Home Care vs Home Health in Texas: What's the Difference?

If you're looking into home care vs home health in Texas, the short answer is this: home care helps with daily life (bathing, meals, companionship), and home health provides medical treatment at home (nursing, physical therapy, wound care). The two serve different needs, cost different amounts, and get paid for in completely different ways. Many Texas families end up using both.

This guide breaks down what each service actually includes, what you'll pay, what Medicaid and Medicare cover, and how to find a licensed provider near you.

In This Guide

• Key Takeaways
• Home Care vs Home Health at a Glance
• What Home Care Covers
• What Home Health Care Covers
• Home Care Costs in Texas
• How Medicaid Covers In-Home Care
• How Medicare Covers Home Health
• How to Find a Provider
• Frequently Asked Questions
• Next Steps

Key Takeaways

• Home care is non-medical. Caregivers help with bathing, meals, light housekeeping, and companionship. No doctor's order needed.
• Home health is medical. Licensed nurses and therapists provide skilled care at home, ordered by a doctor.
• Non-medical home care in Texas costs about $24-$31 per hour, with the statewide average around $24-$26/hour.
• Medicare covers home health at $0 if a doctor orders it and the patient is homebound.
• Texas Medicaid pays for both types through STAR+PLUS, including the Consumer Directed Services option where you hire your own caregiver.

Home Care vs Home Health Care in Texas at a Glance

What Home Care Covers

Home care (sometimes called "non-medical home care" or "personal care") is the kind of help that makes it possible for someone to stay at home safely without needing to move to a facility.

A home care aide typically helps with:

• Personal care: bathing, dressing, grooming, toileting
• Meal preparation and help with eating
• Light housekeeping: laundry, dishes, vacuuming
• Companionship: conversation, activities, preventing isolation
• Errands and transportation: grocery shopping, rides to doctor's appointments
• Medication reminders (but not administering medications)

Home care doesn't involve medical tasks like injections, wound care, or physical therapy. The caregivers are trained but don't hold nursing or therapy licenses. You don't need a doctor's referral to start.

Most families begin with part-time home care, maybe 15-20 hours a week, and adjust from there. The biggest value is often the companionship piece. Isolation is a real problem for homebound seniors, and having someone to talk to a few hours a day makes a bigger difference than most families expect.

What Home Health Care in Texas Covers

Home health care is medical treatment brought to your loved one's home. It requires a doctor's order, and the people providing it are licensed professionals.

Home health services include:

• Skilled nursing: wound care, injections, IV therapy, medication management
• Physical therapy: strength, balance, mobility exercises after surgery or illness
• Occupational therapy: relearning daily tasks, adaptive equipment training
• Speech-language therapy: swallowing therapy, speech rehabilitation
• Medical social work: connecting families with community resources

Home health care is short-term by design. A patient typically receives services for a few weeks or months after a hospital stay, surgery, or change in condition. The goal is recovery or stabilization, not ongoing daily support.

Home Care Costs in Texas

Non-medical home care in Texas costs between $24 and $31 per hour, with the statewide average falling around $24-$26 per hour. That's below the national average of about $27 per hour.

Costs vary by city. Houston tends to run $19-$28 per hour depending on the agency, while Dallas starts around $21 per hour. Rural areas are sometimes higher because fewer agencies operate there.

Home health care (skilled/medical) is typically covered by insurance. If your loved one qualifies for Medicare home health or Medicaid, the medical side usually costs nothing out of pocket. That means families mainly pay out of pocket for the non-medical home care hours.

One thing families often discover too late: you can sometimes reduce your out-of-pocket costs by combining a few hours of Medicaid-covered attendant care (through STAR+PLUS) with private-pay home care hours for the rest. Your MCO service coordinator can help you figure out what Medicaid will cover first.

How Texas Medicaid Covers In-Home Care

If your loved one has Texas Medicaid through STAR+PLUS, both home care and home health can be covered. Here's how each works.

Community Attendant Services (CAS)

STAR+PLUS members who qualify for the HCBS waiver can receive Community Attendant Services, which covers personal care tasks like bathing, dressing, meal prep, and light housekeeping. Your MCO assigns a service coordinator who assesses what your family member needs and authorizes a specific number of hours per week.

