Texas Medicaid covered services for seniors 65 and older run well past basic doctor visits. A senior who qualifies through STAR+PLUS, the state's managed care program for adults 65 or older and adults with disabilities, can get regular checkups, medicine and vaccines, hospital care, x-rays and lab tests, vision and hearing care, mental health care, and long-term services and supports such as personal assistance services. In the STAR+PLUS Home and Community Based Services (HCBS) program, room and board is charged only in an adult foster care home or assisted living facility, and members who qualify through Supplemental Security Income (SSI) never owe a copayment. The hard part is knowing what is limited and how to use each benefit.

In This Guide

What Texas Medicaid Covered Services Does STAR+PLUS Include?

Texas delivers Medicaid to adults 65 or older and adults with disabilities through STAR+PLUS, which combines acute care with long-term services and supports (LTSS).

If your parent also has Medicare, their regular healthcare still comes through their Medicare doctor; joining STAR+PLUS does not change that.

You choose a main doctor, a primary care provider (PCP), from your plan's list.

Not sure what your plan covers? Chat with Brevy's care navigator to check your benefits.

What Are the Prescription Drug Rules?

Texas Medicaid covers prescription medications through the Vendor Drug Program (VDP), whose Medicaid Formulary contains all products available to people enrolled in Medicaid, including those on the Preferred Drug List (PDL). Medicaid MCOs are required to follow the PDL, so these rules apply through your STAR+PLUS plan too.

Is Adult Dental Covered?

This is where Texas Medicaid is thinnest for adults. For residents of Medicaid-certified nursing facilities, Texas HHS will only authorize reimbursement for emergency dental services (controlling bleeding, relieving pain, eliminating acute infection, preventing the imminent loss of teeth, and treating injuries to the teeth or supporting structures), not routine dental.

Individual STAR+PLUS MCOs may offer value-added services (VAS) beyond Medicaid-covered services, and those may include routine dental. Each plan offers its own set, what is offered differs by area of the state, and a plan can change its VAS every six months, so check your plan's current comparison chart or member handbook. Value-added services are not required to be used before STAR+PLUS HCBS waiver dental services.

HCBS Waiver Dental

On the STAR+PLUS HCBS waiver, dental coverage is much broader. The waiver's allowable list runs to five categories: emergency treatment to control bleeding, relieve pain, and eliminate acute infection; preventative procedures required to prevent the imminent loss of teeth; treatment of injuries to the teeth or supporting structures; dentures, including the extractions, molds, and fitting that go with them; and routine and preventative dental treatment. Cosmetic dentistry is not paid for.

The annual cost limit is $5,000 per individual service plan (ISP) year, and the MCO may waive that cap at your request only when an oral surgeon's services are required. If you hit the cap, the dentist may not bill you above the approved amount. Waiver dental is provided only when no other financial resource is available, and your MCO must discuss any available resources with you first. The dentist must be licensed by the State Board of Dental Examiners and enrolled with TMHP.

The waiver also puts the MCO on a clock. It must identify a dental provider with you no later than the first day of your ISP, send an authorization to the dentist within seven days of receiving the treatment plan, and authorize and coordinate a referral within 90 days of your request; services must begin within 90 days of the treatment plan being developed, unless you or the dentist asked for a later date. Two gates come first: the dentist must determine medical necessity and submit a detailed treatment plan, and the MCO must confirm the request meets the allowable-service criteria, except in an emergency, which does not wait on that check.

If you also have Medicare, Original Medicare (Parts A and B) in most cases does not cover routine cleanings, fillings, tooth extractions, dentures, or implants; some Medicare Advantage (Part C) plans may cover check-ups or cleanings.

What About Vision and Hearing?

Both are base benefits for members with Medicaid only; a member who also has Medicare gets only long-term services and supports through STAR+PLUS. Under Texas Medicaid, examination and treatment of eye conditions, including prescribing and dispensing medically necessary eyeglasses or contact lenses, are covered, and clients of any age are eligible for medically necessary hearing aid devices and services. For adults 21 and older, Medicaid pays for one hearing aid (left or right) every 5 years, and only with at least a 35 dB loss in both ears; a routine eye exam is covered once every 24 months, and glasses or contacts once every 24 months, with a sooner pair considered for a medically necessary change of 0.5 diopter or more. MCOs may add value-added extras, such as an allowance toward upgraded frames, lenses, or contacts, or a second hearing aid at no cost for members 21 and older; these differ by plan and service area, so check your MCO's current list.

