In Texas adult foster care, the state or a STAR+PLUS health plan pays for your parent's care in a caregiver's household, and your parent usually pays the provider for room and board., The provider lives in the household and is your parent's primary caregiver. A Texas adult foster home can serve no more than three adults unless it's licensed as an assisted living facility.

In This Guide

What Adult Foster Care in Texas Looks Like

If your mom or dad can't manage at home anymore but doesn't need a nursing home, a small home with one caregiver can feel like the right middle ground, and also like a leap of faith. The Texas Adult Foster Care program, run by HHSC, provides a 24-hour living arrangement in an HHSC-contracted foster home for adults who, because of physical, mental or emotional limitations, can't keep functioning independently in their own homes.

The care is practical, everyday help. In a Texas adult foster home, services may include:

  • Meal preparation and housekeeping
  • Minimal help with personal care
  • Help with activities of daily living
  • Providing or arranging transportation

The rules about the caregiver are what make this different from a facility. The provider must share a common living area with the residents; detached living quarters don't count. Under the program's minimum standards, 26 TAC Chapter 278, Subchapter B, the provider must also own or lease the home and can't be the spouse of a resident in their care. The Texas adult foster care minimum standards moved into Title 26 of the Texas Administrative Code effective June 28, 2024, so a page citing the standards at an older location may be out of date.

Community Care Services and STAR+PLUS Compared

This is the part that confuses most families. HHSC's Community Care Services runs adult foster care under Title XX, the federal block grant to states for social services. STAR+PLUS, part of Texas Medicaid, covers adult foster care as one of the Home and Community Based Services (HCBS) a member receives through their managed care organization. The two don't work the same way.

Community Care Services STAR+PLUS HCBS
Who the home contracts with HHSC Your parent's managed care organization (MCO), directly or through an AFC agency
Who pays for the care services HHSC Medicaid, through the MCO; some members also owe a copayment
Main eligibility gate Financial test plus a score of at least 18 on Form 2060 Enrollment in STAR+PLUS HCBS
How room and board is set Negotiated in the client and provider agreement Formula: SSI federal benefit rate minus the personal needs allowance
What your parent keeps each month At least $50 with Medicaid, $85 without, plus half of any cost-of-living raise $85 ($170 for a couple both in care)
Waiting list Interest list when no home is available Handled through STAR+PLUS (see our STAR+PLUS guide)

If your parent already has STAR+PLUS, start with the health plan. If not, read the Community Care Services section next.

Does Your Parent Qualify Through Community Care Services?

It's natural to worry that your parent has too much to qualify. The Community Care Services test has two parts: money and need.

Financial eligibility. Under 26 TAC section 271.53, a Texas Community Care Services adult foster care applicant must either already receive Supplemental Security Income (SSI), Temporary Assistance for Needy Families, SNAP food benefits, Medicaid, or Medicare Savings Programs benefits as a QMB or SLMB enrollee, or have countable income at or below the special income limit Texas sets for institutional care, with twice that limit for a couple. Our guide to Texas Medicaid income limits explains that special income limit.

Texas Community Care Services eligibility also caps countable resources at $5,000 for one person or $6,000 for a couple, under 26 TAC section 271.89. HHSC's eligibility handbook doesn't count several things toward that Community Care Services resource limit, among them the home, household goods and personal effects, one vehicle, prepaid burial arrangements, the cash value of life insurance, and inaccessible resources such as irrevocable trusts and pension funds, including IRAs. A Texas Community Care Services applicant must also be at least 18 or an emancipated minor.

Functional need. For Community Care Services adult foster care, HHSC currently requires a score of at least 18 on Form 2060, its Needs Assessment Questionnaire, plus the right characteristics on Form 2330 and a supervisor's approval. HHSC can adjust the Form 2060 minimum score for adult foster care based on available funding. HHSC's handbook also says adult foster care shouldn't be authorized for someone who is bedfast, is a danger to themself or others, needs considerable help with personal care, or needs long-term care in a medical or psychiatric facility.

That last list can sting if it describes your parent. It means a setting with more hands, like assisted living in Texas or a nursing home, may be the better match.

