How to Pay for In-Home Nursing Care in Texas: Medicare, STAR+PLUS, and More
Houston Home Care Editorial TeamMay 8, 2026
How to Pay for In-Home Nursing Care in Texas
Cost is the first question most families ask when they begin looking into home health care. It is also the question with the most complicated answer. The price of home care in the Houston area depends on whether you need skilled nursing or personal care, how many hours per week are required, and which funding sources you qualify for. The good news is that Texas offers more pathways to pay for home health care than families typically realize, and many people qualify for programs they have never heard of.
This guide walks through every major payment option available to Houston families in 2026, including who qualifies, what each source covers, and how to apply.
What Home Health Care Costs in Houston
Before exploring payment options, it helps to know the baseline numbers.
Personal Assistance Services (PAS) — non-medical personal care — typically cost between $22 and $38 per hour in the Houston metro area. This covers help with bathing, dressing, meal preparation, companionship, and other daily activities. Most agencies require a minimum visit of 3 to 4 hours.
Licensed and Certified Home Health Services (LCHHS) — skilled nursing and therapy — typically range from $50 to $120 per visit depending on the type of service. A standard skilled nursing visit runs $50 to $75. Physical therapy and occupational therapy home visits range from $100 to $175 per session. Specialized services such as IV therapy or wound care may cost more.
For families needing full-time personal care, monthly costs can reach $5,000 to $7,000 or more. That is why identifying every possible funding source matters.
Medicare Home Health Benefits
Medicare is the largest single payer for home health services in Texas. If your loved one is 65 or older or qualifies for Medicare through disability, home health services may be covered at zero cost to the patient — no copay, no deductible.
Eligibility Requirements
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To qualify for Medicare home health benefits, all four conditions must be met. The patient must be under the care of a physician who certifies the need for home health services. The patient must require at least one of the following: skilled nursing, physical therapy, speech-language pathology, or continued occupational therapy. The patient must be homebound, meaning leaving home requires considerable and taxing effort. And the agency providing care must be Medicare-certified (LCHHS licensed).
What Medicare Covers
Skilled nursing visits and assessments
Physical therapy and rehabilitation
Occupational therapy
Speech-language pathology
Medical social work
Home health aide services (only when the patient is also receiving skilled care)
What Medicare Does Not Cover
Medicare does not pay for 24-hour nursing care at home, homemaker services when that is the only care needed, personal care assistance when the patient does not also have a skilled nursing or therapy need, or meal delivery. If your loved one only needs help with daily activities and does not have a clinical need, Medicare will not cover it.
How to Access Medicare Home Health in Houston
Start with the patient's primary care doctor. The physician must create a home health plan of care and certify that the patient meets homebound criteria. You can choose any Medicare-certified agency. In the Houston metro area, approximately 200 agencies hold LCHHS licenses with active Medicare certification. Use Medicare Care Compare to confirm certification and review available quality data.
Texas Medicaid: STAR+PLUS
Texas delivers most of its Medicaid benefits through managed care organizations (MCOs). For adults aged 21 and older who have disabilities or are age 65-plus, the program is called STAR+PLUS. The Texas HHSC STAR+PLUS overview is the best starting point for understanding eligibility and plan structure. This is the most important Medicaid program for Houston families seeking home health care.
STAR+PLUS Home and Community-Based Services
STAR+PLUS includes a Home and Community-Based Services (HCBS) component that pays for personal care, adaptive aids, minor home modifications, adult foster care, and nursing services for members who would otherwise need institutional care. This is the primary way Texas Medicaid funds long-term personal care at home.
To access STAR+PLUS HCBS, a member must be enrolled in a STAR+PLUS managed care plan and meet the criteria for nursing facility level of care. The MCO conducts a functional assessment and develops a service plan.
Community Attendant Services (CAS)
Within STAR+PLUS, Community Attendant Services provide personal attendant care for members who need help with activities of daily living. This is the benefit that pays for the day-to-day personal care many Houston families need: bathing, dressing, grooming, meal preparation, and light housekeeping. CAS is delivered by PAS-licensed agencies.
STAR+PLUS MCOs in Houston
In the Harris Service Area (which covers the Houston metro), the STAR+PLUS managed care organizations include Molina Healthcare, Superior HealthPlan, Amerigroup, and UnitedHealthcare Community Plan. Each MCO has its own provider network, so the agencies available to you depend on which plan you are enrolled in.
