Paying for Home Care in Texas: Private Pay, Medicaid, Long-Term Care Insurance and VA Benefits

One of the first questions families ask about home care is how to pay for it. The answer depends on the type of care your loved one needs, their health, their finances and any benefits they may already have. In Texas, the most common ways to pay for in-home care are private pay, Medicaid, long-term care insurance and benefits from the Department of Veterans Affairs (VA).

This guide gives a general overview of each option. It is not legal or financial advice. Eligibility and coverage are always decided by the state, the health plan, the insurance company or the VA, so it is important to confirm the details for your own situation.

Private pay

Private pay simply means the person receiving care, or their family, pays the agency directly. Many families use savings, retirement income, help from relatives, or a combination.

Private pay has some advantages:

• Care can often start quickly, without waiting for an approval process
• You have flexibility in choosing services, schedules and hours
• You can adjust care as needs change

If you plan to pay privately, ask the agency for a clear explanation of rates, any minimum hours, and how billing works. Some families start with private pay while they apply for other programs.

Texas Medicaid and STAR+PLUS

Medicaid is a program funded by the state and federal governments for people with limited income and resources. In Texas, many adults who need long-term services and supports receive Medicaid through STAR+PLUS, a managed care program. Depending on a person’s needs and eligibility, Medicaid programs may cover services that help people live safely at home instead of in a facility, such as help with personal care.

Texas also has other Medicaid waiver programs for people with certain disabilities or medical needs, including children. Each program has its own rules about who qualifies and what it covers.

Some important points about Medicaid:

• Eligibility is decided by the state, based on financial rules and a person’s care needs
• The approval process can take time, so it helps to start early
• Once approved, services are often arranged through a health plan and care plan
• Some programs have waiting lists

To learn more or apply, you can contact Texas Health and Human Services. If your loved one already receives Medicaid, their health plan’s service coordinator is a good first contact. You can also read about how we work with these programs on our Medicaid waiver programs page.

Long-term care insurance

Long-term care insurance is a private policy that some people buy years before they need care. Depending on the policy, it may help pay for in-home care, assisted living or nursing home care.

If your loved one has a long-term care policy, find the paperwork and look for:

• What types of care are covered, including in-home care
• What triggers benefits, such as needing help with a certain number of daily activities or having a cognitive impairment
• Whether there is a waiting period before benefits begin
• Any limits on daily or lifetime benefits
• Whether the policy requires a licensed agency or specific paperwork

Call the insurance company to start a claim and ask exactly what documentation they need. The insurer decides what is covered. Keeping copies of care plans and invoices makes the process easier.

VA benefits for veterans and surviving spouses

Veterans and some surviving spouses may be eligible for VA programs that help with care at home. Two well-known options are:

• Aid and Attendance: an added monthly payment for eligible veterans or survivors who receive a VA pension and need help with daily activities, or who are housebound or have limited eyesight.
• Homemaker and Home Health Aide care: a VA program that may provide a trained aide to help eligible veterans with personal care and daily activities at home.

The VA decides who qualifies and what services are approved. A good first step is to talk with the veteran’s VA health care team or contact the VA directly. Accredited veterans service officers can also help with applications at no cost.

Combining payment options

Many families use more than one source. For example, a family might pay privately for a few extra hours each week while Medicaid or VA benefits cover part of the care. Or long-term care insurance may start after a waiting period, with private pay covering care until then.

Planning ahead helps. Try to:

1. Write down your loved one’s needs and how many hours of help they need.
2. Gather documents such as insurance policies, benefit letters and income information.
3. Contact the programs you may qualify for and ask about timelines.
4. Talk with the agency about how they bill each payment source.

Questions to ask an agency about payment

• Which payment sources do you accept?
• Can you work with our Medicaid health plan, insurance company or the VA?
• What paperwork will you provide for insurance claims?
• What happens if our coverage changes?

Take it one step at a time

Figuring out how to pay for care can feel like a lot, especially when you are also worried about someone’s health. You do not have to have every answer before you reach out. Start with the care your loved one needs today, and build a plan from there.

We can help you understand your options

Laulain True Care accepts private pay, Medicaid, long-term care insurance and VA benefits, depending on each client’s eligibility and coverage. We serve families in the Dallas, Rockwall, Kaufman and Ellis County areas. Visit our paying for care page for more details, or contact us and we will talk through where to begin.