By Austin Senior Advisor Care Team · October 23, 2026
Texas pays for an attendant to help your parent at home through a benefit called Community First Choice. Whether your parent can reach it comes down to how their Medicaid is classified, not how much care they need.
The benefit that pays for an attendant, and almost nobody asks for it by name
Most Austin families looking for help at home ask about two things: the STAR+PLUS waiver and private-pay home care. There is a third option sitting between them, and it has a name that tells you nothing. Community First Choice, or CFC, is the Texas Medicaid benefit that pays for an attendant to come to your parent's house and help with the daily, physical work of staying there.
HHSC describes CFC as having four parts. Personal assistance services cover help with activities of daily living, instrumental activities of daily living and health-related tasks, "through hands-on assistance, supervision or cueing, including nurse-delegated tasks." Habilitation covers "acquisition, maintenance, and enhancement of skills" so the person can do those tasks themselves. Emergency response services are the backup system, including the electronic device and a plan for what happens if the attendant does not show. Support management is training for your parent, or for you as the authorized representative, on how to manage and dismiss their attendants.
That last one is worth pausing on. Texas will train the family on how to fire an attendant who is not working out. That is in the benefit by design, because the program assumes the person receiving care is the one in charge of it.
The reason you have not heard of CFC is that it is not a program your parent enrolls in. HHSC calls it "a state plan Medicaid service." It arrives through whichever Medicaid managed care plan your parent already belongs to, and in the Austin area for an adult with long-term care needs that plan is a STAR+PLUS plan. Nobody mails a brochure. You have to ask.
Two parents, the same needs, two different answers
Here is the situation we see most often, with the numbers changed. Two women in their eighties live four miles apart in southeast Austin. Both need help bathing and dressing. Both have had a fall this year. Both would rather die than move, and both have adult children who cannot keep driving over twice a day.
The first woman's only income is $880 a month in Social Security. She receives Supplemental Security Income on top of it, which in Texas means she has Medicaid. Her daughter calls the STAR+PLUS plan, asks for an assessment, and within a few weeks an attendant is coming four days a week. No list, no lawyer, no spend-down.
The second woman has $2,150 a month from Social Security and a small teacher's annuity. On paper she is better off. In practice she gets nothing from CFC, because she does not have Medicaid. Her route to an attendant runs through the STAR+PLUS Home and Community Based Services waiver, which has an interest list that takes years to clear in the Austin area.
The thing separating them is not how sick they are, how much care they need, or how hard their families are trying. It is one classification in a Medicaid file.
The line is SSI, and the disqualifying word is MAO
HHSC's STAR+PLUS operational handbook states it directly: CFC is "Available to members who receive Supplemental Security Income (SSI) or receive SSI-related Medicaid. CFC is not available for medical assistance only (MAO) members."
MAO is the category for people who qualify for Medicaid long-term care because of their medical need and the higher income limit that comes with institutional-level programs, rather than because they qualified for SSI. It is the box the second woman lands in. For her, personal attendant services exist, but they come as a waiver service with a waiver's wait, not as CFC.
So the practical question becomes: is your parent an SSI recipient, or in an SSI-related Medicaid category? The 2026 SSI federal payment standard is $994 a month for an individual and $1,491 for a couple, with a resource limit of $2,000 for an individual and $3,000 for a couple. Those figures rise in January: the Social Security Administration has announced a 3.6 percent cost-of-living increase effective January 2027, taking the individual federal rate to $1,029 a month. If your parent's income is a little above the line this year, run it again in January, and remember that the state counts income its own way rather than simply reading the gross deposit.
Do not try to settle the SSI-related question yourself. "SSI-related Medicaid" is broader than "gets an SSI check" and covers several categories of people who once qualified or who qualify under rules that ignore certain income. It is exactly the kind of determination that someone at HHSC can make in an afternoon and that a family can get wrong for a year.
The money test and the care test are two different tests
Even with the right Medicaid category, there is a second gate, and it has nothing to do with money. HHSC requires that CFC members "meet an institutional level of care" for a hospital, a nursing facility, an intermediate care facility for individuals with an intellectual disability or related condition, or a psychiatric hospital.
In plain terms: your parent has to need the level of care an institution provides, while living at home. That sounds like a high bar and families routinely assume they fail it. Many do not. The test is functional, not diagnostic. A dementia diagnosis by itself does not establish it, and the absence of a diagnosis does not rule it out. What matters is what your parent can and cannot physically do on an ordinary Tuesday.
The assessment is done in person. HHSC requires a face-to-face visit, and the instruments are Form H6516, the Community First Choice Assessment, and Form H2060, the Needs Assessment Questionnaire and Task/Hour Guide. One detail worth knowing before the visit: the handbook's rule that a member must score at least 24 on Form H2060 applies to personal attendant services obtained through programs other than CFC or the STAR+PLUS waiver. Do not let anyone apply a score threshold to a CFC request that the rule does not put there.
