Primary Home Care (PHC) is one of the oldest personal care programs in Texas and one of the most misunderstood, mostly because much of it now runs under a newer name inside STAR+PLUS. Texas Health and Human Services still administers it, and the core rules have not changed much in years.
If you are searching for PHC today, here is the short version: it is an entitlement with no waiting list, it covers up to 50 hours of attendant care a week, and it is tied to full Medicaid eligibility. The rest of this guide explains who qualifies, how it relates to PAS, what the drawbacks are, and how to apply.
What is primary home care?
Primary home care, formally the Primary Home Care program or PHC, is a Texas Medicaid service that sends a trained attendant into your home to help with everyday tasks you can no longer manage safely on your own because of a health condition. The attendant helps with things like bathing, dressing, meals, and keeping the house clean. There is no nursing involved. The goal is to help people stay in their own homes instead of moving into a facility.
The name gets mixed up with "home based primary care," which is something different: a doctor or nurse practitioner making medical visits at home. Primary Home Care is attendant help with daily living, not medical care.
You will also see PHC described alongside PAS, or Personal Attendant Services. Current Texas Health and Human Services guidance describes PAS as the service formerly known as Primary Home Care. In practice they are the same kind of help under two names, with PHC still used in certain transitional situations before someone is enrolled with a STAR+PLUS health plan.
Primary Home Care is not the Primary Health Care program
Two Texas programs use the PHC abbreviation. Primary Home Care, covered here, pays for an attendant to help in your home. The Primary Health Care program is a separate HHSC program that funds clinic visits and preventive care. If you are looking for help at home with daily activities, you want Primary Home Care.
What is the Primary Home Care program in Texas and who is eligible for it?
The Primary Home Care program is run by Texas Health and Human Services and paid for through Texas Medicaid. Because it is an entitlement rather than a waiver, everyone who meets the rules gets services. There is no interest list.
To qualify for PHC in Texas, you must:
- Be 21 or older
- Live in Texas
- Have full Texas Medicaid, which most people get automatically by receiving Supplemental Security Income
- Have a health condition, documented by a medical practitioner, that limits your ability to do at least one activity of daily living
- Meet the regular Medicaid income and asset limits
For 2026, that means income under roughly $994 a month for an individual or $1,491 for a married couple. The asset limit is $2,000 for an individual and $3,000 for a couple, and your home is generally exempt. Our guide on how to qualify for Medicaid home care in Texas walks through the financial rules in more detail.
If your income is a little above the SSI level, you may still qualify for Community Attendant Services, a sister program under the same umbrella that provides the same attendant help.
Primary Home Care vs PAS and the STAR+PLUS waiver
These programs get confused constantly, and the differences matter for a family trying to plan ahead.
| Feature | Primary Home Care | STAR+PLUS HCBS waiver |
|---|---|---|
| Eligibility basis | Tied to SSI and regular Medicaid | Separate income and asset test |
| 2026 income limit | About $994 single, $1,491 couple | $2,982 per applicant |
| Waiting list | None, guaranteed entitlement | Often yes, varies by region |
| Weekly hours | Up to 50 hours | Based on an individual service plan |
| Setting | Own home or a loved one's home only | Broader home and community settings |
The entitlement detail matters
Because PHC is a Medicaid entitlement rather than a waiver, anyone who meets the eligibility requirements is guaranteed services, without being placed on an interest list. Families who assume every Texas home care program has a long wait are often relieved to learn this particular path does not.
For the full picture on the waiver side, see our STAR+PLUS program guide for Texas families.
What services are included in Primary Home Care?
Primary Home Care covers two kinds of help, both delivered by a trained attendant.
Personal care
- Bathing and grooming
- Dressing
- Eating
- Toileting
- Help moving around the home and transferring from bed or chair
Home management
- Housekeeping
- Laundry
- Changing bed linens
- Shopping and errands
- Meal preparation
Primary Home Care does not include skilled nursing, wound care, or giving medications. Services must be provided in your own home or the home of a loved one. They are not covered in an assisted living facility or adult foster care home. If your loved one needs medical care at home as well, our skilled nursing services can run alongside attendant care.
