Community Attendant Services Texas: Free Home Care Without the Medicaid Waitlist

You know your parent needs help at home — bathing, dressing, meal prep — but the STAR+PLUS HCBS waiver has a waitlist of 15,850 people, and your parent's income is $200 over the SSI limit. Most families assume there's no help available in this gap. They're wrong.

Community Attendant Services (CAS) is one of Texas's least-known elder care programs. It provides non-medical personal care at home with no waitlist, and it serves people who make too much for SSI but too little to pay for private home care.

What CAS Provides

CAS is a Medicaid-funded program that delivers personal care attendant services directly in the home. Services include:

• Assistance with activities of daily living: bathing, dressing, grooming, toileting, transferring
• Meal preparation and feeding assistance
• Light housekeeping related to the person's health and safety
• Escort to medical appointments
• Medication reminders (not administration)

Typical authorization is 12-20 hours per week, depending on the clinical assessment of functional need. The services are provided by personal care attendants through HHSC-contracted home care agencies licensed under 26 TAC Chapter 558.

CAS is strictly non-medical — no skilled nursing, no wound care, no physical therapy. For those services, you need home health care covered by Medicare or the STAR+PLUS program.

Who Qualifies for CAS

CAS eligibility is broader than most families expect:

Age: 18 or older (no upper limit). This covers aging parents, not just elderly individuals.

Income: Must be at or below $2,982/month (300% of the SSI Federal Benefit Rate for 2026). This is the same threshold as the STAR+PLUS special income limit. Unlike regular SSI-based Medicaid, CAS uses this higher income limit to serve people who earn too much for standard benefits.

Assets: Standard Medicaid resource limits apply — $2,000 for an individual. Exempt assets include the primary home (up to $752,000 equity), one vehicle, personal belongings, and irrevocable burial trusts.

Functional need: A documented medical need for personal care assistance. The referring physician must certify that the individual requires help with ADLs that cannot be safely provided through informal (family) support alone.

Key limitation: CAS does not allow the use of a Qualified Income Trust (Miller Trust) to qualify. If your parent's income exceeds $2,982/month, they cannot use a QIT to reduce countable income for CAS purposes. For income above the cap, the STAR+PLUS HCBS waiver with a Miller Trust is the appropriate pathway — but that comes with the waitlist.

How CAS Differs from STAR+PLUS HCBS

The practical difference: CAS is immediately available but limited in scope. STAR+PLUS is comprehensive but has a waitlist. Many families use CAS as a bridge while waiting for a STAR+PLUS waiver slot.

Respite Care Options in Texas

If you're the primary caregiver and need temporary relief, Texas offers several respite pathways:

CAS itself functions as partial respite — the 12-20 hours per week of attendant services give you blocks of time for your own responsibilities.

STAR+PLUS HCBS waiver includes respite care as a covered service, but you need an active waiver slot.

National Family Caregiver Support Program (NFCSP) provides respite care through your local Area Agency on Aging. This is available regardless of Medicaid status and can include in-home respite, adult day care, and short-term facility respite.

Adult Day Care (DAHS) at $1,950/month provides structured daytime supervision while you work or handle other obligations. Some slots are subsidized through STAR+PLUS or NFCSP.

VA Caregiver Support provides respite for veterans' caregivers, including up to 30 days per year of facility-based respite.

How to Apply

CAS applications go through the HHSC regional office serving your parent's county. The process:

1. Contact your local HHSC office or call 2-1-1 for a referral
2. A nurse or social worker conducts a functional assessment in the home
3. The assessment determines authorization level (hours per week)
4. HHSC assigns a contracted home care agency to provide services

Processing time is typically 30-45 days from application to services starting — dramatically faster than the STAR+PLUS waiver timeline.

For the full picture of Texas care programs and how they fit together — from CAS through STAR+PLUS through nursing home Medicaid — the Texas Care Decision Toolkit maps every program alongside its eligibility rules, application process, and realistic timelines.

See more Texas guides →