The Primary Home Care (PHC) program is a Medicaid entitlement program designed to provide home care services to Texas residents who require assistance performing the basic activities of daily living, such as bathing, eating and toileting. A Medicaid “entitlement” program means that anyone who is eligible for the program is guaranteed to receive services under the program. This differs from some other Medicaid programs in which eligible individuals may be put on a wait list for services.
Services provided in the Primary Home Care program can be managed by the state (agency option) or participants can choose to manage their care providers themselves. For participant direction, there are two types of service delivery models: the Service Responsibility Option (SRO) and Consumer Directed Services (CDS).
The participant-directed model is becoming increasingly popular with participants. This is because they are given the flexibility to hire and manage their care providers. And certain family members can be hired to provide attendant care services. Typically, spouses and legal guardians are excluded from being hired. But the adult children of aging parents and ex-spouses can be paid caregivers.
To be eligible for the PHC program, Texas residents must be 21+ years old and require assistance to perform at least one of the activities of daily living, such as bathing, grooming, eating, or toileting. Their functional limitation must result from a medical condition and must be documented by a medical professional.
The financial eligibility criteria for PHC are the same as for regular Texas Medicaid.
In 2023, a single aged (65 and over) person applying must have income below $914 per month. A married couple’s combined monthly income cannot be greater than $1,371.
The value of an applicant’s assets cannot be greater than $2,000. For a couple, assets are limited to $3,000.
Some assets, however, are considered exempt. For instance, if the applicant owns a home, the asset limit does not include the home given it is their primary residence. However, if they do not live in their home and it is clear they will not be returning for medical reasons and they do not have a spouse that lives in the home, then the home is valued in their assets.
Over the Financial Limits?
It is possible to qualify for Medicaid in Texas when one exceeds the financial limits by re-allocation of income and assets into trusts and exempt resources. To do this, it is recommended that a Medicaid planning professional provide guidance as these processes can be complicated and carry financial risks. Learn more.
Medicaid has a 60-month look-back period in which all transfers within this time frame are scrutinized. Assets are not allowed to be gifted in order to meet financial requirements, otherwise the individual will be penalized with a period of Medicaid ineligibility.
Benefits and Services
Participants in the PHC program can be approved for up to 50 hours a week of assistance. Services can include assistance with any of the following:
- Personal care assistance with bathing, grooming, dressing, eating, medication administration and transferring
- Assistance with the instrumental activities of daily living such as shopping, housekeeping, laundry and meal preparation
- Assistance with transportation for medical appointments
How to Apply / Learn More
This program is administered by the Texas Health and Human Services Commission. Visit their website to learn more. Readers should be aware that their webpage does not provide much additional information, nor is it intended for a consumer audience.
One can apply online through the website YourTexasBenefits.com.