Accounting and tax for Texas home care agencies
Medicaid pays in one place, payroll runs every week, and the cost report wants it all to tie out.
Texas home care owners juggle STAR+PLUS remittances, private-pay invoices, EVV visits, and a payroll that never stops. Ashmore Books keeps the books behind all of it clean, so you know what each caregiver hour really costs and the HHSC cost report is not a scramble.
Sound familiar
You run a care business. The books keep pulling you away from it.
Most agency owners came up through care, operations, or nursing, not accounting. Then the agency grows, the payers multiply, and the numbers stop agreeing with each other.
Your caregivers get paid every week. The books should show whether that pay is covered.
- The hours in EVV, the hours we billed, and the hours we paid never match.
- STAR+PLUS deposits land as lump sums and I cannot tie them to invoices.
- I do not know what one caregiver hour actually costs me.
- The last cost report was a scramble, and I am not sure it was right.
- My bookkeeper has never heard of STEPS.
- Payroll tax liabilities sit on the balance sheet for months.
- I cannot tell if my Medicaid clients make money or lose it.
- Payroll is due Friday and I am not sure the MCO payment will be in by then.
What it is costing the agency
Messy books in home care do not stay a bookkeeping problem for long.
Revenue that never gets billed
When EVV visits, authorizations, and claims are never compared, unbilled and denied hours go unnoticed. The caregiver was paid. The agency was not.
A cost report built on guesses
HHSC rate setting and the direct care expense ratio both lean on cost report numbers. Attendant wages, office wages, and contract caregivers mixed in one account make the report hard to defend.
Margins you cannot see
Medicaid attendant rates now assume an average wage of $13.00 an hour plus payroll taxes and benefits. Without a cost per hour by payer, you cannot tell which contracts are carrying the agency.
Cash squeezed around payroll
Weekly payroll and slower MCO and insurance payments pull cash in opposite directions. Without a clear receivables picture, every Friday becomes a guess.
How we help
What changes once we are handling it
EVV, billing, and payroll hours tie out
Hours in the EVV system, units billed, and hours paid compared every period, with the differences listed so they get fixed, not carried forward.
Every payer reconciled to the deposit
STAR+PLUS remittances, private-pay invoices, long-term care insurance, and VA payments matched to what actually reached the bank.
A cost per caregiver hour you can trust
Attendant wages, payroll taxes, and benefits kept in their own accounts, so the cost of an hour of care is a number, not an estimate.
Books ready for the HHSC cost report
A chart of accounts set up around the cost report cost areas, with attendant, contract, and office costs kept apart all year instead of sorted out at deadline time.
Payroll liabilities that actually clear
Your payroll provider runs payroll. We check that its tax deposits and filings were made and that the liability accounts go back to zero.
Reporting you can act on
A monthly package with plain commentary on margin by payer, receivables, and cash ahead of payroll. Our Financial Review walks you through it if that helps.
Texas filings watched
TWC quarterly wage reports, the franchise tax information report, and federal payroll forms tracked against their due dates, with reminders before they slip.
Tax planning before the year ends
Entity choice, owner pay, and timing decisions looked at while there is still time to act. See tax planning.
We know where to look
What we usually find in a Texas home care file
None of this is unusual. It is what happens when an agency grows faster than its books.
You will see the list for your own agency, in writing, before you decide anything.
- Attendant wages and office wages posted to one payroll account
- Contract caregivers mixed in with W-2 wages
- MCO payments recorded as lump sums with no link to claims
- EVV hours, billed units, and payroll hours never compared
- Payroll tax liabilities that never clear to zero
- Private-pay invoices still open after the family paid
- Owner and family members paid with no clear payroll record
- Mileage and travel time buried in general expenses
- Cost report figures that cannot be traced back to the books
Why agencies choose Ashmore Books
Why us and not the next firm on the list
Books built around the cost report
Attendant, contract, and office costs kept apart from day one, so the numbers HHSC asks for already exist in the books. See QuickBooks cleanup.
