Compare tool at medicare.gov/care-compare. It shows quality ratings, patient surveys, and inspection results for agencies in your area.

If your loved one is on STAR+PLUS, your MCO's provider directory will list home health agencies in your network. Call your MCO's member services line or ask your service coordinator for a referral.

Key Phone Numbers

These are the four Texas numbers most families need when arranging in-home care.

Medicaid Enrollment Broker (Maximus) Choose, change, or leave a managed care plan. 1-800-964-2777
HHS Ombudsman Managed Care Helpline Problems accessing services or complaints about a managed care plan. 1-866-566-8989
HHSC LTSS Interest List Line Get on a waiver interest list. 1-877-438-5658
2-1-1 Texas Referrals to local health and human services. 2-1-1

If you're feeling overwhelmed, 2-1-1 Texas is often the best first call. It covers the whole state and can route you to the local programs and agencies that fit your situation.

Frequently Asked Questions

Can the same agency provide both home care and home health?

Some Texas agencies are licensed to provide both non-medical home care and skilled home health services. But many specialize in one or the other. If your family member needs both, you might work with two separate agencies, one for the medical visits and another for daily personal care. Your MCO service coordinator can help coordinate if you're on Medicaid.

Does Medicare pay for non-medical home care?

No. Medicare only covers skilled home health care (nursing, therapy) when a provider orders it. It does not cover help with bathing, meals, housekeeping, or companionship when that personal care is the only care needed. For non-medical home care, you'll need Medicaid, private pay, or long-term care insurance.

How many hours of home care does Texas Medicaid cover?

There's no single statewide number. Your MCO service coordinator assesses your loved one's needs and authorizes hours based on that assessment. Some STAR+PLUS members receive 15 to 20 hours per week; others with greater needs receive more. If circumstances change, request a reassessment. You have the right to ask.

Can I hire a family member as a paid caregiver through Medicaid?

Yes, through the Consumer Directed Services (CDS) option. Adult children, siblings, and other relatives can be hired as paid caregivers under CDS, though a spouse cannot be paid as the attendant. You'll work with a Financial Management Services Agency to handle payroll and taxes. See our guide to getting paid as a family caregiver in Texas for the full process.

Next Steps

If you're deciding between home care and home health for someone you love, start by figuring out what kind of help they actually need. Medical issues like wound care or therapy after a hospital stay point to home health, which Medicare can cover at $0 when the patient is homebound. Trouble with daily tasks like bathing, cooking, or getting around the house points to home care, which is private-pay or Medicaid. Most families dealing with aging parents eventually use some of each.

Here's where to go from here:

Learn More

Care TypesHome Care vs. Home Health by State: What's the Difference and Who PaysHome care is non-medical help; home health is skilled, doctor-ordered care. See what each costs, who pays (Medicare vs. Medicaid), and your state's guide. Care TypesAssisted Living in TexasHow to choose an assisted living facility in Texas: check the HHSC inspection record, learn what STAR+PLUS Medicaid covers, and compare 2025 care costs. Care TypesMemory Care in TexasMemory care in Texas runs above the state's ~$5,600/month assisted-living rate in 2026. What Medicaid's STAR+PLUS waiver covers, plus how to choose a facility. Care TypesNursing Homes in TexasNursing homes in Texas in 2026: a semi-private room runs about $67,525/year, well below the national median. What it costs, how Medicaid pays, how to choose. MedicaidTexas Medicaid Programs for SeniorsTexas Medicaid programs for seniors 65+ include STAR+PLUS, CAS, HCBS waivers, and PACE. Find out what each one covers, who qualifies, and how to enroll. MedicaidTexas STAR+PLUS Waiver ProgramTexas STAR+PLUS covers Medicaid managed care for seniors 65+. The HCBS waiver income limit is $2,982/month, and Community First Choice has no waitlist. CaregiverGetting Paid as a Family Caregiver in TexasLearn how to get paid as a family caregiver in Texas through Medicaid CDS, CAS, VA programs, and CMPAS. Covers pay rates, eligibility, and step-by-step process.

Find personalized help choosing Texas home care or home health at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

BC

Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.