Medicaid & Medicare Coverage for Home Health in Texas
A plain-English guide to STAR+PLUS, Texas Medicaid, and Medicare home health benefits — what each covers, who qualifies, and how Newport helps families navigate the paperwork.
Looking for a specific health plan? See the full list of insurance and programs Newport accepts — including Molina, UnitedHealthcare, Superior, and Wellpoint.
The short version
Texas Medicaid (STAR+PLUS) usually pays for ongoing in-home Personal Assistance Services for adults with disabilities and seniors who qualify. Medicare covers short-term, medically necessary skilled care at home — typically tied to recovery from a hospital stay.
Many Newport clients are dual-eligible (both Medicaid and Medicare), which gives the most complete coverage. Companion care and most non-medical respite are typically paid privately or through long-term care insurance.
Texas Medicaid & STAR+PLUS
Most adults receiving long-term Personal Assistance Services through Texas Medicaid are enrolled in STAR+PLUS — the state’s managed care program for adults with disabilities and seniors. STAR+PLUS combines acute care, behavioral health, and long-term services under one Managed Care Organization (Amerigroup, Cigna-HealthSpring, Molina, Superior, or UnitedHealthcare are common).
To qualify for STAR+PLUS-funded home care, a Texas resident generally needs to:
- Be 21 or older
- Receive Medicaid based on age, disability, or another qualifying basis
- Need help with at least one activity of daily living
- Be assessed by an MCO service coordinator who confirms the medical and functional need
Medicare home health
Medicare covers a different kind of home care — short-term skilled care that is medically necessary and ordered by a physician. To qualify, the patient generally must:
- Be under the care of a doctor who certifies the need for home health
- Need intermittent skilled nursing, physical therapy, occupational therapy, or speech-language pathology
- Be considered ‘homebound’ — leaving home requires considerable effort
- Receive services through a Medicare-certified home health agency
When Medicare and Medicaid work together
Many of the families Newport serves are dual-eligible — qualifying for both Medicare (typically by age) and Medicaid (typically by income or disability). Dual eligibility opens the door to the most complete in-home coverage available: skilled nursing through Medicare for short-term clinical needs, and Personal Assistance Services through STAR+PLUS for ongoing daily-living support.
Newport coordinates between the two so the family doesn’t have to. The same care team that delivers PAS hours under Medicaid can hand off cleanly to a Newport nurse when a Medicare-covered episode begins, and back again when it ends.
How Newport helps with the paperwork
Insurance and program eligibility are not simple, especially when families are also coping with a health crisis. Newport’s intake team will:
- Verify Medicaid and Medicare coverage on your behalf
- Identify which MCO a STAR+PLUS member is enrolled with and reach out to the service coordinator
- Help request an in-home assessment if one has not happened yet
- Obtain physician orders for skilled nursing where Medicare authorization is needed
- Tell you honestly when a need is unlikely to be covered, so you can plan
Coverage rules read clean on paper but get complicated in real life.
The fastest way to understand what is realistic for your family is a free 30-minute consultation with a Newport care coordinator.
The Consumer Directed Services (CDS) option
Within STAR+PLUS, Texas Medicaid offers two ways to receive your authorized personal assistance hours. In the agency option, Newport employs the caregiver — including a qualified family member — and handles training, scheduling, EVV visit verification, and payroll. In the Consumer Directed Services (CDS) option, you or your representative act as the employer and direct the care yourself, with a financial management services agency handling payroll and taxes.
Many families use these programs to have a daughter, son, or other relative paid for the care they already provide. Learn more on our Medicaid caregivers page, or call 972-602-3500 and we will explain how both options work with your plan.
Home care services we offer
Available across Texas: Dallas–Fort Worth, Houston, San Antonio.