The interest list. Qualifying doesn't always mean a bed is open. If no Texas adult foster home is available, your parent's name goes on HHSC's interest list, and the caseworker looks at other services that might help in the meantime. Names come off HHSC's adult foster care interest list first come, first served, and eligibility is checked at release. HHSC contacts people on its interest lists once a year, and someone marked inactive for not responding keeps their place. Some Texas Community Care Services programs aren't offered in every part of the state.

How the STAR+PLUS Route Works

If your parent is a STAR+PLUS HCBS member, adult foster care comes through their health plan instead. The home's provider is contracted either directly with the member's managed care organization or with an adult foster care agency that contracts with it. The plan's registered nurse service coordinator monitors the quality of your parent's care.

Your parent's home rights get real teeth here. HHSC's STAR+PLUS Handbook requires the MCO to make sure the adult foster care provider has a written, legally enforceable residential agreement with the member that counts as a lease under Texas Property Code Chapter 92. The member gets, at a minimum, the same responsibilities and eviction protections Texas tenants have. The agreement can't require your parent to sign in and out, the home can't enforce a house-wide curfew, and your parent should be able to lock their entrance door, eat when they like and have visitors of their choosing at any time.

Those protections are real, but they aren't a promise that the arrangement can never end. A STAR+PLUS HCBS member who doesn't pay the agreed room and board or copayment could be terminated from the program. If money gets tight, tell the service coordinator early.

What You Pay for Adult Foster Care in Texas

Money is usually the question behind all the others. In Texas adult foster care, HHSC or the STAR+PLUS plan covers the care services, while your parent pays the provider separately for room and board, meaning the housing and meals.,

In STAR+PLUS, the split matches federal Medicaid rules, which bar Medicaid home and community-based services waivers from paying for room and board, with narrow exceptions that don't apply when the person lives in the caregiver's own home.

Under Community Care Services, your parent pays the room and board amount written into the client and provider agreement, and the HHSC caseworker helps the two of you negotiate it. HHSC notes that the amount may be influenced by what's typical in the community. Under 26 TAC section 271.161, a Texas adult foster care resident with Medicaid must be allowed to keep at least $50 a month for personal needs, and a resident without Medicaid must keep at least $85 a month for personal needs and medical expenses. Every Texas Community Care Services adult foster care resident also keeps at least half of any cost-of-living adjustment received on or after January 1, 1993. HHSC calls these amounts minimums, so your parent may need to keep more.

Under STAR+PLUS, room and board isn't negotiated. HHSC's STAR+PLUS policy calculates adult foster care room and board as the SSI federal benefit rate minus the personal needs allowance, and in 2026 a STAR+PLUS adult foster care resident keeps $85 a month for personal needs ($170 between them for a couple). If the provider moves into your parent's own home instead, STAR+PLUS charges no room and board. STAR+PLUS adult foster care members who qualified under the special institutional income limit may also owe a monthly copayment toward their services, paid to the provider, but SSI recipients don't owe one.

Whichever route applies, get the room and board amount in writing before your parent moves in. For the full picture of how Texas families pay for care outside a nursing home, see how to pay for assisted living in Texas, and for what your parent keeps in a nursing home instead, see our guide to the Texas Medicaid personal needs allowance.

Is the Home Allowed to Take Your Parent?

Before your parent moves in, count the residents. For the adult foster care program, HHSC says no more than three adults can receive foster care services in a home unless the home is licensed by the state as an assisted living facility, and a home serving four or more adults must hold that license. Texas law defines an assisted living facility as a place that provides food and shelter to four or more people unrelated to the owner, plus personal care or medication help.

If a home with four or more residents tells you it holds a "Type C" license, ask more questions. Under 26 TAC section 553.5, Texas assisted living facilities are licensed as Type A or Type B, based on residents' ability to evacuate. Type C was a four-bed license originally issued for adult foster care, and HHSC no longer issues new ones; only renewals remain. You can look up any licensed facility on HHSC's Long-Term Care Provider Search.

Who Inspects the Home and Where to Complain

You can't be there every day, and other people are checking too. In Community Care Services adult foster care, HHSC regional contract managers conduct fire and health inspections, reassess the provider and the home, and can disenroll a home, while HHSC caseworkers monitor each resident. A Texas Community Care Services adult foster home must be inspected at least once a year by fire safety authorities and at least once a year by health authorities. State representatives may enter an enrolled home at any time to inspect it or to talk with residents privately.

