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. If your parent needs both kinds of help, they can get both at the same time.

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 Aides and attendants (non-medical) RNs, LVNs, PTs, OTs, speech therapists
Doctor's order needed? Medicaid's CAS program needs a practitioner's statement of medical need Yes, plus a face-to-face visit (telehealth counts) from 90 days before to 30 days after care starts
Services Bathing, dressing, meals, housekeeping, shopping, going along to medical appointments Skilled nursing, physical, occupational, and speech therapy, medical social services
Cost (private pay) About $30/hour in Texas $0 for covered Medicare services; a private duty nurse runs about $90/hour
Medicare coverage Not on its own Yes, at $0 if homebound and part-time or intermittent skilled care is needed
Medicaid coverage Yes, through programs such as CAS and STAR+PLUS Yes, a required Medicaid benefit

The short version: home health is skilled care, ordered by a doctor or other provider, that Medicare pays for in full when someone is homebound and needs part-time or intermittent skilled care; 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.

Texas's Medicaid attendant programs list the everyday tasks a home care aide typically handles:

  • Personal care: bathing, dressing, grooming, toileting, and help moving from bed to chair or walking
  • Meal preparation and help with eating
  • Housekeeping: cleaning and laundry
  • Shopping for the things your loved one needs
  • Escort: going along to a doctor's office or clinic for medical care

Home care stops short of skilled work. Texas's Medicaid attendant programs can't pay an aide for injections, tube feedings, sterile dressings, or giving medication, because those take professional training; their attendants are trained and supervised by non-medical staff. In Community Attendant Services and Primary Home Care, the need also has to be documented on a practitioner's statement of medical need.

You don't have to start with full days. You can book a few hours a week and add more as needs change; just ask each agency about its minimum shift length (more on choosing an agency below).

What Home Health Care in Texas Covers

Home health care is medical treatment brought to your loved one's home. For Medicare to pay, a doctor or other provider (like a nurse practitioner) must confirm your loved one needs home health care and order it, and a Medicare-certified home health agency must provide it. That provider also has to see your loved one face to face, for the main reason they need home health, and the visit can happen by telehealth: no more than 90 days before home health starts or within 30 days after.

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. Under Medicare it can't start the benefit on its own; it has to be ordered along with nursing, physical therapy, or speech therapy, and can then continue alone.
  • Speech-language therapy: swallowing therapy, speech rehabilitation
  • Medical social work: connecting families with community resources

Home health is built around a skilled need, often recovery after a hospital stay, surgery, or a change in condition. Medicare sets no cap on the number of visits for someone who qualifies, but it covers them only while the skilled need and the other conditions are met, and not at all for someone who needs more than part-time or intermittent skilled care.

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 is paid for differently. If your loved one qualifies for Medicare home health, the covered services themselves cost nothing, though medical equipment carries a 20% coinsurance after the Part B deductible. Hiring a nurse privately is another matter: the same CareScout survey puts a private duty nurse in Texas at $90 an hour, or $150 a visit.

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

Texas Medicaid can pay for both home care and home health. Here's how each works.

Community Attendant Services (CAS)

Community Attendant Services is an HHSC Medicaid program that pays an attendant to help with bathing, grooming, dressing, meal preparation, housekeeping, shopping, and getting to medical appointments. It can't pay for skilled tasks such as injections, tube feedings, or giving medication. Financial eligibility runs through Medicaid for the Elderly and People with Disabilities (MEPD).

To qualify on need, a person must score at least 24 on HHSC's needs assessment (Form 2060), and a practitioner must document the need on a statement of medical need (Form 3052). The usual floor is six hours of help a week, but someone who needs fewer hours can still qualify if any one of five conditions applies: they need CAS to support their caregiver; they live with someone who already gets Primary Home Care, CAS, or Family Care; they already get congregate or home-delivered meals, help from a home health aide, or certain adult day services; they get VA aid-and-attendance benefits; or the assessment finds them at high risk of going into a facility without the help.

