PRIMARY HOME CARE
The Primary Home Care (PHC) Program is a Medicaid entitlement program designed to provide home care services to Texas residents that require assistance performing the basic activities of daily living such as bathing, eating and toileting. A Medicaid "entitlement" program means that anyone who is eligible for the program is guaranteed to receive services under the program. This differs from some other Medicaid programs in which eligible individuals may be put on a wait list for services.
Services provided in the Primary Home Care Program can be managed by the state (agency option) or participants can choose to manage their care providers themselves. For participant direction, there are two types of service delivery models are referred to as Service Responsibility Option (SRO) and Consumer Directed Services (CDS), respectively. The participant directed model is becoming increasingly popular with participants. This is because they are given the flexibility to hire and manage their care providers and certain family members can be hired to provide attendant care services. Typically, spouses and legal guardians are excluded from being hired but the adult children of aging parents and ex-spouses can be paid caregivers. This type of program is also referred to as Cash and Counseling. The main difference between SRO and CDS is that with CDS, the program participant is considered the employer of record and is responsible for providing substitute attendant care, whereas this is not the case with SRO.
It is worth noting that this is a Medicaid program, meaning participants must be eligible for Medicaid. Texas also has a very similar program for non-Medicaid eligible residents called the Community Attendant Services (CAS) Program.
To be eligible for the PHC Program, Texas residents must be 21+ years old and require assistance to perform at least one of the activities of daily living, such as bathing, grooming, eating or toileting. Their functional limitation must result from a medical condition and must be documented by a medical professional.
The financial eligibility criteria for PHC are the same as for regular Texas Medicaid. In 2019, a single aged (65 and over) person applying must have income below $771 per month and the value of their assets cannot be greater than $2,000. If the applicant owns a home, this does not include any home equity that they might have in their primary residence. However, if they do not live in their home and it is clear they will not be returning for medical reasons and they do not have a spouse that lives in the home, then the home is valued in their assets. An additional exception to the exempt home rule is when the value of their home equity exceeds $585,000.
It is worth noting that although the home is exempted from consideration during eligibility, it is still possible that the state will place a lien on the home to recover part of the value of the services paid during the Medicald recipient's lifetime.
If two individuals, a married couple, are both seeking Medicaid simultaneously, their combined monthly income cannot be greater than $1,157. Countable resources are limited to a value of $3,000.
Qualifying for Medicaid When Over the Limits
It is possible to qualify for Medicaid in Texas when one exceeds the financial limits by re-allocation of income and assets into trusts and exempt resources. To do this, it is recommended that a Medicaid planning professional provide guidance as these processes can be complicated and carry financial risks.
Benefits and Services
Participants in the PHC Program can be approved for up to 50 hours / week of assistance. However, the average individual receives approximately 16 hours / week. Services can include assistance with any of the following:
Personal care assistance with bathing, grooming, dressing, eating, medication administration and transferring
Assistance with the instrumental activities of daily living such as shopping, housekeeping, laundry and meal preparation
Assistance with transportation for medical appointments
How to Apply / Learn More
This program is administered by the Texas Health and Human Services Commission. Visit their website to learn more. Readers should be aware that their webpage does not provide much additional information, nor is it intended for a consumer audience.
One can apply online through the website YourTexasBenefits.com.