Guide
Texas STAR+PLUS Medicaid: nursing home and home care
Updated October 15, 2026 · Reviewed against official sources
If your mom or dad lives in Texas and already needs daily help, you'll very likely hear about STAR+PLUS. It's the name the Texas Health and Human Services Commission (HHSC) uses for its managed care Medicaid for older adults and people with disabilities. In this guide, we explain step by step what it is, what it covers, and how to apply.
What is STAR+PLUS?
STAR+PLUS is a Medicaid managed care program. The person chooses a private health plan that has a contract with the state, and that plan coordinates their services. Each member has a service coordinator who helps put together the care plan, find services, and communicate with doctors. According to HHSC, the plan must schedule a visit within the first 30 days of enrollment and at least once a year, and the family can take part in those meetings.
According to HHSC, STAR+PLUS is for adults who have already been approved for Medicaid and are in one of these situations, among others:
- They get SSI (Supplemental Security Income).
- They don't get SSI, but they need STAR+PLUS HCBS services so they don't have to live in a nursing home.
- They live in a nursing home and get Medicaid there.
People who have Medicare can usually enroll too. In that case, Medicare keeps paying first for medical services, your loved one keeps their Medicare doctors, and STAR+PLUS adds long-term services and supports.
People who don't have full Medicaid can't enroll. For example, someone who only gets help paying Medicare premiums (the QMB or SLMB programs) can't join STAR+PLUS. If your loved one doesn't have a qualifying immigration status, read immigration status and benefits.
What services it covers
STAR+PLUS offers medical care and long-term services and supports. Some of the ones families use most are:
- Personal Attendant Services: help at home with bathing, dressing, eating, or getting around.
- Community First Choice (CFC): support with daily activities for people who need an institutional level of care.
- Day Activity and Health Services (DAHS): adult day centers.
- Emergency response (a help button at home).
- Medical transportation for non-emergencies.
- Consumer Directed Services (CDS): an option that lets the person hire and direct their own attendant. Ask the service coordinator about the requirements and whether a family member can be hired in your case.
DAHS adult day centers
DAHS is a Medicaid service provided at centers that are licensed and certified by HHSC, under the supervision of a nurse. It includes:
- Nursing and tasks delegated by the nurse.
- Physical rehabilitation.
- Nutrition and meals.
- Social activities.
- Transportation to and from the center when there's no other way to get there.
It's for people with a chronic medical condition who can benefit from this kind of program. Centers are usually open Monday through Friday, and the person can attend up to five days a week. Authorization usually lasts 12 months. For families who work, it's a way to know their loved one has company during the day. You can search for centers in our adult day centers section and read adult day care for seniors.
STAR+PLUS HCBS: when someone would otherwise need a nursing home
STAR+PLUS HCBS (formerly called a waiver) is for people who, without help, would have to live in a nursing home. Its goal is to let the person stay at home or in the community. According to HHSC, it adds services such as:
- Services in assisted living.
- Adult foster care.
- Home-delivered meals and medical supplies.
- Minor home modifications (for example, grab bars in the bathroom or ramps) and adaptive equipment.
- Respite care for the family caregiver.
- Nursing and therapies (physical, occupational, and speech).
- Help leaving a nursing home and returning to the community.
Medicaid pays for care services in assisted living, but not for rent or food. The person pays those costs with their income (for example, their Social Security or SSI).
The interest list
STAR+PLUS HCBS uses an interest list: a waiting list for people who don't get these services yet. According to the HHSC handbook:
- If your loved one isn't in STAR+PLUS yet, they sign up by calling the HHSC interest list unit. When their turn comes, they're contacted to start the assessment.
- If your loved one already has Medicaid and is enrolled in a STAR+PLUS plan, they can ask the plan for an assessment to "upgrade" to HCBS, without going through the list.
- If your loved one lives in a nursing home and wants to return to the community, they can ask about the Money Follows the Person program.
That's why we recommend signing up as soon as possible, even if your loved one doesn't need the service right away.
STAR+PLUS and nursing homes
If the person already needs to live in a nursing home, Texas Medicaid can pay for the stay if they meet the medical and financial requirements. Nursing home care is a required Medicaid benefit in every state, so it doesn't depend on the HCBS interest list. Adults who live in a nursing home with Medicaid get their services through a STAR+PLUS plan.
Before you choose, check whether the place accepts Medicaid and has a bed available, and look at its Medicare star ratings and inspection reports. A report is a snapshot of one moment: if something catches your eye, feel free to ask what has changed since then. You can start with our directory of nursing homes and senior living in Texas, read how to read Medicare star ratings, and bring our visit checklist.
Financial requirements (the basics)
For long-term care, Medicaid looks at income and assets. The 2026 federal figures used as a reference are:
| Item | 2026 |
|---|---|
| Typical asset limit (one person) | $2,000 |
| Special income rule (300% of SSI) | $2,982 a month |
| Resources the spouse at home can keep | $32,532 to $162,660 |
Some key points:
- The home usually doesn't count, up to a certain value.