Prepare for that visit the way you would prepare for a deposition. The assessor is scoring what your parent needs help with, and your parent, sitting in her own living room with company over, will tell them she manages fine. Write down the real week beforehand: who buttons the shirt, who stands in the bathroom doorway, how many times the stove was left on. Bring it.
Where the care can happen, and what it will never pay for
CFC is a benefit for a person living in the community. HHSC says CFC services "are provided in a community-based setting," and that community-based settings "do not include: hospitals; NFs; institutions for mental disease (IMD); ICF/IID; and any setting with the characteristics of an institution."
What HHSC's handbook does not say in so many words is whether CFC specifically can follow a resident into a licensed Austin assisted living facility. The handbook is explicit that STAR+PLUS waiver members "may reside alone, with family members or others at locations of their choice in the community, including adult foster care (AFC) homes or in licensed assisted living facilities," and that contracted agencies serve members in "their own homes, foster homes, assisted living facilities (ALFs) and other locations where service is needed" — but those passages are about waiver services generally. Some third-party guides state flatly that CFC is limited to your parent's own home or a relative's home. We could not confirm that restriction in HHSC's own text, and we are not going to publish it as settled. Ask the plan, and ask for the answer in writing.
What is not ambiguous is rent. No Texas Medicaid program pays the room-and-board portion of an assisted living bill; Medicaid treats the room, the meals and the utilities as the resident's own responsibility, covered by their income. The 2025 CareScout Cost of Care Survey, released March 2026, puts the Texas statewide median for assisted living at $5,666 a month, and Austin generally runs above the state median — we do not publish an Austin-specific figure because CareScout does not survey metros separately. CFC pays for an attendant's hands. It does not pay for a building.
That is why CFC belongs in the conversation early, while your parent is still at home. It is a benefit for keeping someone where they are, and it loses most of its usefulness the month after the move.
Why you will get two different answers from two competent people
There is a genuine inconsistency in HHSC's published material, and knowing about it will save you from thinking someone lied to you. Section 1142 of the STAR+PLUS handbook limits CFC to members "who receive Supplemental Security Income (SSI) or receive SSI-related Medicaid." Section 1143.1.2 of the same handbook describes CFC as "available to all Medicaid-eligible members (with the exception of members who are considered medical assistance only (MAO))." The STAR+PLUS operational handbook, revised in February 2026, uses the first formulation and adds the MAO exclusion explicitly.
Those are not identical statements, and HHSC does not reconcile them on the page. One more wrinkle from the same handbook: "Most members will receive PAS through Community First Choice (CFC), with the exception of members who are medical assistance only (MAO), or members who also require protective supervision. Protective supervision is not a benefit of CFC." If your parent wanders, that sentence matters, and the answer is that protective supervision can still go on the service plan — just not as CFC.
On the question families care about most, whether CFC has a waiting list, we will tell you what we actually know. CFC is a state plan service rather than a waiver, and the Texas programs that run formal interest lists are the waivers — STAR+PLUS HCBS, CLASS, DBMD, HCS, TxHmL, MDCP. We did not find an HHSC page that says in so many words that CFC never has an interest list, so we are not going to put that sentence in your mouth when you call. Ask whether there is a list. If the answer is no, ask how long the assessment takes.
What to do this week
Start with the free navigator rather than the plan. The Aging and Disability Resource Center of the Capital Area at 855-937-2372, open weekdays 8 a.m. to 5 p.m., is the front door for long-term services and supports in Travis, Williamson, Hays, Bastrop, Caldwell, Blanco, Burnet, Fayette, Lee and Llano counties. Say the words "Community First Choice" and "is my mother SSI-related or MAO." Those two phrases will get you to the right person faster than a paragraph of explanation.
Then do three things in parallel, because they move at different speeds. Ask the Area Agency on Aging of the Capital Area at 512-916-6062 for benefits counseling, which is free and covers the Medicaid category question. Call 2-1-1 or go to YourTexasBenefits.com and get your parent's name on the STAR+PLUS HCBS waiver interest list whether or not you think they qualify for CFC — it costs nothing and the clock only starts once. And if your parent already has Medicaid, call the member services number on their plan card and ask the service coordinator for a CFC assessment.
While all of that is pending, the gap is yours to cover, and there are Texas-funded options that do not require Medicaid at all. Day Activity and Health Services is one. Respite is another. Neither replaces an attendant, and both buy back hours.
One last thing. If your parent is close to the SSI line but not under it, do not start moving money to get there. Medicaid long-term care has a look-back period, and the timing of a spend-down is the part families get wrong most expensively. Get the category determined first, by someone whose job it is to determine it, and then decide.
