Home Health After Hospital Discharge in Texas: Medicare Coverage and How to Get Started

Your parent is coming home from the hospital, and the discharge planner mentioned "home health." You are not sure what that means, who pays for it, or how to get it set up before your parent walks through the door. Here is what you need to know.

What Medicare Home Health Actually Covers

Medicare covers home health services at 100% — no copay, no deductible — for beneficiaries who meet the criteria. Unlike SNF coverage, home health does not require a prior hospital stay of any specific length. A patient discharged from observation status still qualifies.

Covered services include:

• Skilled nursing — wound care, IV medication, catheter management, disease management education
• Physical therapy — strength, balance, gait training
• Occupational therapy — relearning daily activities, adaptive equipment training
• Speech-language pathology — swallowing therapy, cognitive-communication rehabilitation
• Medical social services — care coordination, community resource connections
• Home health aide services — personal care (bathing, dressing) when skilled services are also being provided

Medicare does not cover 24-hour home care, meal delivery, homemaker services (cleaning, laundry), or personal care aide services when no skilled care is being provided.

The Homebound Requirement

To qualify for Medicare home health, a physician must certify that the patient is "homebound." This does not mean the patient can never leave the house. It means:

• Leaving the home requires considerable and taxing effort, OR
• The patient needs the help of another person, a wheelchair, a walker, or special transportation to leave, OR
• The patient's physician advises against leaving the home due to their condition

A patient can attend adult day care, receive outpatient dialysis, or go to church occasionally and still be considered homebound. The standard is functional limitation, not total confinement.

Home Health vs Home Care

These terms sound similar but describe very different services with different funding sources:

Home health is medically focused. A physician orders it, a licensed agency provides it, and Medicare pays for it. Services are intermittent — a nurse or therapist visits several times per week for a defined period, typically 30 to 60 days per certification period.

Home care (also called personal care or custodial care) is non-medical. An aide helps with bathing, dressing, meals, companionship, and light housekeeping. Medicare does not cover it. Families pay out of pocket, through long-term care insurance, or through Texas Medicaid's STAR+PLUS program if the parent qualifies.

Many families need both — a home health nurse for wound care and medication management, plus a personal care aide for daily living support. The overlap is where care gaps appear.

How to Get Home Health Set Up in Texas

Step 1 — Get the physician's order. Before discharge, ask the hospital physician to write a home health referral. The referral must include the patient's diagnosis, the specific services needed, and certification that the patient is homebound.

Step 2 — Choose an agency. The hospital may recommend one, but you are not required to use it. In Texas, home health agencies are licensed as Home and Community Support Services Agencies (HCSSAs) by the Health and Human Services Commission. Check Medicare's Care Compare tool to review agency ratings in your parent's zip code.

Step 3 — Confirm the timeline. Under Texas regulations, an HCSSA must initiate services within 14 days of the referral. For a patient coming home from the hospital, you want services to begin within 24 to 48 hours of discharge — push for this during discharge planning.

Step 4 — Coordinate with DME delivery. If your parent needs a hospital bed, wheelchair, walker, or oxygen equipment at home, coordinate delivery before the discharge date. Home health services and DME are separate — the agency does not provide equipment.

When Home Health Ends

Medicare home health is not indefinite. Coverage continues as long as the patient remains homebound, continues to need skilled care, and shows measurable progress. When the home health agency determines the patient has met their goals or plateaued, they will notify you and the physician. If you disagree, you can request continued services or file an appeal through Acentra Health.

The Hospital-to-Home Texas toolkit includes a home health agency comparison worksheet, a caregiver daily log template, and a medication reconciliation form — designed for families coordinating care across multiple providers.

See more Texas guides →