Texas Community First Choice: Texas 2026 Guide
Texas offers Community First Choice (CFC), a state plan option that pays for attendant care and habilitation for Medicaid members who meet an institutional level of care. For older adults and adults with physical disabilities, CFC is delivered through STAR+PLUS plans. It is overseen by Texas Health and Human Services (HHSC).
Below: 2026 eligibility for Community First Choice, the tasks it covers, how to get an assessment, and how it compares with Texas’s waivers and nursing home coverage. 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 First Choice is
CFC is an entitlement under the federal 1915(k) option: members who meet the rules receive services without an interest list. It covers personal assistance, habilitation (help learning or keeping skills), emergency response and support management. Members can self-direct through Consumer Directed Services.
Personal care is hands-on help with everyday activities such as bathing, dressing, eating, using the toilet and moving around, plus related tasks like light housework when they support the person’s 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 full Texas Medicaid;
- meet an institutional level of care, such as nursing facility medical necessity;
- live at home or in a community setting; and
- have needs that CFC services can meet.
Who qualifies financially. Applicants need regular Texas Medicaid, whose income limit for older adults is often below the long-term care limit. Some people who would qualify for nursing home care therefore qualify for state plan services only through a spend-down, or not at all.
CFC follows the member’s Medicaid group income rules. For people who qualify through the STAR+PLUS HCBS route, Texas long-term care rules apply: $2,982 a month of income in 2026 and $2,000 in assets.
The main Texas long-term care figures for 2026, taken from our state guide, are below.
| 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 First Choice can cover
The assessment sets the hours, and the help can include:
- personal assistance services
- habilitation
- emergency response services
- support management
- consumer directed services
Limits. Community First Choice is not 24-hour care and does not cover room and board or general housekeeping; skilled nursing and therapy are separate Medicaid services. A waiver can add services such as respite and home changes when needs grow.
How to apply for Community First Choice
The steps are generally:
- Make sure the person has full Texas Medicaid and is in STAR+PLUS.
- Request a CFC assessment from the plan’s service coordinator.
- The plan assesses level of care and needs.
- Choose an agency or Consumer Directed Services.
- Services start once authorized.
Practical tips. Keep copies of everything you send and note the name of each person you speak with. 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
CFC has no interest list for eligible members.
Community First Choice is not capped, so there is no formal waiting list. Delays come instead from paperwork, assessments and staffing.
How it relates to nursing home Medicaid
Community First Choice reaches people earlier, often before they would qualify for nursing home care. It is not designed for people who need care around the clock; for them, a waiver, managed care or a nursing home is the usual next step. 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.
Planning ahead for Community First Choice
The need for Community First Choice often arrives suddenly, after a hospital stay or a fall. Some preparation goes a long way. Begin with a list of daily tasks, the people who handle them, and the gaps that appear when a caregiver is away. It also helps the assessor see real needs rather than a single snapshot.
Paperwork usually includes bank statements, income letters, insurance cards, and proof of identity and residence in Texas. Holding on to five years of records now saves time if fuller long-term care Medicaid is needed later. Legal documents matter too. A durable power of attorney and a health care directive let a trusted person act on applications without a guardianship.
Needs rarely stay the same, so revisit the arrangement regularly and request a reassessment when things change. A running log of health changes helps with every later review.
Tips for families
A simple list of tasks, frequency and time helps the assessment reflect real needs. Rules on paying relatives vary, so check them before counting on a family worker. Low hours can be appealed through a fair hearing.
Working with a Certified Medicaid Planner is often the fastest way through Community First Choice. A planner who handles Texas cases regularly can spot eligibility problems before Texas Health and Human Services does, organize the records and help plan around any wait. Costs range widely, from about $150 to $600 an hour, about $500 to $6,000 for application help, and about $2,500 to $15,000 or more for full planning.
Related pages
- Texas Medicaid guide
- 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.