How to Get on a Texas HCBS Waiver Program

Texas runs seven home- and community-based services (HCBS) waiver programs, but only one is built specifically for seniors: the STAR+PLUS HCBS waiver.1 If you are trying to keep a parent or loved one at home instead of in a nursing facility, this guide explains which Texas HCBS waiver programs they might qualify for, what each one covers, and how to get on the interest list. The hard part: every waiver is capped, so collectively well over 100,000 Texans are on interest lists waiting for a slot.2

In This Guide

• Key Takeaways
• What Is a Texas HCBS Waiver?
• STAR+PLUS HCBS: The Main Waiver for Seniors
• Other Texas Waiver Programs
• The Interest List: How Waitlists Work
• How to Get on the Interest List
• Texas HCBS Waivers vs. Regular Medicaid
• Money Follows the Person: Leaving a Nursing Facility
• Frequently Asked Questions
• Next Steps

What Is a Texas HCBS Waiver?

A 1915(c) HCBS waiver is a Medicaid program that lets Texas deliver long-term care in the community as an alternative to an institution, "waiving" the rule that this level of care be provided in a facility such as a nursing home.4 Instead, the person receives services at home or in the community.

The federal government approves each waiver under Section 1915(c) of the Social Security Act. These waivers must be cost-neutral, are initially approved for three years, and are renewed every five years after that.1 Texas designs the specific services, eligibility rules, and enrollment caps for each program.

Here is why waivers matter: base STAR+PLUS covers medical care and limited attendant services, but it does not cover home modifications, home-delivered meals, in-home nursing, respite care, or assisted living.4 Waivers fill that gap for people who need a higher level of support to stay out of a nursing facility.

The catch is that waivers have enrollment caps. Unlike base Medicaid acute care, which is an entitlement, waiver slots are limited.4 When they are full, you go on an interest list.

STAR+PLUS HCBS: The Main Waiver for Seniors

If your loved one is 65 or older and needs help staying at home, the STAR+PLUS HCBS waiver is the program to know. STAR+PLUS is Texas's Medicaid managed care program for adults 21 and older who have disabilities or are 65 or older, and the HCBS portion serves members who would otherwise need nursing-facility placement but choose to be served in the community.3

Who Qualifies

• Age 21 or older (most enrollees are 65+)3
• Texas resident on Medicaid
• Monthly income at or below $2,982 for a single applicant (300% of the Supplemental Security Income (SSI) federal benefit rate, effective January 1, 2026); income above that routes through a Qualified Income Trust (Miller Trust)6
• Countable assets at or below $2,000 for a single individual ($3,000 for a couple when both apply)7
• Must meet Nursing Facility Level of Care (NFLOC) based on activity-of-daily-living limitations and care needs
• Must be safely servable in the community

What It Covers

The STAR+PLUS HCBS waiver adds home- and community-based services well beyond base Medicaid for members who meet nursing-facility level of care:3

• Personal assistance services (bathing, dressing, grooming, eating, household tasks)
• In-home nursing
• In-home and out-of-home respite care
• Home-delivered meals
• Minor home modifications (ramps, grab bars, widened doorways)
• Adaptive aids and medical supplies
• Emergency response services (personal alert buttons)
• Physical, occupational, speech, and cognitive rehabilitation therapy
• Dental services
• Assisted living
• Adult foster care
• Transition assistance services
• Employment assistance and supported employment
• Financial management services (for the consumer-directed option)

The Interest List

The STAR+PLUS HCBS program has roughly 24,000 participant slots, and as of late 2025 approximately 15,850 people were on the interest list.2 The list is first-come, first-served, ordered by the date a name is added. When a slot opens, Texas Health and Human Services Commission (HHSC) contacts the next person on the list to begin the eligibility assessment.2

Texas does not assess eligibility before adding a name to the list.2 Some people are denied when they reach the top because they do not meet the nursing-facility level of care requirement. Getting on the list early, even before you think services are needed, is common advice from Medicaid planners.

How Services Are Delivered

STAR+PLUS HCBS services are delivered through a managed care organization (MCO). Under contracts effective September 1, 2024, seven MCOs serve the program across 13 service delivery areas, with members choosing from at least two plans in each area.8 Your MCO assigns a service coordinator who develops your Individual Service Plan (ISP) and visits you face-to-face at least twice a year if you receive STAR+PLUS HCBS.9

You can choose the Consumer Directed Services (CDS) option to hire and manage your own attendants. Adult children, grandchildren, and other adult relatives may be hired, but you cannot hire your own spouse.10

Other Texas Waiver Programs

While STAR+PLUS HCBS is the main waiver for seniors, Texas operates six other waivers. Most serve people with an intellectual or developmental disability (IDD) or a related condition and have long interest lists.1

CLASS (Community Living Assistance and Support Services)

The CLASS waiver was first authorized September 1, 1991, and serves Texans with a "related condition" (a disability other than an intellectual disability that began before age 22 and substantially limits functioning) as an alternative to an Intermediate Care Facility for Individuals with an Intellectual Disability or Related Condition (ICF/IID).1 The CLASS cost limit is set at 210% of the annualized cost of ICF/IID care.1 It is a capped waiver with an interest list, and services are delivered through contracted case management agencies.

CLASS could apply to an older adult who has a related condition diagnosed earlier in life and now needs community support as they age.

