Texas Primary Home Care: Texas 2026 Guide
Primary Home Care (PHC) is a Texas Medicaid state plan service that pays for attendant care at home for adults with full Medicaid who need help with personal care. Many members now receive equivalent attendant services through their STAR+PLUS plan.
Below: 2026 eligibility for Primary Home Care, 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 Primary Home Care is
PHC provides non-skilled help with daily activities, authorized in hours a week after an assessment. Care is provided by a home care agency or through Consumer Directed Services. PHC does not require a nursing facility level of care.
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. When personal care is part of a state’s regular Medicaid program (the “state plan”), it is an entitlement: anyone who qualifies gets it, without waiver enrollment caps. Service lists are shorter than under a waiver, and an assessment decides the hours.
Who qualifies in 2026
Generally, to qualify for Primary Home Care a person must:
- be 21 or older and eligible for full Texas Medicaid, such as through SSI;
- have a medical need certified by a practitioner;
- need help with at least one personal care task, with a score of at least 24 on the HHSC functional assessment; and
- live at home.
The money test. Because Primary Home Care is a regular Medicaid service, the applicant must first be on Texas Medicaid, and for older adults the regular income limit is often lower than the special long-term care limit used for nursing homes and waivers. Some people who would qualify for nursing home care therefore qualify for state plan services only through a spend-down, or not at all.
PHC follows the income rules for the member’s full Medicaid group, which for many older adults is the SSI-related level. People with somewhat higher income may qualify for Community Attendant Services instead.
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) |
If married. Spousal impoverishment protections may not apply to regular Medicaid in the same way as for waivers, so couples can see different results between programs.
Services Primary Home Care can cover
Hours are set by the assessment. Covered tasks include:
- bathing, dressing and grooming
- eating
- toileting
- transfers and walking
- meal preparation, housekeeping and laundry tied to personal care
- escort to appointments
- consumer directed attendant services
What is usually not covered. State plan personal care generally does not pay for round-the-clock supervision, room and board, or housekeeping unrelated to care, and skilled nursing is covered separately. A waiver can add services such as respite and home changes when needs grow.
How to apply for Primary Home Care
The usual path is:
- Make sure the person has full Texas Medicaid.
- Request an attendant care assessment from the STAR+PLUS plan, or from HHSC if not in a plan.
- A practitioner completes a statement of medical need.
- Hours are authorized after assessment.
- Choose an agency or Consumer Directed Services.
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. Supervision needs, confusion and falls matter as much as hands-on help. A denial notice explains the fair hearing process and its deadline.
Waiting lists and timing
PHC has no waiting list for eligible members.
Primary Home Care 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
Many Primary Home Care recipients have needs below a nursing home level of 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 coverage uses different, often more generous income rules.
Getting ready for Primary Home Care
Most families come to Primary Home Care 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. A good first step is a short written picture of the day: which tasks need help, who does them now, and what the backup is. That list supports the assessment and shows where paid help would make the biggest difference.
On the financial side, gather recent bank statements, income letters such as Social Security and pension notices, health insurance cards, and proof of age and residence in Texas. Keep older statements too: if a waiver or nursing home becomes necessary, the five-year look-back applies. Legal documents matter too. A durable power of attorney and a health care directive let a trusted person act on applications without a guardianship.
Finally, review the plan every few months. Needs change, and Texas’s programs are designed to change with them through reassessments. Notes on falls, hospital visits and new diagnoses make later reviews easier.
Tips for families
Write down each task, how often it happens and how long it takes before the assessor arrives. Programs differ on whether relatives can be paid and what training is needed. If the approved hours seem too low, get the decision in writing and consider a fair hearing.
Working with a Certified Medicaid Planner is often the fastest way through Primary Home Care. 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. 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 Community Attendant Services
- 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.