How Does Behavioral Health Work?

STAR+PLUS covers mental health treatment and substance use disorder treatment, the latter a Texas Medicaid benefit for anyone who meets the criteria for a substance-related disorder under the current edition of the DSM. You do not have to route the request through a primary care provider: a Medicaid managed care enrollee may self-refer. Contact your health plan first, because an MCO may subcontract with a separate behavioral health organization for that part of the benefit.

Outpatient mental health may be delivered by phone (audio-only), but only under narrow conditions. The billing provider must already have an existing clinical relationship with the person, meaning at least one in-person or live-video outpatient mental health service from that same billing provider within the prior six months (another clinician at the same practice can have delivered it), and Texas states that requirement may not be waived. The provider must also find audio-only clinically appropriate and safe, and the person must agree. In practice, a first appointment with a practice your parent has never used cannot be a phone visit.

How Do I Get a Ride to Appointments?

Texas Medicaid covers non-emergency medical transportation for members who have no other way to get to a covered appointment, through the Medical Transportation Program (MTP), run by the Texas Health and Human Services Commission (HHSC). Which number you call depends on how you receive your Medicaid.

Can I Use Telehealth?

In Texas Medicaid fee-for-service, telemedicine and telehealth may be delivered by live video, by audio-only phone, or by store and forward technology used with audio-only, but coverage is decided service by service rather than across the board. HHSC has not authorized every Medicaid-covered service for telehealth, and a service authorized only for live video may not be delivered by audio-only or store and forward technology. Distant site providers must be licensed in Texas and enrolled as Texas Medicaid providers. Audio-only mental health has its own limit, described under behavioral health above.

Home telemonitoring (remote patient monitoring) is a separate benefit, and a qualifying diagnosis alone does not secure it. For a client of any age with diabetes or hypertension or both, approval also requires at least one of five documented risk factors: two or more hospitalizations in the previous 12 months, frequent or recurrent emergency department visits, poor adherence to medication regimens, risk of falls, or a history of care access challenges. It requires prior authorization and may be approved for up to 180 days per request.

These rules describe fee-for-service. If your parent is in a managed-care plan, ask the plan which services it pays for by telehealth.

What Long-Term Care Stays at Home?

For seniors who need personal attendant care, Community Attendant Services (CAS) provides non-technical attendant services: personal care such as bathing, dressing, grooming, meal preparation, feeding, toileting, transfer, and ambulation; home management such as cleaning, laundry, and shopping; and escort to a clinic or doctor's office. CAS attendants are trained and supervised by non-medical staff, and anything needing professional or technical training is excluded, including tube feedings, injections, and administration of medication. A qualified income trust, which does solve an over-income problem for institutional or HCBS-waiver Medicaid, cannot be used to overcome income ineligibility for CAS.

CAS runs under the Medicaid state plan rather than a waiver, but it is not a no-waitlist program. HHSC intake screeners must assign a request for personal attendant services from someone who does not already receive SSI or SSI-related Medicaid to a caseworker as a CAS application, and screeners may not steer the person to Family Care or put them on the Family Care interest list themselves. It is then the caseworker who determines whether the person goes on an interest list. Hour limits are in our programs guide, linked above.

The STAR+PLUS HCBS waiver adds in-home nursing, respite care, home-delivered meals, minor home modifications, emergency response, assisted living, and therapies, drawn from the Texas Healthcare Transformation and Quality Improvement Program Section 1115 waiver. Texas maintains an interest list for the HCBS arm: 12,100 people as of August 31, 2026, part of an unduplicated 199,471 Texans across HHSC's six interest-list programs (people can be on more than one list, so the program counts don't add up to that total). HHSC updates the counts monthly, so pull the current figure from its Interest List Reduction page.

But the interest list is not every applicant's door, and for many older adults it is not their door at all. HHSC's STAR+PLUS Handbook routes a request by who the person is. An SSI recipient, or anyone on another full Medicaid program, never goes on the STAR+PLUS HCBS interest list; if they are already enrolled with a STAR+PLUS MCO, the handbook says to refer them to the MCO for the HCBS program, and if they are not yet enrolled, to forward the request to the enrollment broker. A nursing facility resident enrolled with a STAR+PLUS MCO is referred to that MCO for an upgrade; one who is not enrolled is placed on the list under Money Follows the Person and immediately assigned. The applicant the handbook actually places on the interest list is the medical assistance only (MAO) applicant, the person not already on full Medicaid. And while anyone waits for managed-care enrollment, referrals to the Community Care for Aged and Disabled program must be made for all full Medicaid recipients. So if your parent already has SSI, do not put their name on a list and wait. Call the MCO, or the enrollment broker if they are not in a STAR+PLUS plan yet.

