Eligibility and Authorization

Insurance & Medicaid Information

Coverage and network status can change. Confirm the member’s current plan and authorization before services begin.

Coverage is individual

Eligibility, covered services, authorized hours, and provider-network participation are determined by the applicable program or health plan and can change.

Have the member’s plan name available when you call. Use our before-you-call checklist to prepare your questions. Primetime will confirm current agency participation and explain what information is needed for onboarding.

No guarantee of coverage

Information on this website is general and does not guarantee eligibility, authorization, payment, or availability. Confirm benefits and network status directly with the plan and with Primetime before relying on coverage.

Insurance plans and Medicaid

Contact Primetime about services through the plans shown below. Coverage and availability depend on the member’s benefits, service authorization and location.

Call 713-977-7721 Contact Primetime

How to ask about Medicaid personal assistance

Identify the plan or program. Have the plan name, client ZIP code and a short description of the daily help needed available when you call 713-977-7721.
Check benefits and provider participation. Ask the plan whether personal assistance is a covered benefit for this member and whether Primetime is currently an available provider.
Confirm the authorization pathway. Ask who assesses needs and issues the service authorization. For STAR+PLUS long-term services and supports, the MCO service coordinator develops the service plan with the member and coordinates authorization.
Confirm agency acceptance and scheduling. If an authorization has already been issued, tell our office. Ask what documents are needed and how to provide them securely. A separate referral is not a prerequisite to an initial phone inquiry.

Do not send member numbers, medical records or authorization documents through public website messages or social media. Ask our office for the appropriate transfer method.

Which program applies?

Similar names can describe different services or eligibility routes. These summaries explain public programs, not a list of programs Primetime accepts.

STAR+PLUS: Medicaid state-plan personal assistance services (PAS) and the expanded Home and Community Based Services (HCBS) program have different requirements. Ask your plan's service coordinator about an assessment for daily assistance and which benefit applies. See HHSC's STAR+PLUS services overview and service coordination guidance.
Primary Home Care (PHC): Full Medicaid eligibility is one requirement; functional needs and other program requirements also apply. Read the PHC and CAS eligibility guidance.
Community Attendant Services (CAS): Financial eligibility is handled through Medicaid for the Elderly and People with Disabilities (MEPD). The attendant-service benefit does not provide regular Medicaid health coverage. See HHSC's explanation of CAS.
Family Care: This Title XX-funded program is separate from Medicaid. HHSC screens for PHC and CAS eligibility first, and an interest list may apply. Read the Family Care guidance; availability is not guaranteed.

The plan or HHSC determines eligibility and authorization. Separately confirm whether Primetime can accept the individual's authorization in their ZIP code. Our described services remain non-medical PAS.

If you do not know your plan or where to start, use the official aging and disability navigation route.

Review our non-medical attendant care scope and service-area information, then confirm your specific plan, location and approved tasks by phone.