The Community Attendant Services (CAS) Program is part of the Community Care for the Aged / Disabled (CCAD) Program, which offers a suite of services designed for Texas residents to assist them in living in the community, rather than require institutionalization. While most of the services provided under CCAD are not Medicaid funded, CAS is an exception and is Medicaid funded. To be very clear, CAS is only available to Medicaid recipients.
CAS is intended for seniors and disabled individuals who are functionally unable to manage their Activities of Daily Living (ADLs), which includes actions such as bathing, dressing, and mobility, without assistance. Program participants receive non-technical, attendant care in their homes.
Under the CAS Program, certain family members can be hired and paid to serve as caregivers to their aging relatives.
Enrolled individuals have the option of using the state agency to manage their care services or they can participate in the Consumer Directed Services (CDS) option, which means they receive “cash and counseling” and are responsible for hiring, training, and managing their own care providers. One especially attractive component of the CDS option is that friends and some family members can be hired as caregivers; they can be paid to provide attendant care services. Sometimes this means that an elder’s current unpaid family caregivers can become paid contractors. Spouses and legal guardians, however, are typically excluded from this option.
While this model of program is often referred to as Cash and Counseling, the name is slightly misleading. The CDS option requires the use of a fiscal intermediary that actually receives the money from the state and pays the care providers following authorization of payment by the program participant.
There are medical and financial eligibility requirements for the CAS Program. Functionally, individuals must be unable to perform some of their activities of daily living without assistance, such as dressing, eating, transferring, toileting or basic mobility. A medical doctor must document their need for assistance.
Financially, as of 2020, individuals must have a monthly income less than $2,349 ($28,188 / year) and assets / resources valued at less than $2,000. For couples, the monthly income limit is twice the individual limit, $4,698 ($56,376 / year) and the resource limit is 50% higher at $3,000. Note that some assets, such as a primary home up to an equity value of $595,000, may be considered exempt. Financial eligibility changes annually and is calculated as a percentage of SSI income limit. There are no age restrictions in order to be eligible for this program.
CAS provides up to 50 hours / week of personal attendant services, although the average participant receives approximately 15 – 20 hours / week of assistance. Personal attendant services can be provided by a state approved agency or can be self-directed (meaning the care provider is selected by the participant). Services can include:
Personal Care – Assistance with the activities of daily living such as bathing, dressing, eating, grooming, toileting, medication administration, mobility, and accompanying an elder to medical appointments.
Home Management – Assistance with the Instrumental Activities of Daily Living (IADLs), such as housekeeping, laundry, meal planning and preparation, and shopping for groceries and other essentials.