Community First Choice Texas: No-Waitlist Medicaid Home Care

The STAR+PLUS HCBS waiver waitlist in Texas is 6 to 18 months long, depending on your metro area. Community First Choice (CFC) covers many of the same personal care services — and it has no waitlist at all. If your parent qualifies for Medicaid and meets the clinical threshold, CFC is the fastest path to funded home care in the state.

What CFC Covers

Community First Choice is a federal Medicaid state-plan option that Texas implemented to expand home-based services without the capacity constraints of waiver programs. Because it's a state-plan entitlement (not a waiver), Texas must serve everyone who qualifies. No interest list, no waiting.

CFC covers:

• Personal assistance services — help with activities of daily living (bathing, dressing, grooming, toileting, eating, transferring) and instrumental activities (meal preparation, light housekeeping, medication reminders)
• Habilitation services — skill-building support to help the individual acquire, maintain, or improve daily living skills
• Emergency backup systems — personal emergency response systems (PERS) and backup attendant arrangements
• Voluntary training for the individual and their attendants on managing care at home

Like other Texas Medicaid home care programs, CFC includes the Consumer Directed Services (CDS) option. Your parent can hire their own attendants — including adult children and family members — through an HHSC-approved Financial Management Services Agency (FMSA).

CFC vs. STAR+PLUS: What's the Same, What's Different

Both programs require Medicaid eligibility and a clinical threshold. The applicable income and resource limits depend on the Medicaid eligibility pathway; do not assume the STAR+PLUS HCBS waiver's $2,982/month and $2,000 limits apply to every CFC applicant.

CFC requires an institutional level of care determination — the same Nursing Facility Level of Care (NFLOC) standard that STAR+PLUS uses. The applicant's medical and functional needs must be significant enough to justify nursing facility placement, even though they'll be served at home.

The key differences:

The practical gap: CFC delivers the personal attendant hours but not the wrap-around services. No minor home modifications, no adaptive medical equipment, no facility respite. For families whose primary need is hands-on personal care, CFC fills the gap immediately. For families who also need a wheelchair ramp, hospital bed, or periodic respite care, the STAR+PLUS waiver remains the more complete package.

How to Apply

For a parent enrolled in STAR+PLUS, CFC enrollment flows through the STAR+PLUS managed care system. The parent must be enrolled in a qualifying Medicaid pathway, and the relevant Managed Care Organization (MCO) — Molina, UnitedHealthcare Community Plan, Superior HealthPlan, or another plan — depends on the Service Delivery Area.

1. Ensure Medicaid eligibility is established. If your parent isn't already on Medicaid, apply through the Your Texas Benefits portal or call 1-877-438-5658. The financial eligibility determination must be complete before CFC services can be authorized.

2. Request a functional assessment. Contact your parent's STAR+PLUS MCO service coordinator and request a screening for Community First Choice. The MCO will schedule a home-based functional assessment to determine whether your parent meets the NFLOC clinical threshold.

3. Develop the person-centered service plan. Once the NFLOC determination is complete, the MCO service coordinator builds a care plan specifying the number of personal care hours per week, the type of services, and the delivery model (agency or CDS).

4. Choose your delivery model. Agency Option routes services through a licensed home care agency. CDS Option lets your parent hire, schedule, and manage their own attendants through an FMSA.

The Bridge Strategy

The most effective approach when your parent needs comprehensive home care: apply for the STAR+PLUS HCBS waiver (to get on the interest list) and simultaneously request CFC authorization (to start personal care services immediately). When the waiver slot opens months later, coordinate with the MCO to move from the CFC authorization into the waiver's broader service package and ask how personal care hours and any new services will be authorized.

The Aging in Place in Texas guide walks through this bridge strategy step by step, including the MCO coordination timeline, the CDS setup process, and the exact language to use when requesting CFC from your service coordinator.

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