Your mother’s hours were fine six months ago. They are not fine now, and Texas Medicaid does not know that, because nobody told it. If her Primary Home Care or STAR+PLUS hours were set at an assessment that no longer describes how she lives, the fix is a reassessment request: evidence of what changed, sent to the right person, with a paper trail you control.

Key Insights

• Hours are not permanent. They are tied to a functional assessment score, and that score can be revisited whenever your parent’s condition changes significantly, not only at the annual reassessment.
• Requests go to the HHSC caseworker for state plan Primary Home Care and Community Attendant Services, or to the MCO service coordinator for STAR+PLUS.
• What moves a reassessment is documented change: a fall, a hospitalization, a new diagnosis, a caregiver who can no longer help, a task your parent has lost since the last assessment.
• For Primary Home Care and Community Attendant Services, HHSC’s rule is that the caseworker must revise the service plan within 14 calendar days of learning of a significant change, or document why no change is needed. STAR+PLUS waiver increases run through an ISP revision the MCO must review and authorize, with no fixed statutory turnaround.
• If the request is denied, or comes back lower than the documented need supports, there is a real appeal path, on a clock.

Table of Contents

1. Why does Texas Medicaid set in-home care hours, and why do they need to change?
2. How do you request a reassessment for more hours?
3. What is different between Primary Home Care and the STAR+PLUS waiver?
4. What documentation makes a request hard to say no to?
5. What do you do if the answer is no?
6. What do families ask most about this process?

Why Your Parent’s Hours Were Never Meant to Be Permanent

Every Texas Medicaid in-home care allocation traces back to a functional assessment. For state plan Primary Home Care and Community Attendant Services, that is Form 2060, where HHSC’s rule is that a person “must score at least 24 on Form 2060 and require at least six hours of service per week” to qualify, with narrow exceptions. For the STAR+PLUS Home and Community Based Services waiver, it is the individual service plan the coordinator builds after an assessment visit, priced against a cost ceiling, not an hour cap.

Both are snapshots. HHSC requires that the caseworker “reassesses the person’s functional needs within 12 months of the previous assessment”, and STAR+PLUS runs its own annual review. But “annual” is a ceiling on how long HHSC can wait, not a floor on how soon you can ask. The same handbook directs the caseworker to review each Form 2060 task “for each request for a change in service plan or hours,” and a separate rule starts a clock once HHSC learns the status changed. That is the door most families never know exists.

How to Request a Reassessment for More Hours

The process differs by program, but the shape is the same: name the change, ask for the reassessment, document the gap.

If your parent receives Primary Home Care or Community Attendant Services (state plan, no managed care organization involved):

1. Call the HHSC caseworker directly, not the general intake line. Regional community care intake can route you.
2. Say the condition has changed since the last assessment and you are requesting a reassessment, not a new application.
3. Describe the change: a fall, new mobility loss, a hospitalization, a diagnosis progression, a caregiver who can no longer provide backup.
4. The caseworker schedules a new Form 2060 assessment on current status, and hours are recalculated from that score.
5. HHSC’s rule is that the caseworker “must revise the service plan within 14 calendar days of learning that the person’s status or condition changed or must document why no changes to the service plan are needed”. Changes are recorded on Form 2060, and Form 2101 is updated to authorize any change to priority level or service hours.

If your parent is on the STAR+PLUS HCBS waiver (through a Medicaid managed care organization):

1. Contact the MCO service coordinator, a different person than the HHSC caseworker, and the one who controls the individual service plan.
2. Request a reassessment and a revision to the individual service plan (ISP), explaining what changed.
3. The coordinator schedules a visit and builds a revised ISP documenting why the added services are medically necessary, not just wanted.
4. The MCO reviews the revised ISP and authorizes or denies it. Texas rule is that the cost of STAR+PLUS HCBS services on the plan “should not exceed 202 percent of the cost of care” HHSC would pay for that person in a nursing facility, under 1 Texas Administrative Code Section 353.1153(c)(1)(H). A plan above that ceiling goes to HHSC’s Office of the Medical Director and Utilization Review staff, who decide whether the person qualifies for the Medically Fragile group or general revenue funds. That adds time.

In both tracks, the person on the phone needs a reason, not a feeling. “She’s struggling more” gets logged and forgotten. “She fell twice in March, was hospitalized four days, and cannot transfer bed to wheelchair without two-person help” gets a reassessment scheduled.

Primary Home Care vs. STAR+PLUS: What Changes When You Ask for More

If you are not sure which program your parent is on, check the current authorization letter or ask whoever assigned the attendant. The two systems use different forms, contacts, and math.

