Texas Community Attendant Services: Texas 2026 Guide
Community Attendant Services (CAS) is a Texas Medicaid program that pays for attendant care at home for people whose income is too high for regular Medicaid but within a higher CAS limit. It is overseen by Texas Health and Human Services (HHSC) and is a key program for people who are not on SSI.
This guide covers who qualifies for Community Attendant Services, what help is included, how to start, and where it fits among Texas’s other long-term care options. For the full statewide rules on income, assets, spouses and the look-back, see our Texas Medicaid guide.
Figures change periodically. Double-check current amounts before relying on them.
What Community Attendant Services is
CAS provides non-skilled help with personal care and household tasks. It is one of the few Texas programs that does not require a nursing facility level of care, and because it uses its own income test, it reaches people who do not qualify for Primary Home Care. Members can choose an agency or Consumer Directed Services.
The core of Community Attendant Services is hands-on help with daily activities: bathing, dressing, eating, toileting and getting around, plus household tasks tied to that care. As a state plan benefit, it is an entitlement in Texas, so there is no enrollment cap for people who qualify. The trade-off is that state plan services are narrower than waiver services, and hours are set by an assessment.
Who qualifies in 2026
Texas’s basic requirements are that a person must:
- be eligible for Medicaid under the CAS income and asset rules;
- have a medical need for help with at least one personal care task, as certified by a practitioner;
- score at least 24 on the HHSC functional assessment (Form 2060), usually with a need for at least six hours of service a week; and
- live at home.
Financial rules. Community Attendant Services requires full Texas Medicaid. For many older adults, the regular Medicaid income limit is lower than the long-term care limit used for nursing homes and waivers. As a result, some people qualify for nursing home Medicaid but not for state plan home care, or only with a spend-down.
CAS uses its own income limit: in 2026, $2,982 a month for one person and $5,964 for a couple (300 percent of the SSI rate), with assets up to $2,000 for one person or $3,000 for a couple. People who already qualify for full Medicaid are referred to Primary Home Care instead. A Qualified Income Trust does not help someone meet the CAS income test.
For reference, these are Texas’s key 2026 long-term care Medicaid figures:
| Item | 2026 figure |
|---|---|
| Income limit (applicant) | $2,982 a month (special income limit). Above this, a Qualified Income Trust is needed |
| Asset limit (single applicant) | $2,000 |
| Asset limit (couple, both applying) | $3,000 |
| Home equity limit | $752,000 |
| Spouse at home: resource allowance (CSRA) | Minimum $32,532 / maximum $162,660 |
| Spouse at home: monthly income allowance | $4,066.50 (Texas uses the federal maximum) |
| Personal needs allowance (nursing home) | $75 a month |
| Look-back period | 60 months (5 years) |
Married applicants. For many state plan services, both spouses’ income and assets are counted together, and the spousal protections used for nursing homes and waivers may not apply the same way.
Services Community Attendant Services can cover
The assessment sets the hours, and the help can include:
- bathing, dressing and grooming
- eating and meal preparation
- toileting
- walking and transfers
- housekeeping and laundry tied to personal care
- escort to appointments
- consumer directed attendant services
Limits. Community Attendant Services is not 24-hour care and does not cover room and board or general housekeeping; skilled nursing and therapy are separate Medicaid services. People needing more help often move on to a waiver or managed long-term care.
How to apply for Community Attendant Services
The steps are generally:
- Contact HHSC to ask about CAS, or apply for Medicaid through HHSC’s benefits website.
- A practitioner completes a statement of medical need.
- HHSC or the plan completes the functional assessment.
- Choose an agency or Consumer Directed Services.
- Services start once authorized.
Staying organized. Copy every form before you send it and keep a simple call log. At the assessment, talk about the hardest days, not the best ones, and bring someone who sees the care needs firsthand. Cognitive problems and fall risk count toward need. If services are denied, the notice lists the deadline to appeal.
Waiting lists and timing
CAS has no interest list for people who meet the rules.
As an entitlement, Community Attendant Services has no enrollment cap. Delays come instead from paperwork, assessments and staffing.
How it relates to nursing home Medicaid
Many Community Attendant Services recipients have needs below a nursing home level of care. It is not meant to replace a nursing home for someone who needs care around the clock. If needs grow, the next steps are usually a waiver, managed care or nursing home care. Nursing home Medicaid uses the special long-term care income limit and spousal protections, so a person over the limit for state plan care may still qualify for a nursing home.
Getting ready for Community Attendant Services
Most families come to Community Attendant Services during a change: a fall, a hospital stay, or a caregiver who can no longer keep up. Planning a little ahead makes each step easier. Start by writing down what help is needed each day, who provides it now, and what would happen if that person were unavailable for a week. That list supports the assessment and shows where paid help would make the biggest difference.
For the Medicaid application, collect bank statements, income notices, insurance cards, and proof of identity and Texas residence. Holding on to five years of records now saves time if fuller long-term care Medicaid is needed later. Without a durable power of attorney, a family member may need a court order to manage finances, so signing one early is wise.
Finally, review the plan every few months. Needs change, and Texas’s programs are designed to change with them through reassessments. Families who keep notes on changes, such as new diagnoses, falls or hospital visits, find later reviews and applications go more smoothly.
Tips for families
Write down each task, how often it happens and how long it takes before the assessor arrives. Rules on paying relatives vary, so check them before counting on a family worker. If the approved hours seem too low, get the decision in writing and consider a fair hearing.
We encourage families to consult a Certified Medicaid Planner before filing for Community Attendant Services. A planner can compare Texas’s programs side by side, protect a spouse’s share where the rules allow, and prepare the paperwork. Typical fees vary widely: help with an application alone often runs about $500 to $6,000, full planning about $2,500 to $15,000 or more, and hourly advice about $150 to $600.
Related pages
- Texas Medicaid guide
- Texas Primary Home Care
- Texas STAR+PLUS
- In-home care and Medicaid
- Activities of daily living
- Consumer-directed care
- Paid family caregivers
- HCBS waivers explained
Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.