Hours vary based on the assessment. Some members get 15-20 hours per week; others with higher needs get more. If you feel the authorized hours aren't enough, you can request a reassessment through your MCO service coordinator. Many families don't realize they can ask for more hours when conditions change.

Consumer Directed Services (CDS)

Here's where it gets interesting for families. The Consumer Directed Services option lets the person receiving care (or their representative) hire, train, and manage their own caregiver. That caregiver can be a family member: an adult child, sibling, or other relative. (Spouses can't be hired under CDS.)

Under CDS, you work with a Financial Management Services Agency (FMSA) that handles payroll, taxes, and workers' comp. The caregiver becomes a W-2 employee. CDS is available through STAR+PLUS, CAS, Community First Choice, and several other Medicaid programs.

STAR+PLUS Home Health Services

For the medical side, STAR+PLUS covers skilled home health services (nursing visits, physical therapy, occupational therapy) at no cost to the member. Your doctor orders the services, and your MCO coordinates the home health agency.

PACE

Texas has three PACE (Program of All-Inclusive Care for the Elderly) providers in El Paso, Amarillo, and Lubbock. PACE wraps everything together (medical care, home care, adult day care, prescriptions, transportation) into one program. If you live in one of those service areas and qualify, PACE can be a good all-in-one option. But it's only available in those three cities right now.

How Medicare Covers Home Health Care

Medicare covers home health care at $0 cost to the patient when three conditions are met: a doctor orders the services, the patient is "homebound" (needs help leaving home due to illness or injury), and the patient needs part-time skilled services like nursing or physical therapy.

According to Medicare.gov, covered services include skilled nursing care, physical therapy, speech-language therapy, occupational therapy, medical social work, and part-time home health aide care (only if you're also receiving skilled services).

"Part-time or intermittent" typically means up to 8 hours per day and a maximum of 28 hours per week.

What Medicare doesn't cover:

• 24-hour home care
• Meals delivered to the home
• Homemaker services (housekeeping only)
• Personal care if that's the only care needed

So if your parent needs both medical care and help around the house, Medicare handles the medical part while you'll need Medicaid or private pay for the non-medical support.

How to Find a Licensed Provider in Texas

Finding Home Care Agencies

Texas licenses home care agencies through the Health and Human Services Commission (HHSC). You can search for licensed home and community support services agencies at apps.hhs.texas.gov/LTCSearch.

When comparing agencies, ask about:

• Caregiver screening and training procedures
• Backup plans when your regular caregiver is sick
• Minimum hour requirements (some agencies require 4-hour shifts)
• Whether they accept Medicaid or only private pay

Finding Home Health Agencies

For Medicare-certified home health agencies, use Medicare's Care Compare tool at medicare.gov/care-compare. It shows quality ratings, patient surveys, and inspection results for agencies in your area.

If your loved one is on STAR+PLUS, your MCO's provider directory will list home health agencies in your network. Call your MCO's member services line or ask your service coordinator for a referral.

Key Phone Numbers

The ADRC is often the best first call if you're feeling overwhelmed. They cover all 254 Texas counties and can help you sort out which programs and agencies fit your situation.

Next Steps

If you're trying to decide between home care and home health for someone you love, start by figuring out what kind of help they actually need. Medical issues like wound care or therapy after a hospital stay point to home health. Trouble with daily tasks like bathing, cooking, or getting around the house points to home care. Most families dealing with aging parents eventually use some of each.

Here's where to go from here:

• Learn what Medicaid covers: Read our guide to Texas Medicaid programs for seniors to see if your loved one qualifies for coverage
• Explore getting paid as a caregiver: Our guide to getting paid as a family caregiver in Texas walks through the CDS process step by step
• Understand STAR+PLUS: If your family member is on Medicaid, the STAR+PLUS waiver program guide explains how in-home services work
• Compare facility options: If home care isn't enough, see our guide to assisted living in Texas for costs and Medicaid coverage
• Find home health care near you at brevy.com

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Medicaid rules vary by state and change frequently. Always verify eligibility and benefits with your state Medicaid agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.