If something seems wrong, your parent and you, as their responsible person, have the right to complain about abuse, neglect, exploitation or poor care without retaliation. Under 26 TAC section 271.159, the complaint goes to one of two places:

The provider has duties too: they must respond to, investigate and document complaints, and report any they can't resolve to the HHSC caseworker within five days.

How to Apply for Adult Foster Care in Texas

Asking for help is the first step, and you can take it on your parent's behalf. For Community Care Services, the process looks like this:

1
Step 1

Contact your local HHSC office

A request can be made by phone, in writing or in person, by your parent or by a relative, friend or other interested person. Another agency can also make a referral.

2
Step 2

Have the home visit

An HHSC caseworker visits to assess financial and functional eligibility using Form 2060, and completes Form 2330 to see whether adult foster care is a good fit.

3
Step 3

Visit homes and reach an agreement

Your parent can visit potential adult foster homes, and before adult foster care is approved, the caseworker must confirm your parent has an agreement to move into an enrolled home.

4
Step 4

Get a decision

Your parent is entitled to an interview, and HHSC decides Texas Community Care Services adult foster care eligibility within 30 calendar days of the signed application, or, for someone already receiving SSI or similar benefits, within 30 calendar days of the assessment or face-to-face contact with the caseworker, whichever comes first.

If your parent already has STAR+PLUS, ask their service coordinator about adult foster care instead. Our guide to Texas Medicaid waiver programs covers how people who aren't yet in STAR+PLUS get in line.

Frequently Asked Questions

How many residents can an adult foster home have in Texas?

A Texas adult foster home can serve no more than three adults unless it's licensed as an assisted living facility. Private-pay residents count toward the home's enrolled or licensed capacity: to get paid, a Texas Community Care Services adult foster care provider can't exceed that capacity, whether residents receive adult foster care services or pay privately. HHSC regional contract managers approve private-pay residents.

Can a family member be my parent's adult foster care provider?

Through STAR+PLUS, a relative other than a spouse can be the adult foster care provider in a Texas home with up to three residents. Under the Texas Community Care Services minimum standards, the provider can't be the spouse of a resident in their care.

What happens if my parent's needs increase after moving in?

Eligibility isn't permanent. HHSC says a person who no longer scores 18 or above on Form 2060 is no longer eligible for Texas Community Care Services adult foster care. If that happens, ask the caseworker about settings with more support.

Does my parent have to live in Texas to join the interest list?

Yes. Only people who live in Texas can be placed on an HHSC community services interest list, including the Community Care Services adult foster care list, with exceptions for some military families.

Learn More

Care TypesBoard and Care Homes: What They Are, What They Cost, and Who They SuitBoard and care homes are small homes, usually 20 or fewer residents, with meals, personal care and 24-hour staff. What they cost, who pays, and how to vet one. Care TypesHow to Choose an Assisted Living Facility in TexasHow to choose assisted living in Texas: confirm the HHSC license, ask about inspections, learn what STAR+PLUS Medicaid covers, and compare 2025 care costs. Care TypesCost of Senior Care in TexasWhat senior care costs in Texas in 2026: assisted living about $5,666 a month, a nursing home about $5,627 a month. Every setting, how it compares, how to pay. MedicaidTexas STAR+PLUS: Who Qualifies, What It Pays, and How to EnrollTexas STAR+PLUS covers Medicaid managed care for seniors 65+. The HCBS income limit is $2,982/month, and 12,100 people were on its interest list in August 2026. MedicaidHow to Get on a Texas HCBS Waiver ProgramTexas HCBS waiver programs help seniors stay home instead of a nursing facility. Learn how STAR+PLUS HCBS, CLASS, HCS, interest lists, and applying work. Care TypesHow to Pay for Assisted Living in TexasHow to pay for assisted living in Texas: private pay, long-term care insurance, VA Aid and Attendance, and the STAR+PLUS Medicaid waiver, explained.

Find personalized help working out whether Community Care Services or STAR+PLUS adult foster care fits your parent at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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