HCS (Home and Community-based Services)

The HCS waiver serves Texans of all ages who have an intellectual disability (IQ of 69 or below) or an approved related condition (IQ of 75 or below), together with mild to severe deficits in adaptive behavior.11 It is one of the largest IDD waivers in Texas and has one of the longest interest lists in the state. Service coordination is provided by the local LIDDA (Local Intellectual and Developmental Disability Authority).11

TxHmL (Texas Home Living)

TxHmL shares the same clinical eligibility as HCS but provides a smaller service package: its individual cost limit is set at 50% of the annualized cost of ICF/IID care.11 It is designed for people who need less intensive support and is also coordinated through the local LIDDA.

DBMD (Deaf Blind with Multiple Disabilities)

DBMD serves Texans of all ages who are deaf-blind with additional disabilities that impair independent functioning.1 Like the other IDD waivers, it is capped and uses an interest list.

Youth-Focused Waivers

Two waivers serve children and young adults exclusively:1

• MDCP (Medically Dependent Children Program): Ages 0-20, an alternative to nursing-facility placement for medically dependent children.
• YES (Youth Empowerment Services): For youth with serious emotional disturbances.

The table below summarizes all seven Texas HCBS waivers, who each one serves, and the level-of-care test it uses.1

The Interest List: How Waitlists Work

Texas calls its waiver waitlists "interest lists," tracked in HHSC's Community Services Interest List (CSIL) database. The lists are very large, collectively well over 100,000 people across programs, and they operate first-come, first-served.2

How It Works

1. You request to be added to the interest list for a specific waiver.
2. You are placed based on the date of your request (first-come, first-served).2
3. When a slot opens, HHSC contacts you for an eligibility assessment.
4. If you meet all requirements, services begin.
5. If you do not qualify, you are removed from the list.

Important Details

• You can be on multiple interest lists at once.
• Being on the list does not mean you will qualify when your turn comes; HHSC does not pre-screen for eligibility before placing you on the list.2
• HHSC periodically releases interest-list-reduction slots by program, so any specific head count should be pulled fresh from current HHSC data.2
• The STAR+PLUS HCBS list generally moves faster than the IDD waiver lists because it has more annual slots.

How to Get on the Interest List

Where you call depends on the waiver. Most waivers use the statewide HHSC interest-list line, but the HCS and TxHmL (IDD) waivers are joined through your local authority instead. You do not need a Medicaid determination before you get on the list, though you will need to qualify for Medicaid before you can enroll.12,2

The interest-list line (1-877-438-5658) and the LIDDA route for HCS and TxHmL are both confirmed by HHSC.12 Getting on the list as early as possible is the single most useful thing you can do. Families who wait until care needs are urgent often face the hardest choices, because the wait can stretch for years on some lists.

Texas HCBS Waivers vs. Regular Medicaid

If your parent is already on STAR+PLUS, they are getting base Medicaid services: doctor visits, hospital care, prescriptions, personal attendant services, and behavioral health.4 So why bother with a waiver?

The waiver unlocks services that base Medicaid does not cover.4

What base STAR+PLUS already covers: doctor visits, hospital, prescriptions, limited personal attendant services, and behavioral health.

What the HCBS waiver adds on top: in-home nursing, respite care (in-home and out-of-home), home-delivered meals, minor home modifications, emergency response services, assisted living, adult foster care, dental, and therapies (physical, occupational, speech, and cognitive).3

A second structural difference matters: waivers require an institutional level-of-care determination (nursing-facility level for STAR+PLUS HCBS, ICF/IID level for the IDD waivers) on top of basic Medicaid financial eligibility, and waivers are capped while base Medicaid acute care is an entitlement.4

Meanwhile, Community First Choice (CFC) is a Medicaid State Plan option under Section 1915(k), not a waiver, so it is an entitlement with no interest list and provides personal attendant services to all Medicaid-eligible individuals who meet an institutional level of care.13 It bridges the gap between base services and waiver services for people who need personal care but do not yet have a waiver slot.

Money Follows the Person: Leaving a Nursing Facility

If your loved one is currently in a nursing facility and wants to come home, Money Follows the Person (MFP) can help them transition into a community-based waiver program.5

Who Qualifies for MFP

• Currently on Medicaid5
• Living in a nursing facility, state supported living center (SSLC), or ICF/IID
• Eligible for one of the qualifying Texas Medicaid waiver programs

What You Get

• Transition Assistance Services (TAS): A one-time benefit of up to $2,500 for essential set-up costs such as furniture and other relocation expenses when a nursing-facility resident discharges into a waiver program5
• Supplemental Transition Services (STS): Up to an additional $2,500 for expenses TAS does not cover; a member receiving STS must be able to move to a community setting within 60 days after STS is authorized5

Who Can Help

A nursing facility social worker, long-term care ombudsman, your LIDDA habilitation coordinator, a relocation specialist, or your MCO service coordinator can start the process. Anyone can make a referral, including family members.

This is one of the most underused community-transition paths in Texas. If your parent ended up in a nursing home and you are wondering whether they could come back, MFP is the first call to make.

Learn More

Next Steps

The single most useful move is to get on the interest list now, because placement is by the date you call. If your loved one is already in a nursing facility, ask the facility social worker or your MCO service coordinator about Money Follows the Person to transition home.5 And if you need attendant care while you wait, ask whether Community First Choice can start now, since it has no waitlist.13

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.