Hours come out of that assessment: up to 50 a week, or up to 42 for someone with priority status. Priority status takes all three of these: the person can't manage a basic task like eating, getting out of bed, or using the toilet without hands-on help; no one else is able and willing to help during the scheduled shift; and missing that shift would likely put their health or safety at risk.

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. HHSC's list of people who can't be your CDS employee covers the CDS employer; the spouse of the person receiving services and the employer's spouse, except in Client Managed Personal Attendant Services (CMPAS); the designated representative and their spouse; and the parent or legally authorized representative of someone under 18. HHSC adds that limits vary by program, so check yours with the service coordinator, case manager, or your FMSA. HHSC's Form 1726 goes further: a legally authorized representative is barred at any age, which includes an adult's court-appointed guardian, and in Primary Home Care, Family Care, and CAS the primary caregiver can't be the paid provider. Relatives the rules don't name, such as an adult child or sibling, aren't excluded, as long as they're 18 or older and meet the program's requirements.

Under CDS, the person receiving care (or their legally authorized representative) is the employer of record: they hire, manage, and supervise the caregiver and set wages and benefits. A Financial Management Services Agency (FMSA) acts as that employer's "employer agent," the IRS term for an agency approved to handle payroll, taxes, and reporting on the employer's behalf without becoming the caregiver's actual employer. Hiring, supervising, scheduling, and dismissing the caregiver stay with the employer, not the FMSA. The FMSA does run background and credential checks, and you can't hire anyone until it confirms they're eligible; hours worked before that aren't paid. The caregiver is hired as an employee, not an independent contractor, so taxes are taken out of each paycheck. CDS is available through STAR+PLUS, CAS, and eleven other Texas long-term services and supports programs on the HHSC list. Community First Choice is not a program of its own on that list: CFC personal care services and CFC habilitation are self-directable inside STAR+PLUS, STAR+PLUS HCBS, STAR Health, STAR Kids, CLASS, DBMD, HCS, MDCP, and Texas Home Living, and HHSC's table lists no CFC service for CMPAS or for the combined Primary Home Care, Family Care, and Community Attendant Services row.

Medicaid Home Health Services

For the medical side, federal rules make home health a required Medicaid benefit in every state, Texas included: part-time nursing, home health aide services, and medical supplies and equipment, ordered by a doctor or other qualified practitioner as part of a written plan of care. Therapy is an optional add-on a state may cover. Medicaid also can't limit home health to people who are homebound, a condition Medicare does require., If your loved one is in STAR+PLUS, the MCO arranges 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 into one program: it must provide all Medicare- and Medicaid-covered services, including in-home services, adult day care, prescription drugs, and transportation. Because it is all-inclusive, it can't be combined with STAR+PLUS or other HHSC programs, so someone can't be in PACE and STAR+PLUS at the same time. 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

For covered home health services, you pay nothing. Your loved one has to meet every condition, though: they're homebound; they're under the care of a doctor or allowed practitioner who sets up and reviews a plan of care; they need part-time or intermittent skilled nursing, physical therapy, speech-language pathology, or continued occupational therapy; and a Medicare-certified home health agency provides the care. Medical equipment is the exception: after the Part B deductible, you pay 20% of the Medicare-approved amount.

"Homebound" has two parts, and both must be true. Leaving home isn't recommended because of their condition, or they need help to leave (a cane, walker, wheelchair, special transportation, or another person). And they normally can't leave home, and leaving takes a lot of effort. It doesn't mean never going out: trips for medical treatment, short and infrequent outings such as religious services, and adult day care are all allowed. A doctor or provider such as a nurse practitioner must also see your loved one face to face, and telehealth counts. That visit can take place up to 90 days before home health begins or within 30 days after it starts. If your loved one is in a Medicare Advantage plan, check the plan's own home health rules.

