Table of Contents
This webpage will help Texans understand the costs associated with assisted living, home care, and adult day throughout the state. It also explores various payment options and financial assistance programs available to assist in caring for the elderly, be that in residential care or for aging in place at home.
The average cost of assisted living in Texas as of 2018 is $3,585 / month, which is slightly under the national average of $3,670 / month. The areas of Texas with the most expensive assisted living include Amarillo, Austin, Beaumont, Odessa, Victoria and San Antonio, where the monthly cost averages between $4,030 and $4,646. The most affordable assisted living in the state can be found in Corpus Christi, El Paso, Waco, and Texarkana, where it ranges from $2,070 to $2,711 / month.
Memory Care, also referred to as Alzheimer's residential care, adds as much as $1,270 to the monthly cost of assisted living. This is due to the increased level of care provided and the extra safety precautions.
The average hourly rate for home care across Texas in 2018 is $19.75. Abilene, Brownsville, Laredo, Waco, and McAllen, have the most affordable home care with the hourly cost is between $15.50 and $17.50. Round Rock / Austin area, Midland, Wichita Falls, and Odessa are the most costly areas at $21.25 - $25.25 / hour. Home health care is also available for those who need a slightly higher level of care (medical) and is approximately $1.25 - $1.75 / hour more.
Texas continues to have one of the least expensive average daily rates for adult day care in the nation. The daily cost averages just $38 in 2018, and this figure increased very little from the previous few years. Austin, Dallas, Houston, and Midland are the most expensive areas in Texas for adult day care and even in these areas, the cost ranges from $63 - $71 / day. The national average for adult day care is $71 /day, so even on the high end, one can find care well below this average. The most affordable adult day care can be found in Laredo, Corpus Christi, Longview, McAllen, Brownsville, Beaumont, and Abilene at $28 - $35 / day.
Medicaid is health insurance for low-income and disabled individuals and seniors. Medicaid care was originally provided as institutional care (nursing home), and also provided limited personal care. Now states also offer Medicaid waivers, often referred to as Home and Community Based Services Waivers (HCBS). These waivers allow individuals to receive Medicaid care outside of nursing home residences, such as in their home and in the community.
In 2015, Texas made sweeping changes to its Medicaid programs for the elderly. The STAR+PLUS Waiver, which was rolled out county by county over the last few years, is available statewide. This program provides a range of services (personal care, adult day care, meal delivery, etc.) for the elderly to help them remain living in their homes or in assisted living communities. Medical and non-medical care is available via this program and is provided through managed care organizations. Read more about STAR+PLUS.
With the statewide rollout of STAR+PLUS, three other Texas Medicaid programs have changed. These include the Community Based Alternatives Waiver (CBA), Primary Home Care Program (PHC), and Day Activity and Health Services (DAHS). The services that were provided via the CBA program are now available through the STAR+PLUS HCBS Waiver, and the services provided by PHC and DAHS are now available via STAR+PLUS’s state Medicaid plan.
Also, recently launched is a new Medicaid entitlement program called Community First Choice (CFC). This program differs from STAR+PLUS significantly in that there are no waiting lists for services. (Being an entitlement program, anyone who is eligible for services is able to receive them). Benefits available via CFC include assistance with activities of daily living, personal emergency response systems, and health maintenance. This program allows for consumer direction, also referred to as self-direction. This means eligible applicants are able to choose the personal care assistant of their preference, including some family members.
To qualify for long-term care Medicaid in Texas, elderly individuals must demonstrate a functional need, as well as have have limited financial resources and income. While the eligibility requirements may vary based on if one is applying for the state Medicaid plan, a Medicaid waiver, or institutional care (nursing home), as a general rule of thumb, the monthly income in 2018 for an individual cannot exceed $2,250 / month. For married couples, with both spouses applying for Medicaid services, each spouse is considered as a single applicant. This means each spouse is able to have as much as $2,250 / month in income, or said another way, up to $4,500 / month as a couple. The asset limit is $2,000 for individuals, and $3,000 for couples. One's home (limited to an equity value of $572,000), household items, and vehicle are not included in the asset calculation.
Persons with income and assets over these limits may still become eligible for Medicaid in Texas. By working with a Medicaid planning professional, monthly income in excess of the limit can be allocated to qualified income trusts. Financial assets in excess of the limit can be converted into exempt assets, such as home reparations, additions, and modifications. For individuals that are near the financial limits, or over them, it is strongly recommended they consult with a Medicaid planning professional prior to application to ensure the best possibility of acceptance into Medicaid. Read more.
The State of Texas offers two programs that provide assistance to elderly individuals that are not Medicaid qualified. These are:
1) Community Care for Aged/Disabled (CCAD) - this program provides non-medical personal care services and support to nursing home eligible individuals who choose to reside at home instead. Services may also be provided in assisted living residences and foster homes. Read more about CCAD eligibility and benefits.
2) Community Attendant Services (CAS) - this program provides attendant services or non-medical personal care to individuals in their homes. There is an option for self-direction of care, and friends, as well as some family members, may be hired as a caregiver. Learn more about CAS eligibility and benefits.
Please note, two programs, in which one may be familiar, HHS Services to Assist Independent Living (SAIL) and In-Home and Family Support Grants (IFHS), are no longer available. With the abolishment of the Texas Department of Aging and Disability Services in 2017, SAIL is no longer an active program. That said, similar services may be available through one’s local Area on Agency office. IFHS was also terminated in 2017. This is due to unavailable funding.
In addition to the state specific options that help pay for care, there are many non-profit and federal options. By using our Resource Locator Tool to find other programs that help pay for or reduce the cost of care, you’ll be able to find that most suitable program for your situation. There are also programs that help veterans with assisted living and there are eldercare loans available in Texas.
To help families find affordable care in Texas, we've partnered with several organizations that maintain databases of care providers. These organizations all provide free services that match an individual's specific care needs with care providers in their preferred geographic area. Click here to find affordable care.