Texas home care programs

Home health: the medical benefit

In Texas, skilled home health is Home health services (Texas Medicaid) (HHA). It is a medical benefit: a doctor or other practitioner orders nursing, therapy or home health aide visits under a written plan of care, and the visits stop when the skilled need ends.

Only a licensed home health agency enrolled with Texas Medicaid can bill it, and the agency's own nurses, therapists and aides make the visits. Family members are not paid under this benefit.

Home care: non-medical personal care through an agency

Help with bathing, dressing, eating, toileting and household tasks is "home care" or personal care. In Texas the agency route is Community First Choice (CFC) (PAS) and Primary Home Care (PHC) and Community Attendant Services (CAS). No skilled need is required; the person qualifies on functional need, usually measured by an assessment of daily activities.

The agency recruits, trains, schedules and pays the aides, and it is the employer. Community First Choice (CFC) (PAS) and Primary Home Care (PHC) and Community Attendant Services (CAS) let the agency hire a family member as the aide, with the agency still the employer.

Consumer-directed care: the person hires their own aide

Texas's consumer-directed option is Consumer Directed Services (CDS) option (FMSA) and Consumer Managed Personal Attendant Services (CMPAS). The person receiving care, or a representative, recruits, hires, trains, schedules and supervises the aide, and can let go of one. A fiscal intermediary runs payroll, taxes and background checks, so the person never handles wages directly.

This is the route most families use to be paid: Consumer Directed Services (CDS) option (FMSA) and Consumer Managed Personal Attendant Services (CMPAS) allow a relative to be hired as the paid aide. Which relatives qualify (adult children, parents of adults, spouses, legal guardians) and how a live-in caregiver is treated are set program by program.

Structured family caregiving: a paid live-in family caregiver

Texas has no structured family caregiving program. A family caregiver is paid instead through consumer-directed care (Consumer Directed Services (CDS) option (FMSA) and Consumer Managed Personal Attendant Services (CMPAS)), by the hour, as the participant's chosen aide.

Other ways Texas pays for care at home

Waiver in-home services: Community Living Assistance and Support Services (CLASS), HCS and Texas Home Living waivers (TxHmL), Medically Dependent Children Program (MDCP), and STAR+PLUS Home and Community Based Services. These pay for in-home supports for people who meet a nursing-home or similar level of care, often with more services than state plan personal care and, in some programs, a waiting list or enrollment cap.

PACE: Program of All-Inclusive Care for the Elderly (PACE). One PACE organization covers medical care, a day center and home care for people 55 and over who need nursing-home level care.

State-funded: Family Care (FC). Paid from state funds outside Medicaid, for people who do not qualify for Medicaid or are waiting for it.

Which one fits

• Needs nursing, wound care, injections or therapy at home: home health (Home health services (Texas Medicaid) (HHA)).
• Needs daily help and wants an agency to supply and manage the aide: Community First Choice (CFC) (PAS) and Primary Home Care (PHC) and Community Attendant Services (CAS).
• Wants to choose the aide, including a relative where allowed: Consumer Directed Services (CDS) option (FMSA) and Consumer Managed Personal Attendant Services (CMPAS).
• Meets nursing-home level of care and needs more than personal care: Community Living Assistance and Support Services (CLASS), HCS and Texas Home Living waivers (TxHmL), Medically Dependent Children Program (MDCP), and STAR+PLUS Home and Community Based Services.