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 getting skilled care. Medicare's own examples of aide care are help with walking, bathing or grooming, changing bed linens, and feeding, so if a nurse or therapist is already visiting, ask the agency about aide hours. 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) unrelated to the plan of care
  • 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 (plus some aide help while skilled care lasts), while you'll need Medicaid or private pay for ongoing non-medical support.

How to Find a Licensed Provider in Texas

Finding Home Care Agencies

Texas licenses home care and home health providers as Home and Community Support Services Agencies (HCSSAs) through the Health and Human Services Commission (HHSC). Apart from limited exemptions in state law, an agency needs an HHSC license to provide home health or personal assistance services for pay, and the license categories include Licensed Home Health Services, Licensed and Certified Home Health Services, and Personal Assistance Services, so ask which one an agency holds. You can search HHSC-licensed long-term care providers through the HHSC Long-Term Care Provider Search at tulip.hhs.texas.gov.

When comparing agencies, ask about:

  • Caregiver screening and training procedures
  • Backup plans when your regular caregiver is sick
  • Minimum hour or shift requirements
  • 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.

Texas Enrollment Broker Helpline Change a Medicaid managed-care health or dental plan, including STAR+PLUS. 1-800-964-2777
HHS Ombudsman Managed Care Help Line Questions or complaints about a Medicaid managed-care plan, including problems with access to care. Monday to Friday, 8 a.m. to 5 p.m. 1-866-566-8989
Medicaid Waiver Interest List Get added to a Medicaid waiver interest list. For the HCS and Texas Home Living waivers, contact your local Intellectual and Developmental Disability Authority (LIDDA) instead. 1-877-438-5658
2-1-1 Texas Referrals to local health and human services. 2-1-1 (or 877-541-7905)

If you're feeling overwhelmed, 2-1-1 Texas is often the best first call. It's free, anonymous, and answers 24 hours a day, every day, and it 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?

Not on its own. Medicare covers home health, which is skilled care (nursing, therapy) a provider orders. It does not cover help with bathing, dressing, or using the bathroom when that personal care is the only care needed, and it does not cover meal delivery or homemaker services like housekeeping that aren't part of the care plan. While skilled care is under way, though, a home health aide can help with things like bathing and grooming. 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?

It depends on the assessment. In Community Attendant Services, the usual floor is six hours of help a week, though someone who needs fewer can still qualify under one of five exceptions, such as getting VA aid-and-attendance benefits or being at high risk of moving into a facility. A person can get up to 50 hours a week, or up to 42 with priority status. In STAR+PLUS, your MCO service coordinator assesses your loved one's needs and authorizes hours. If circumstances change, ask for the hours to be looked at again.

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

Often, yes, through the Consumer Directed Services (CDS) option. Relatives the rules don't name, such as an adult child or sibling, aren't excluded if they're 18 or older and meet the program's requirements. Some people are barred: a spouse (the care recipient's or the CDS employer's) except in Client Managed Personal Attendant Services (CMPAS), the designated representative, a legally authorized representative such as a court-appointed guardian, and the primary caregiver in Primary Home Care, Family Care, or CAS. A relative barred under CDS should ask the service coordinator or case manager whether the agency option can pay them instead. You'll work with a Financial Management Services Agency to handle payroll and taxes, and you can't hire anyone until it confirms they're eligible. 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 in full when the patient is homebound and needs part-time or intermittent skilled care. Trouble with daily tasks like bathing, cooking, or getting around the house points to home care, which is private-pay or Medicaid. If both apply, your parent can use both at once.

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 assisted living in Texas: confirm the HHSC license, ask about inspections, learn what STAR+PLUS Medicaid covers, and compare 2025 care costs. Care TypesMemory Care in TexasCareScout has no Texas memory care median; its $5,666/month assisted-living median is the closest reference. What STAR+PLUS covers and 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 income limit is $2,982/month, and 12,100 people were on its interest list in August 2026. 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.

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