In-Home Care Costs Texas: What You'll Pay for Private and Medicaid-Funded Care

What Home Care Costs in Texas Right Now

Private-pay nonmedical home care in Texas averages about $30 per hour, or roughly $5,720 per month for a 44-hour-per-week schedule. That puts Texas slightly below the national average, but the number varies significantly by metro area:

• Austin and Dallas corridor: $28–$35/hour (higher demand, tighter labor market)
• Houston and San Antonio: $25–$32/hour
• El Paso, Lubbock, and smaller markets: $22–$28/hour
• Rural East and West Texas: $22–$28/hour, but availability is extremely limited

These are nonmedical personal care rates — a caregiver helping with bathing, dressing, meal preparation, medication reminders, and light housekeeping. Medicare-certified home health (skilled nursing, physical therapy, wound care) is a separate category with different pricing and coverage rules.

The 24-Hour Care Math

Families needing round-the-clock care face a steep cost curve. At $30/hour, 24-hour care costs roughly $21,600 per month — nearly four times the cost of an assisted living facility ($5,666/month average in Texas) and significantly more than a nursing home semi-private room ($5,627/month).

Most 24-hour home care arrangements use either:

• Live-in care: One caregiver stays in the home, typically working 12–16 active hours with 8 hours designated as sleep time. Rates are lower per hour (sometimes a flat daily rate of $250–$375), but the caregiver needs their own room and gets breaks.
• Shift-based care: Two or three caregivers rotate shifts, covering all 24 hours with fully active staffing. This is the $21,600/month scenario.

For families whose parent needs overnight supervision (wandering, fall risk, nighttime bathroom assistance), live-in care is significantly cheaper than shift coverage. But not every caregiver does live-in work, and agencies that offer it charge premium placement fees.

How Medicaid Pays for Home Care

If your parent qualifies for Texas Medicaid, several programs provide personal care at no cost to the family:

Primary Home Care (PHC): An entitlement program — no waitlist. Covers personal attendant services for individuals on SSI-linked Medicaid with documented functional limitations. A doctor must certify the medical need on Form 3052. Hours are authorized based on a functional assessment.

Community Attendant Services (CAS): Another entitlement — no waitlist. Covers personal care for individuals with physical disabilities whose income is under the $2,982 monthly cap and assets under $2,000. The applicant must score at least 24 on the Form 2060 functional assessment.

STAR+PLUS HCBS Waiver: The most comprehensive program, covering personal care, respite, home modifications, medical equipment, and home-delivered meals. But it's capped by legislative funding — over 14,400 people are on the statewide interest list, with typical waits of 6–18 months depending on the metro area.

The key difference: PHC and CAS are entitlements (you qualify, you get services), while STAR+PLUS HCBS is a waiver (you qualify, then you wait). Families often start with PHC or CAS while waiting for the HCBS waiver to come through.

Consumer Directed Services: Hiring Family and Reducing Costs

Under any of these Medicaid programs, your parent can choose the Consumer Directed Services (CDS) option instead of receiving care through an agency. CDS lets your parent (or their authorized representative) hire their own caregivers — including adult children, extended family, or trusted neighbors — and pay them through a state-approved Financial Management Services Agency (FMSA).

CDS doesn't increase the total hours authorized, but it gives families flexibility and often results in better care continuity (a family member who knows the parent's preferences vs. rotating agency staff). Spouses and legal guardians generally cannot be paid caregivers under CDS.

Private Pay vs. Long-Term Care Insurance

For families above Medicaid income limits who haven't yet set up a Miller Trust, private pay is the immediate reality. Long-term care insurance — if your parent has a policy — may cover in-home care after the policy's waiting period and up to a daily or monthly benefit cap.

Check the policy carefully. Many older LTC policies cover only "licensed" home care, which means the caregiver must work through an HCSSA-licensed agency. Private caregivers hired directly may not trigger the insurance benefit.

If your parent has no LTC insurance and income above the $2,982 cap, a Qualified Income Trust (Miller Trust) can bridge the gap to Medicaid eligibility — routing excess income through an irrevocable trust so the state sees only the trust-adjusted figure.

Comparing Home Care to Facility Options

Home care at 44 hours per week costs roughly the same as assisted living. But at-home, your parent keeps their independence, their familiar environment, and (with the right legal protections) their homestead.

Making the Cost Equation Work

The Aging in Place in Texas guide includes a cost-of-care calculator, the Miller Trust setup process for over-income families, and the complete Medicaid application flow for PHC, CAS, and STAR+PLUS. It maps private-pay, insurance, and Medicaid funding into a single plan.

See more Texas guides →