What to Document Before You Call

A request succeeds or stalls on specificity. Before you call, put this in writing:

• The date and nature of the change. A fall, a diagnosis, a hospital or rehab stay, a new limitation.
• What your parent could do at the last assessment and cannot do now. Transferring, bathing, toileting, medications, meal prep. Name the task, not the impression.
• Who has been covering the gap, and for how long. Two unpaid extra hours a day from you or a sibling is exactly the evidence a reassessment needs.
• Safety incidents, even minor ones. A near-fall, a missed medication, or a wandering episode weighs more than “she seems more tired.”
• Any new physician or hospital record. A discharge summary describing new limitations strengthens the request.

Keep a copy of what you submit, plus who you spoke with and when. If the request is contested, that record is the difference between a call and an appeal.

If the Answer Is No

Requests can come back denied, or approved for fewer hours than the documented need supports. You have the right to appeal, and the clock starts when the notice arrives.

For STAR+PLUS waiver decisions, appeal internally with the MCO, then request a State Fair Hearing through HHSC. HHSC’s rule is that a member “can request an appeal within 90 days from the effective date” of the HHSC action, measured from the date on Form H2065-D. Keeping current services in place during the hearing runs on a shorter clock: benefits continue only if the request is filed within the adverse action notification period or by the effective date of the action. Read the notice the day it arrives. For Primary Home Care and Community Attendant Services, HHSC’s own fair hearing process applies instead, and the right to it is stated on Form 2065-A.

This is the point to talk to an elder law attorney, particularly if the denial involves a large hours reduction or your parent’s safety is at risk. An attorney who knows Texas Medicaid appeals can tell you whether the notice qualifies for continued benefits.

Frequently Asked Questions

How often can I request a reassessment for more Medicaid in-home care hours?
There is no fixed limit, but each request needs a documented reason: a real change in condition, safety, or living situation since the last assessment. Asking every few months with no new evidence gets treated as noise. One documented request, timed to an actual change, moves faster than several vague ones.

Will my parent lose their current hours while the reassessment is pending?
Generally, current authorized hours continue while a reassessment is processed, since it is a revision to an existing plan rather than a new determination. If a reduction is proposed instead, different notice and appeal rules apply, and the notice should give the effective date and your rights. Call the caseworker or coordinator if the timeline is unclear.

Does a dementia diagnosis by itself qualify my parent for more hours?
A diagnosis alone typically doesn’t move the number. What moves it is functional impact: what your parent can no longer safely do alone. Dementia often shows up as behavioral and safety risk, such as wandering, medication errors, or resistance to care, rather than physical limitation, and scoring follows function, not diagnosis.

What if my parent is on the STAR+PLUS interest list and hasn’t gotten the waiver yet, but their needs have increased?
If your parent is on the STAR+PLUS HCBS waiver interest list and receiving Primary Home Care or Community Attendant Services meanwhile, the request goes through the state plan process, not the MCO. The change is documented the same way, and PHC hours can be revised while the interest list moves at its own pace, which in much of Texas means years.

Related Reading

• Does Texas Medicaid Cover In-Home Care? How to Get the Hours at Home: the four pathways to hours.
• STAR+PLUS Waiver Eligibility in Texas: who qualifies, and the interest list reality.
• Get Paid to Care for Your Parent in Texas: Consumer Directed Services and paid family attendants.

Talk to a Proactive Caregiver Financial Strategist

A denied or shrinking hours authorization rarely arrives alone. It comes with a benefits question, a spend-down decision, or a family argument about who covers the gap. If you’re working out what the change means for your household budget and your parent’s long-term plan, talk to a Proactive Caregiver financial strategist about your numbers. This is not a substitute for a physician, elder law attorney, licensed investment adviser, insurance adviser, or an official government eligibility determination.

Citations

• CCSE Handbook 2700, Service Monitoring, Changes and Transfers (Texas HHS): 2721.4, the 14 calendar day service plan revision rule; 2721.6, Form 2060 and Form 2101 documentation.
• CCSE Handbook 2600, Authorizing and Reassessing Services (Texas HHS): 2663, the 12 month reassessment cycle; 2664, review of each Form 2060 task on any request to change hours.
• CCSE Handbook 4600, Primary Home Care and Community Attendant Services (Texas HHS): 4633, the minimum Form 2060 score of 24 and six weekly service hours; 4624, the 42 hour weekly cap with priority status, 50 without it.
• STAR+PLUS PSU Handbook 1200, HCBS Program Eligibility (Texas HHS): 1260, the ISP cost limit of 202 percent of nursing facility cost and the Office of the Medical Director and Utilization Review referral above it.
• 1 Texas Administrative Code Section 353.1153, STAR+PLUS HCBS Program: the rule at (c)(1)(H) behind the 202 percent ceiling.
• STAR+PLUS PSU Handbook 7200, State Fair Hearing Procedures (Texas HHS): the 90 day appeal window from the effective date of the action and the date on Form H2065-D; 7222.1, continued benefits.
• CCSE Handbook 2900, Appeals and Fair Hearings (Texas HHS): the state plan fair hearing path for PHC and CAS; hearing rights on Form 2065-A.