They sound alike, they are completely different, and the difference decides whether anyone helps pay for your mother’s care. This is the single most common misunderstanding we hear.
| Medicare | Medicaid | |
|---|---|---|
| Who runs it | Federal government | Federal and the State of Texas together |
| Who qualifies | Age 65 and over, or certain disabilities. Income does not matter | Based on income and assets, whatever your age |
| What it is for | Medical treatment and short term recovery | Medical care, and long term support with daily living |
| Pays for help with bathing and dressing at home | No, not on its own | Yes, through STAR+PLUS |
| Can a family member be paid | No | Often yes |
| How long it lasts | Weeks, tied to an episode of illness | Ongoing, for as long as the need continues |
Medicare does cover home health, but the conditions are narrow. All of these must be true:
✓ A doctor has certified that you need part-time or intermittent skilled care, meaning skilled nursing, physical therapy, occupational therapy or speech-language pathology.
✓ You are homebound, meaning leaving home takes considerable effort or is not recommended.
✓ A Medicare-certified home health agency provides the care.
If you meet all three, Medicare will also pay for a home health aide to help with bathing, grooming, feeding and walking. But only alongside the skilled care, and only part-time. In most cases that means up to 8 hours a day and 28 hours a week combined, and it stops when the skilled care stops.
Straight from Medicare’s own coverage rules, Medicare does not pay for:
✗ Custodial or personal care that helps with daily living, such as bathing, dressing or using the bathroom, when that is the only care you need.
✗ 24 hour care at home.
✗ Homemaker services such as shopping and cleaning, unrelated to your care plan.
✗ Home meal delivery.
That first line is the one that matters. It describes exactly what most families are looking for when they call us, and Medicare will not pay for it.
Texas Medicaid’s STAR+PLUS programme covers personal attendant services for adults who need help with daily activities at home. This is long term support, not recovery care. There is no requirement to be homebound and no requirement for a nurse to be involved.
It covers the ordinary, unglamorous work that keeps someone in their own home: bathing, dressing, grooming, toileting, moving safely around the house, meals, laundry and light housekeeping.
And in many cases, a family member can be the paid caregiver. We have written a separate guide on how that works.
Plenty of people qualify for Medicare and Medicaid at the same time. They are called dual eligible. Medicare generally pays first for medical care, and Medicaid covers what Medicare does not, including the long term personal care at home.
If your parent is on Medicare and money is tight, it is worth finding out whether they also qualify for Medicaid. Many people who are eligible never apply because they assume they earn too much.
1 If you are coming out of hospital and need nursing or therapy, ask the discharge planner about Medicare home health. It is real, it is free to you, and it is short.
2 If the need is ongoing help with daily living, Medicare is not the answer. Look at Medicaid STAR+PLUS, at VA benefits if there is a veteran in the family, at long term care insurance, or at paying privately.
3 If you are not sure which situation you are in, call us. We will tell you honestly, including when the answer is that you do not need us yet.
We would rather you verified this than took our word for it.
Call and describe the situation. We will tell you what is likely to cover it, even when that turns out not to be us.
Call (682) 200-9125This page is general information, not advice about your situation, and programme rules change. Verify eligibility with Medicare, Texas Health and Human Services, or the VA before making decisions. Last reviewed September 2026.