How many hours Primary Home Care covers
Primary Home Care can cover up to 50 hours of attendant care per week, as set out in the HHSC eligibility handbook. The actual number is set by an HHSC caseworker after assessing how much help the person needs with personal care tasks, so most people receive fewer hours than the maximum. Hours are reviewed over time and can change if needs increase.
The three services under the PHC program
The Primary Home Care program is actually an umbrella over three related services. Primary Home Care itself is for people with full Medicaid. Community Attendant Services, or CAS, serves people whose income is above the SSI level but who still qualify for Medicaid under a special federal provision. Family Care serves some lower income adults who do not have Medicaid at all. The attendant tasks are similar across all three; what differs is the eligibility route.
What are the drawbacks of Primary Home Care?
Primary Home Care is a valuable program, but it is not right for everyone, and it helps to know the limits before you apply.
- The income limit is low. Because eligibility runs through SSI and regular Medicaid, a lot of seniors with a modest pension or Social Security check earn too much to qualify.
- Hours are capped. The maximum is 50 hours a week, and most people are approved for fewer. Around the clock care is not possible through PHC alone.
- There is no medical care. Attendants cannot give medications, handle wound care, or provide any other nursing task. Anyone with skilled needs will need a separate service alongside PHC.
- It only works at home. Once someone moves into assisted living or adult foster care, PHC stops.
- Getting started takes time. Applying for SSI through Social Security usually takes three to five months, and only after that come the medical statement, the caseworker assessment, and choosing a provider.
- Attendants follow a set plan. They can only do the tasks listed in the service plan, so extra help like caring for another family member in the house falls outside what they are allowed to do.
For families who do not qualify, or who need more hours than PHC allows, the STAR+PLUS waiver or private pay care are the usual next steps.
How much does it cost to have a caregiver come to your home?
If you qualify for Primary Home Care, it costs you nothing. Texas Medicaid pays the provider directly for your approved hours.
Paying privately is a different story. The latest national survey from CareScout puts the median cost of a nonmedical caregiver at $35 an hour, which comes to about $80,000 a year for full time care of 44 hours a week. Texas generally runs below that, with statewide rates in the high $20s an hour. Houston area pricing depends on the agency, how many hours you need, and how involved the care is.
To put that in perspective, 20 hours a week of private care at $28 an hour comes to roughly $2,400 a month. That is why it is worth checking PHC, PAS, and STAR+PLUS eligibility before paying out of pocket.
Trying to figure out which program applies to you?
Our care coordinators can help you understand how PHC, PAS, and the STAR+PLUS waiver relate to your specific situation.
How to apply for Primary Home Care in Texas
For most people the path starts with Social Security, not the state. Approval for Supplemental Security Income brings Texas Medicaid with it automatically, and you apply for SSI through the Social Security Administration. Expect that step to take three to five months.
Once Medicaid is in place, contact Texas Health and Human Services to request Primary Home Care. A practitioner completes a statement documenting the medical need, a caseworker assesses how much help is required, and you choose a provider from the regional list. If you already receive SSI, you can skip straight to contacting HHSC.
How care is delivered
Like the broader PAS program covered in our guide to choosing a PAS provider, Primary Home Care can be delivered three ways. Under the agency option, a licensed provider hires, trains, and supervises the attendant. Under the Consumer Directed Services option, you hire and manage your own attendant, often a friend or family member, with a financial management agency handling payroll. The Service Responsibility Option sits in between: you choose and direct the attendant while the agency handles the employer side.
Provider licensing requirements
Providers delivering PHC services must be licensed as a Home and Community Support Services Agency in one of three categories: Licensed Home Health Services, Licensed and Certified Home Health Services, or Personal Assistance Services. They must also hold a contract with Texas Health and Human Services to provide PHC. This licensing and contracting structure is set out in Texas Administrative Code Title 26, Chapter 277, and it is worth asking any provider you are considering to explain clearly how they meet it.