Apply for Medicaid Home Care in Texas

Applying for Medicaid home care in Texas involves more steps than most Dallas families expect. There’s the Medicaid application itself, then STAR+PLUS enrollment, then a functional assessment, then the Consumer Directed Services setup — and if you don’t know the sequence, the whole thing feels like a maze with no map. This guide is the map.

Here’s every step, in order, from having no Medicaid coverage to having a family member on payroll as your loved one’s paid caregiver.

Step 1: Apply for Medicaid

Your loved one must be enrolled in Texas Medicaid before they can access any home care program. If they’re already on Medicaid, skip to Step 2.

How to apply:

The primary route is through YourTexasBenefits.com— the state’s online portal for public benefits. You can create an account, complete the application, upload documents, and track the status of your case online. You’ll need your loved one’s Social Security number, proof of Texas residency, proof of identity (driver’s license, state ID, or passport), income documentation (Social Security benefit statements, pension letters, pay stubs, tax returns), and bank statements and documentation of other financial assets.

You can also apply in person at a local Texas Health and Human Services (HHS) office. In the Dallas area, multiple HHS offices serve Dallas County. Calling ahead to confirm hours and required documents is recommended. A third option is calling 2-1-1, the statewide Texas Health and Human Services helpline. A representative can assist with the application process and answer eligibility questions.

Important note about Texas Medicaid eligibility: Texas has not expanded Medicaid under the Affordable Care Act, which means eligibility categories are more limited than in some other states. For STAR+PLUS — the program that funds home care — your loved one generally qualifies if they are 65 or older, or 21 or older with a disability recognized under Medicaid criteria.

Individuals receiving SSI (Supplemental Security Income) are generally automatically eligible for Medicaid in Texas.
Standard Medicaid processing takes up to 45 days for disability-related applications. If your loved one is being discharged from a hospital or facility and needs services urgently, mention this in the application — expedited processing may be available.

Step 2: Enroll in STAR+PLUS

Once Medicaid eligibility is established, individuals who are 21+ with a disability or 65+ are enrolled in STAR+PLUS — Texas’s Medicaid managed care program for long-term services and supports. Your loved one will either be assigned to a Managed Care Organization or given the opportunity to choose one.

In the Dallas area, four MCOs currently operate STAR+PLUS: Superior HealthPlan, Molina Healthcare, Amerigroup, and UnitedHealthcare. Each MCO manages service authorizations, care coordination, and the provider network.

If your loved one is assigned an MCO and you’d prefer a different one, they can request a change during the initial enrollment period or during annual open enrollment. The choice of MCO matters — it affects how quickly a service coordinator is assigned, how responsive member services is, and how smoothly the CDS process runs.

Step 3: Request a Functional Assessment for HCBS

Contact your MCO’s member services line and request a functional assessment for Home and Community-Based Services (HCBS). This is the assessment that determines whether your loved one qualifies for home care — and if so, what services and how many hours are authorized.

The MCO assigns a service coordinator to your case. The service coordinator schedules an in-home assessment to evaluate your loved one’s daily living needs: bathing, dressing, eating, mobility, toileting, medication management, housekeeping, and other daily activities.

The assessment determines whether your loved one meets the nursing-facility level of care threshold — meaning their needs are significant enough that, without adequate support at home, a nursing facility would be the alternative. This doesn’t mean they need to be bedridden. Individuals who need regular help with several daily activities often meet the standard.

Tips for the assessment: Be thorough and honest about your loved one’s limitations. Describe the bad days, not just the good ones. Have medical records, medication lists, and any hospital discharge paperwork available. Be present during the assessment to provide firsthand observations. Mention overnight and weekend care needs — the assessment should capture the full picture, not just weekday daytime activities.

Step 4: Develop the Care Plan and Choose CDS

After the assessment, the service coordinator develops a care plan with your family. The care plan specifies which HCBS services are authorized — personal attendant services, homemaker services, adaptive aids, emergency response, respite care — and how many hours per week or month are approved.

This is the critical moment: during care planning, request the Consumer Directed Services(CDS) delivery model. Tell the service coordinator that your family wants to hire their own caregiver rather than receive services through a traditional agency.

The service coordinator will explain how CDS works and connect you with an approved
Financial Management Services Agency (FMSA). The FMSA handles all employer-side responsibilities: payroll processing, tax withholding, workers’ compensation, and regulatory compliance.

If nobody mentions CDS during care planning, ask for it directly. Some service coordinators default to the agency model unless the family specifically requests otherwise.

Step 5: Set Up the Employer/Attendant Arrangement

Under CDS, two roles must be designated — and they must be filled by different people.

The employer of record is the person who directs the care: choosing the attendant, setting the schedule, assigning tasks, and approving timesheets. This is usually the care recipient themselves, or their Legally Authorized Representative (someone with power of attorney or legal guardianship).

The attendant is the person providing hands-on care. This is the family member who will receive a paycheck. Qualifying family members include adult children, siblings, grandchildren, grandparents, aunts, uncles, nieces, nephews, and other relatives. Spouses cannot serve as paid attendants under STAR+PLUS.

The FMSA will guide you through designating the employer and enrolling the attendant. The attendant completes a criminal background check, employment paperwork (W-4, I-9), and direct deposit enrollment through the FMSA.

Step 6: Begin Services and Receive Payment

Once the attendant clears background checks and the FMSA has processed all enrollment paperwork, care officially begins. The attendant provides services according to the care plan, submits timesheets to the FMSA, the employer approves them, and the FMSA processes payroll.

The service coordinator checks in periodically to ensure the care plan is being followed and to help with any adjustments. If your loved one’s needs change, the care plan can be reassessed and hours can be increased or modified.

Total Timeline: What to Expect

From initial Medicaid application to first CDS paycheck, Dallas families should plan for approximately
eight to twelve weeks. Here’s where the time goes: Medicaid application processing takes up to 45 days for disability-related cases. STAR+PLUS enrollment and MCO assignment take one to two weeks after Medicaid approval. The functional assessment is typically scheduled within two to four weeks of MCO enrollment. Care plan development and CDS setup take one to two weeks after the assessment. Attendant background check and FMSA enrollment take two to three weeks.

Starting multiple steps simultaneously — applying for Medicaid while researching MCOs, for example, or beginning FMSA paperwork while the assessment is being scheduled — can compress the timeline significantly.

Common Delays and How to Avoid Them

Medicaid application stalls. Follow up with the local HHS office or call 2-1-1 if you haven’t received a determination within 30 days. Make sure all requested documentation was submitted completely.

MCO doesn’t assign a service coordinator promptly. Call member services directly and request a timeline. If the delay extends beyond two weeks, ask to escalate.

Assessment underestimates needs. You can request a reassessment or appeal through the MCO’s grievance process. Additional medical documentation strengthens the case.

Background check takes too long. Ask the FMSA for a status update. Some delays are caused by missing information from the attendant — make sure all forms were completed fully.

CareChoice Helps Dallas Families Through Every Step

CareChoice serves Dallas-area families navigating this exact process. From the initial Medicaid application through STAR+PLUS enrollment, functional assessment, CDS setup, and FMSA enrollment, we help ensure each step happens on time and nothing gets lost between offices.

Talk to our Dallas team → Contact CareChoice

How to Apply for Medicaid Home Care in Texas: Your Step-by-Step Guide