Frequently Asked Questions - Medicaid

Eligibility depends on the specific program and typically includes income limits, asset limits for certain groups, Texas residency, and categorical criteria such as age, disability, pregnancy, or having dependent children.

Some long-term services and supports programs also require a functional assessment showing a need for help with daily activities.

Limits vary by program type (for example, community Medicaid vs. long-term services and supports) and by household situation.

Because amounts change and different programs apply different rules, confirm current limits through HHSC or YourTexasBenefits.com before applying.

Texas Medicaid can cover in-home personal care (non-medical attendant services) through long-term services and supports programs.

It can also cover skilled home health services when medically necessary and authorized, depending on the person’s coverage and program.

Home health typically refers to skilled services ordered by a clinician, such as nursing, therapy, or wound care.

Personal care (attendant care) helps with daily living, such as bathing, dressing, meal prep, and mobility support.

Depending on program and assessed need, Medicaid may cover help with activities of daily living (ADLs) like bathing, dressing, grooming, toileting, transferring, and mobility.

Some programs also support instrumental activities of daily living (IADLs) such as light housekeeping, meal preparation, and errands, plus supports like respite care or home modifications through certain waivers.

Common pathways include STAR+PLUS (managed care for adults 65+ and adults with disabilities), Primary Home Care (PHC), Consumer Directed Services (CDS) options, and certain waiver programs.

Which program applies depends on age, disability status, financial eligibility, and the results of a needs assessment.

STAR+PLUS is a Texas Medicaid managed care program for adults age 65 or older and adults with disabilities who qualify for Medicaid.

It combines basic Medicaid health services with long-term services and supports, with care coordination through a managed care organization.

Waiver programs are designed to provide home and community-based services that help people avoid institutional care.

They often include additional supports that traditional Medicaid does not typically cover, such as respite, specialized therapies, or home modifications, depending on the waiver.

Many waivers do have interest lists and can have long waits. People can often pursue other Medicaid benefits while waiting, depending on eligibility.

Apply online at YourTexasBenefits.com, by calling 2-1-1 (Option 2), by mail, or in person at an HHSC benefits office.

Common documents include proof of identity, Texas residency, income, and assets, plus any documentation related to disability or medical need when applicable.

Many applications are processed within about 45 days.

Some situations can take longer, especially if more information is needed or if a disability determination is required.

Yes. HHSC staff can explain application requirements.

ADRCs and Area Agencies on Aging can help people understand long-term care options, gather information, and navigate the process.

In some situations, programs that allow participant direction (such as CDS) may allow hiring certain family members as paid attendants, subject to program rules.

Eligibility, relationship restrictions, and authorization rules vary, so confirm through the member’s managed care plan or HHSC.

CDS is an option in certain Texas Medicaid programs that lets the participant (or an authorized representative) manage services.

The participant can choose attendants, set schedules, and handle day-to-day management, typically with support from a financial management services agency.

Skilled home health services generally require medical necessity and clinical authorization.

Personal care hours and long-term services typically require an assessment of functional need, and sometimes additional documentation depending on the program.

Hours are usually based on an assessment of needs, including help required with ADLs and IADLs, health and safety factors, and the program’s service guidelines.

The managed care plan or HHSC-authorized assessor typically determines the service level.

Choice depends on the program and plan network. Many managed care programs require using in-network providers.

Not all agencies accept Medicaid or participate in all Medicaid programs, so availability varies by location and plan.

Some Medicaid services have limited cost-sharing depending on the benefit and eligibility group.

Medicaid generally does not cover room and board for many community settings, and certain long-term care pathways can involve rules about income contributions or spend-down.

Applicants and members generally have the right to request a fair hearing or appeal an adverse decision.

Denial notices typically include deadlines and instructions for how to appeal through HHSC or the managed care plan.

Texas Medicaid can cover nursing facility care for eligible individuals.

Some programs may help support assisted living or other community settings, but coverage depends on eligibility, availability, and program rules.

Long-term care insurance can help pay for care before Medicaid eligibility.

Qualifying Partnership policies may allow certain asset protection rules if the person later applies for Medicaid, subject to Texas Partnership requirements.

Contact local Area Agencies on Aging or ADRCs for immediate support options and referrals.

If there is a safety concern, consider short-term private pay services, community resources, or medical follow-up while eligibility is being determined.