- If income is over the limit, in Texas you can use a Qualified Income Trust (also called a Miller trust). Check with HHSC or an elder law attorney if this applies to you.
- Medicaid reviews asset transfers from the last 5 years. Giving away money or property can lead to a penalty.
For more detail on these rules, read our guide Does Medicaid pay for nursing homes?.
How to apply for STAR+PLUS, step by step
- Gather documents: ID, proof of income (Social Security letter, pensions), bank statements, Medicare card, and proof of Texas residency.
- Apply for Medicaid: online at YourTexasBenefits.com or by calling 2-1-1 (2-1-1 Texas). Help is available in Spanish.
- Ask for a needs assessment: if you're looking for in-home services or STAR+PLUS HCBS, say so clearly and ask about the interest list.
- Choose a STAR+PLUS plan: you'll get a choice of plans in your area. Compare which doctors, pharmacies, and providers work with each one.
- Talk with the service coordinator: they put together the care plan. Ask for it in writing and bring your questions to the care plan meeting.
- Open all mail from HHSC and respond on time. An unanswered letter can close the case.
Starting January 1, 2027, for new applications from older adults or people with disabilities, federal law cuts Medicaid retroactive coverage from 3 months to 2 months before the month of the application. If your loved one has to move into a nursing home suddenly, apply for Medicaid as soon as possible.
How to check a facility's license in Texas
Texas divides assisted living into Type A and Type B. In Type A, residents can evacuate without physical help. In Type B, they may need help to evacuate or care during the night. Places that advertise Alzheimer's care need a special certification. You can check licenses in the official HHSC search tool (Long-term Care Provider Search). Find more details in our guides what is assisted living and memory care for Alzheimer's and dementia.
Other options if your loved one doesn't qualify
- PACE: this all-inclusive program is available in some parts of Texas. Read PACE program.
- Local Area Agency on Aging (AAA): meals, respite care, and support for caregivers. Call the Eldercare Locator at 1-800-677-1116.
- Privately paid home care: estimate the cost with our home care calculator and see how much a caregiver charges per hour in Houston, Los Angeles, and Miami.
If you don't know where to start, use our guided search.
Frequently asked questions
Will my loved one lose their Medicare doctor if they join STAR+PLUS?
No. According to HHSC, people with Medicare keep their Medicare doctors. STAR+PLUS adds the long-term services.
How long is the wait on the interest list?
It varies by region and funding. That's why it's a good idea to sign up early and let them know if your loved one's health changes.
Who pays the rent in assisted living?
The person does, with their income. STAR+PLUS HCBS pays for the care services.
Medicaid rules change and depend on each case. This guide is for information only and is not legal advice.
Sources
- Texas HHSC, STAR+PLUS: https://www.hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-members/starplus (accessed October 15, 2026)
- Texas HHSC, STAR+PLUS HCBS handbook, eligibility and interest list: https://fhb.hhs.texas.gov/handbooks/starplus-program-support-unit-operational-procedures-handbook/1200-starplus-hcbs-program-eligibility (accessed October 15, 2026)
- Texas HHSC, state plan long-term services (DAHS): https://www.hhs.texas.gov/book/export/html/97371 (accessed October 15, 2026)
- Texas HHSC, Long-term Care Provider Search: https://tulip.hhs.texas.gov/TULIP/s/ltc-provider-search (accessed October 15, 2026)
- YourTexasBenefits: https://www.yourtexasbenefits.com/ (accessed October 15, 2026)
- CMS, 2026 SSI and spousal impoverishment standards: https://www.medicaid.gov/federal-policy-guidance/downloads/cib12092025.pdf (accessed October 15, 2026)
- CMS, summary of changes under P.L. 119-21 (retroactive coverage): https://www.medicaid.gov/federal-policy-guidance/downloads/cib11182025.pdf (accessed October 15, 2026)
- Eldercare Locator (ACL): https://eldercare.acl.gov/ (accessed October 15, 2026)
Senior living in the cities with the most options
Only those that accept Medicaid: Houston · San Antonio · Dallas · Fort Worth · Austin · El Paso · Lubbock · Plano · Arlington · Conroe · McKinney
This is general information, not medical, legal or financial advice. Rules vary by state and by year: confirm with the official agency that applies to you.
Keep reading
Does Medicaid pay for care?
Yes, Medicaid pays for a nursing home if your loved one qualifies. 2026 limits, the 5-year look-back, spouse protections, waivers and how to apply.
Home care
A caregiver from an agency or hired by your family, Medicare home health and Medicaid (IHSS, STAR+PLUS): typical costs and your duties as an employer.
What is assisted living
What assisted living is, who regulates it in each state (RCFEs in California, Type A and B in Texas), what it costs, and when Medicaid pays for services.
Adult day care
What adult day care is, how it differs from adult day health care, what it costs and how to pay for it with Medicaid, PACE, CBAS or the VA.
