Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Overview


In 1979, Texas added personal care to its Medicaid State Plan. The personal care program is called the Primary Home Care Program, and it serves the aged and disabled. The program provides non-technical, medically related personal care services prescribed by a physician as part of a client's plan of care. Primary Home Care is available to eligible Medicaid clients whose health problems cause them to be functionally limited in performing activities of daily living. It is available statewide, and there is no waiting list.

Services are provided by a primary home care attendant employed by a licensed home and community support services agency. The agency's license must cover the provision of home health services, personal assistance services, or both.

Each eligible client may receive up to 50 hours of primary home care per month (42 hours per week for a client with priority status). The Primary Home Care Program provides three services:

  • Personal care: help with bathing, dressing, grooming, routine hair and skin care, preparing meals, feeding, exercising, helping with self-administered medication, toileting, and transferring/ambulating.

  • Home management: assistance with housekeeping activities that support the client's health and safety, such as changing bed linens, housekeeping, laundering, and shopping.

  • Escort: accompanying the client on trips to obtain medical diagnosis or treatment, or both. This service does not include the direct transportation of the client by the attendant.

Excluded services that must be provided by a person with professional or technical training, include:

  • insertion and irrigation of catheters;
  • irrigation of body cavities;
  • application of sterile dressings involving prescription medications and aseptic techniques;
  • tube feedings;
  • medication administration; and
  • any other skilled services identified by the regional nurse.

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