Texas does not screen for eligibility before placing someone on a list, so not everyone on it will turn out to qualify. HHSC says applicants are placed on its interest lists first-come, first-served, that allocations depend on available funding, and that people who have waited longest are enrolled first.

Which Texas Medicaid Covered Services Are Limited or Excluded?

Service Coverage status
Doctor visits, hospital care, x-rays and lab tests, medicine and vaccines, vision and hearing care, mental health care, personal assistance services Covered
Hearing aids Covered when medically necessary; for adults 21 and older, one device every 5 years with at least a 35 dB loss in both ears
Adult dental Limited: emergency dental only in a Medicaid-certified nursing facility; a $5,000-per-ISP-year cap on the HCBS waiver
Routine adult dental Not covered in a nursing facility; covered on the HCBS waiver, and some plans offer it as a value-added service,

If you are unsure whether something is covered, call your health plan before the appointment.

When Do I Need Prior Authorization?

Some STAR+PLUS services require your MCO's approval before they are delivered, called prior authorization. Check your plan's list before you schedule.

Under Texas law, if you are hospitalized, your MCO must decide within one business day, within 72 hours where an acute care inpatient provider requests services or equipment necessary to discharge you, and within one hour for poststabilization care or a life-threatening condition. If you are not hospitalized, the deadline is three business days, or a longer HHSC-set clock if the request lacks documentation (Tex. Gov't Code §§ 540.0302 to 540.0303). Separately, under the 2024 CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), which covers Medicaid managed care plans, payers must decide within 72 hours for urgent requests and seven calendar days for standard ones, effective January 1, 2026. Those federal timeframes do not apply to prior authorization for drugs.

An MCO may not require prior authorization for a nursing facility resident in need of emergency hospital services (Tex. Gov't Code § 540.0752(e)), a protection that reaches STAR+PLUS because Texas delivers Medicaid to nursing facility residents through that program.

How Do I Find a Doctor Who Takes Medicaid?

Start with your health plan: in STAR+PLUS, each MCO has its own provider list, and you choose a PCP from it.

Call ahead to confirm a provider still takes your plan.

What Do I Do If a Service Is Denied?

If your MCO denies, reduces, or terminates a service, you can challenge it. Our Texas Medicaid appeals guide walks the whole process; below is the sequence and the two clocks that catch families out.

1
Step 1

Appeal to your MCO within 60 calendar days

of the date on the adverse benefit determination notice, verbally or in writing. The MCO must give you a member advocate to help file and track it, and let you examine the case file, medical records included. Resolution takes up to 30 calendar days, extendable by 14. If waiting could seriously jeopardize your life or health, ask for an expedited appeal: federal rules cap it at 72 hours from the plan's receipt, and HHSC's older handbook's three business days can run longer, so count 72 hours. An ongoing emergency or denied continued hospitalization gets one business day.

2
Step 2

Request a State Fair Hearing within 120 days

of the MCO's decision notice, in writing, by calling 2-1-1, or at a local HHSC office. If the plan misses its own notice and timing requirements under 42 CFR 438.408, you are deemed to have exhausted its appeals process and can go straight to a hearing. A STAR+PLUS HCBS denial runs on a shorter clock: 90 days from the date on Form H2065-D.

3
Step 3

Keep your services running, and watch the second clock

Continuation is not available for every appeal. The plan must continue benefits only where the appeal concerns the termination, suspension, or reduction of services it had already authorized (a first-time denial does not qualify), the services were ordered by an authorized provider, the original authorization period has not expired, and you filed both the appeal and the continuation request on time. "On time" for continuation means the later of 10 calendar days after the MCO sends the notice, or the intended effective date of the action, so do not assume the window shuts at day 10. HHSC's handbook states the appeal-filing condition more strictly, as filed by the effective date of the action, so act by the earliest date either rule allows.