STAR Kids
STAR Kids is the Medicaid managed care program for children and young adults under 21 who have disabilities. It covers skilled nursing, therapy, personal care, and medical equipment at home. Families of children with complex medical needs, ventilator care requirements, or intellectual and developmental disabilities should explore STAR Kids benefits.
STAR Kids MCOs in the Houston area include Texas Children's Health Plan, Superior HealthPlan STAR Kids, and UnitedHealthcare Community Plan STAR Kids.
Community First Choice (CFC)
Community First Choice is a Medicaid benefit option that provides personal attendant services and habilitation to Medicaid members who meet an institutional level of care. CFC is available statewide and does not have a waiver waiting list — if you meet the eligibility criteria, you can receive services.
CFC covers personal assistance with activities of daily living, health-related tasks that can be delegated by a registered nurse, emergency response services, and support management to help coordinate care. CFC services are delivered through STAR+PLUS MCOs.
Private Health Insurance
Most commercial health insurance plans in Texas cover some home health services, but coverage varies significantly. Skilled nursing and therapy ordered by a physician are generally covered with a copay or coinsurance, subject to the plan's deductible. Personal care and homemaker services are rarely covered by commercial insurance.
Major insurers in the Houston market include Blue Cross Blue Shield, Aetna, United Healthcare, Cigna, and Humana. Before selecting an agency, call your insurer to verify which agencies are in-network and what prior authorization is required.
Long-Term Care Insurance
If your loved one purchased a long-term care (LTC) insurance policy, it is often the most flexible payment source for home care. Most LTC policies cover both skilled nursing and personal care at home.
Key Policy Terms to Check
Review the policy for the elimination period — the number of days you must pay out-of-pocket before benefits begin (commonly 30, 60, or 90 days). Check the daily or monthly benefit maximum. Check whether the policy requires care from a licensed agency or allows independent caregivers. And check the benefit trigger, which is typically the inability to perform two of six activities of daily living or the presence of cognitive impairment.
Contact the insurance company as soon as home care is being considered. Many policies require advance notification before benefits begin.
Veterans Benefits
Veterans in the Houston area have access to several home care programs through the Michael E. DeBakey VA Medical Center and the VA Texas Valley Coastal Bend Health Care System.
VA Home Health Care provides skilled nursing and home health aide services for enrolled veterans through VA-contracted agencies.
Aid and Attendance Pension is a monthly cash benefit for wartime veterans or their surviving spouses who need help with daily activities. In 2026, the maximum monthly benefit is approximately $2,300 for a single veteran. This money can be used to pay for home care from any provider.
Veteran Directed Care lets qualifying veterans manage their own care budget, choosing and scheduling their own caregivers, including family members.
[Tricare](/agencies?insurance=Tricare) covers home health services for active-duty family members and retirees, with coverage for skilled nursing and some personal care under certain conditions.
Contact the DeBakey VA or call the VA Caregiver Support Line at 1-855-260-3274 to explore eligibility.
Private Pay Strategies
If insurance coverage is limited, there are ways to manage private pay costs.
Start with fewer hours and adjust. Many families begin with 3 to 4 visits per week rather than daily care, then increase if needed based on how the patient responds.
Ask about package rates. Some Houston agencies offer discounts for clients committing to 20 or more hours per week.
Mix professional and family care. A paid caregiver for 4 to 6 hours during the day combined with family caregiving in the evenings can cut costs while preventing burnout.
Use the right level of care. If your loved one needs personal care but not skilled nursing, a PAS agency will cost significantly less than an LCHHS agency. Do not pay for clinical staff if the need is non-medical.
Combining Payment Sources
Many families use more than one payment source. A common combination: Medicare covers skilled nursing visits after a hospital discharge, then the patient transitions to STAR+PLUS Community Attendant Services for ongoing personal care. Or a veteran might use VA Aid and Attendance alongside STAR+PLUS HCBS services.
A good home health agency will help you navigate payment options. Ask any agency or plan coordinator what insurance they accept and whether they have staff who can assist with Medicaid enrollment, managed-care coordination, or VA benefit paperwork.
Getting Started
Understanding your payment options is the first step toward affordable home care. Begin by determining whether your loved one needs skilled services (LCHHS) or personal care (PAS), then check eligibility for Medicare, STAR+PLUS, or CFC. For veterans, explore VA benefit programs. And for everyone, request quotes from at least three agencies to compare pricing.
Browse Houston home health agencies in our directory, filter by insurance accepted, and contact providers directly to discuss your situation.