We take the files others turn away
Years behind, payroll never reconciled, a previous bookkeeper gone. That is the work we are known for, not the work we avoid. See cleanup and catch-up.
Reconciled is not the same as correct
Matching the bank is the easy part. We check whether the entries behind the match make sense, which is how books pass a reconciliation and still mislead an owner.
Enrolled Agent led
An Enrolled Agent is licensed federally, tested specifically on tax, and can represent before the IRS. The return is handled by the team that already knows the file.
A fixed quote before anything starts
You see the findings and the price first, then decide. No open-ended hourly bill landing at the end of a cleanup.
A reply within one business day
Payroll and cash questions do not sit in an inbox for a week. You get an answer while the decision is still live.
You keep your own file
Work happens inside your accounting file with your access intact. Your payroll provider and agency software stay exactly as they are.
We explain it in plain words
Findings and reports come in language you can use to run the agency, not accounting jargon.
How it starts
Find out what is actually wrong before you spend anything.
The Books X-Ray is a read-only review. Nothing is changed, nothing is committed, and you keep the findings whether you hire us or not. Written findings, a recommended scope, and a fixed quote come back within 24 hours.
- You give read-only access to QuickBooks and a recent payroll register
- We review it and write up what we find, in plain English
- You get a recommended scope and a fixed quote
- You decide. If it is a no, the findings are still yours
Where we work
Whatever your agency already runs on.
- QuickBooks Online
- QuickBooks Desktop
- Xero
- Payroll reports (ADP, Paychex, Gusto)
- Agency software exports (AxisCare, WellSky, CareSmartz360)
- EVV visit reports (HHAeXchange)
- MCO remittance advices
- Bank statements and spreadsheets
Pricing
From $80/month, a fixed price you can approve in advance.
Monthly bookkeeping starts at $80/month and is priced on your annual revenue. Payroll support and cleanup of past months are quoted separately, and preparing the HHSC cost report itself is scoped separately. You approve the price before work begins. See the full pricing.
Before you ask
The questions agency owners ask us first
General information for Texas home care agencies, not tax or legal advice for your business.
Do you prepare the HHSC cost report, or only the books?
Our core work is getting the books cost-report-ready: attendant wages, contract labor, payroll taxes, and benefits kept in the right accounts with a clear trail back to the source. If you want help with the report itself, mention it in the quote request and it is scoped separately.
We already use AxisCare, WellSky, or CareSmartz360. Do we need to change anything?
No. Your agency software keeps doing scheduling, billing, and payroll exports. We work from what it already produces and fix what goes wrong between the export and QuickBooks.
Do you run our payroll?
No. Your payroll provider keeps running payroll. We record it correctly in the books, compare it to EVV and billing hours, and check that tax deposits and filings were actually made.
Our STAR+PLUS payments never match our invoices. Can you fix that?
Yes. MCO remittances are matched to claims and then to the deposit, so short pays, denials, and recoupments show up as items to follow up instead of disappearing into a lump sum.
Our books are a year behind and the cost report is coming. Is that too late?
Usually not. Catch-up and cleanup work is what we are known for. The Books X-Ray tells you how far back the problem goes and what the cleanup involves before you commit to anything.
Are our caregivers W-2 employees or 1099 contractors?
When the agency sets schedules, trains caregivers, and directs how care is delivered, caregivers are usually employees. We review how your workers are set up and flag classification and overtime questions early.
How do we know what this will cost before we commit?
The Books X-Ray comes back with written findings, a recommended scope, and a fixed quote within 24 hours. If the answer is no, you keep the findings.
Get the books ready before the next payroll, not after the next cost report.
Tell us how many caregivers you have, which payers you bill, which software you use, and how far behind things are. You get a read-only review, written findings, and a fixed quote. You will hear back within one business day.