4
Step 4

Then re-request continuation within 10 days of losing the plan appeal

Continued services stop at whichever comes first: you withdraw, a fair hearing decision goes against you, or you fail to request both the State Fair Hearing and continuation of benefits within 10 calendar days after the plan sends notice upholding its decision. You have 120 days to request the hearing but only 10 to keep services running, so filing after day 10 keeps the hearing but loses the care. If the final resolution upholds the plan, it may recover the cost of services furnished while the appeal was pending.

Who to Call in Texas

Texas Medicaid Helpline Which services Medicaid pays for, or a bill from a Medicaid provider. 1-800-335-8957
Ombudsman Managed Care Helpline Questions or complaints about a managed care plan, including problems getting access to care. 1-866-566-8989
Medicaid Managed Care Enrollment Broker Change your STAR+PLUS health plan, which you can do at any time. 1-800-964-2777
Medical Transportation Program (MTP) Non-emergency rides for members with no other way to get there. Health-plan members call their plan's transportation number instead. 1-877-633-8747
HHSC LTSS Interest List Line Get added to a Medicaid waiver interest list (for STAR+PLUS HCBS, only if not already on SSI or full Medicaid)., 1-877-438-5658
2-1-1 Texas General health-and-human-services information and referral. 2-1-1 211texas.org

Frequently Asked Questions

Does Texas Medicaid cover dental for seniors?

It depends on the setting. In a Medicaid-certified nursing facility, Texas HHS reimburses emergency dental only. On the STAR+PLUS HCBS waiver, coverage includes dentures and routine and preventative care, up to $5,000 per individual service plan year. Some MCOs also offer value-added dental, which differs by plan and by area of the state.

Are there copays for Texas Medicaid services?

For many members, no. In STAR+PLUS HCBS, room and board is charged only to members living in an adult foster care (AFC) home or an assisted living facility (ALF), and copayments reach only AFC and ALF residents and members with a qualified income trust. Supplemental Security Income (SSI) recipients, including those who also receive RSDI, never have a copayment; medical assistance only (MAO) members eligible under the institutional income limit pay both. The MEPD specialist sets the copayment: it applies only to STAR+PLUS HCBS services, cannot exceed their cost, and leaves a personal needs allowance of $85 for a single person and $170 for a couple. A facility can negotiate room and board down but cannot waive it. If the amount looks unaffordable, ask the specialist whether your unreimbursed medical costs (insurance premiums, deductibles and coinsurance, and needed care Medicaid does not cover) and, where applicable, a spouse's needs at home have been deducted, as federal post-eligibility rules require. Not paying the agreed amounts can get you disenrolled.

Can I see a doctor through telehealth on Texas Medicaid?

Yes, but not for every service. HHSC has not authorized every Medicaid-covered service for telehealth delivery, and a service authorized only for live video may not be delivered by audio-only phone or store and forward technology. Confirm with your provider, and with your health plan if your parent is in managed care.

How do I get a ride to my medical appointment through Medicaid?

Without a Medicaid health plan, call the Medical Transportation Program at 877-633-8747 at least two workdays ahead, or five days for an appointment outside your county. With a health plan, call your plan's transportation number instead.

Learn More

MedicaidHow to Apply for Texas MedicaidHow to apply for Medicaid in Texas in 2026: the four ways to apply, the documents seniors need, the income-cap trap, timelines, and where to get free help. MedicaidTexas Medicaid Programs for SeniorsTexas Medicaid programs for seniors 65+ include STAR+PLUS, CAS, HCBS waivers, and PACE. Find out what each one covers, who qualifies, and how to enroll. MedicaidWhat Medicaid Covers NationallyWhat does Medicaid cover? States must cover hospital, doctor, home health and nursing facility care (21+). For adults, drugs, dental and glasses vary by state. MedicaidTexas Medicaid Spend-DownTexas allows no income spend-down for long-term care. As an income-cap state it uses a Qualified Income (Miller) Trust. See the 2026 income and asset rules. MedicaidTexas Medicaid Long-Term Care & Nursing HomesTexas Medicaid pays for nursing home care under regular Medicaid, not a capped waiver. See the 2026 income and asset limits and what the at-home spouse keeps. CaregiverHow to Get Paid as a Family Caregiver in TexasLearn how to get paid as a family caregiver in Texas through Medicaid CDS, CAS, VA programs, and CMPAS. Covers pay rates, eligibility, and step-by-step process.

Find personalized help with Texas Medicaid coverage 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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