Texas runs seven home- and community-based services (HCBS) waiver programs, but for an older adult without a developmental disability, the one that matters is the STAR+PLUS HCBS waiver. If you are trying to keep a parent at home instead of in a nursing facility, the hard part is this: most of these waivers are capped, and when demand outruns the slots, families wait on an interest list.

In This Guide

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, "waiving" the rule that this level of care be provided in a facility such as a nursing home.

Most of these programs are approved under Section 1915(c) of the Social Security Act, but not all seven run on that authority. HHSC says STAR+PLUS HCBS operates like a 1915(c) waiver while actually being provided through the state's 1115 Healthcare Transformation Waiver, and that MDCP operates as a 1915(c) waiver concurrent with that same 1115 authority. Section 1915(c) waivers must be cost-neutral, run three years from first approval, can be extended in five-year periods at the state's request, unless CMS finds the prior period's assurances were not met and is not satisfied with the state's assurances for the extension, and require an institutional level of care.

Here is why waivers matter: the waiver adds services not on HHSC's list of base STAR+PLUS benefits, such as minor home modifications, home-delivered meals, respite care, assisted living, and adult foster care. Waivers fill that gap for people who need more support to stay out of a nursing facility. The trade-off is enrollment: unlike regular Medicaid, a waiver can cap how many people it serves, and when the slots are full you go on an interest list.

Not sure which program fits your family? Chat with Brevy's care navigator for a personalized recommendation based on your loved one's needs.

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 who have disabilities or are 65 or older; the HCBS portion carries its own age floor of 21 and serves members who would otherwise need nursing-facility placement but choose to be served in the community.

Who Qualifies

  • Age 21 or older
  • Full Medicaid financial eligibility, U.S. citizenship, and Texas residency
  • Countable monthly income at or below $2,982 for an individual, which is 300% of the full individual Supplemental Security Income (SSI) federal benefit rate of $994, effective January 1, 2026 (the couple limit is twice that, $5,964). Where countable income does exceed the limit, HHSC says a Qualified Income Trust (QIT, "sometimes referred to as a Miller Trust") can overcome it
  • Countable resources at or below $2,000 for an individual. Texas applies that individual limit to a person who is single, to a person whose spouse lives in a different household, and to the institutional spouse under spousal-impoverishment policy; the $3,000 couple limit applies to married adults who live in the same household as their spouse
  • An approved medical necessity for Nursing Facility Level of Care (NFLOC)
  • An individual service plan whose services fall under the program's cost limit, an unmet need for at least one STAR+PLUS HCBS service, and an appropriate living situation

What It Covers

For members who meet nursing-facility level of care, the waiver adds:

  • Personal assistance services
  • In-home nursing
  • In-home and out-of-home respite care
  • Home-delivered meals
  • Minor home modifications
  • Adaptive aids and medical supplies
  • Emergency response services
  • 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

Texas maintains an interest list for STAR+PLUS HCBS: 12,100 people as of August 31, 2026, part of an unduplicated 199,471 Texans across HHSC's six interest-list programs. Those counts come monthly, so pull the current figure from HHSC's Interest List Reduction page. HHSC says anyone can add their name first-come, first-served, and that eligibility is not determined until a slot opens and the person is at the top. HHSC's Interest List Reduction page, which names STAR+PLUS HCBS among its interest-list programs, says allocations are based on available funding and the people who have waited longest are enrolled first.

Before you join the list, check whether it is even your door. For many older adults the interest list is the wrong path. HHSC's STAR+PLUS Handbook says an SSI recipient, or anyone on another full Medicaid program, never goes on the STAR+PLUS HCBS interest list, whether they are enrolled with STAR+PLUS or not. If that describes your parent, contact their STAR+PLUS MCO or the enrollment broker rather than the interest-list line. While anyone waits for managed-care enrollment, the handbook says they are entitled to services from Community Care for Aged and Disabled (CCAD), and referrals to CCAD must be made for all full Medicaid recipients. The interest list is the path the handbook describes for medical assistance only (MAO) applicants, who select an MCO once their name reaches the top.

Texas does not assess eligibility before adding a name to the list. HHSC officials say some people turn out to be ineligible when their turn comes, which is one reason a headline waitlist count overstates how many will actually be served. Get on the list early, even before you think services are needed.

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 at least two plans to choose from in each. Your MCO provides service coordination: the coordinator develops your Individual Service Plan (ISP) with you, your family, and your providers, the planning is led by you, and an HCBS member must be visited face-to-face at least twice a year.

You can choose the Consumer Directed Services (CDS) option to hire and manage your own attendants, with one placement limit worth knowing up front: CDS is not available to members living in adult foster care homes or assisted living facilities. Under CDS you or your representative are the employer of record. You recruit, hire, train, manage, and terminate the attendants and set wages within the authorized service plan, while a Financial Management Services Agency runs payroll and files the withholding reports. HHSC is blunt that you assume all liability related to employment, are solely responsible for negligent acts by your employees, and remain ultimately responsible for payroll taxes owed to the IRS and the Texas Workforce Commission even if the agency fails to pay them. You also find your own backup attendants, and you must keep documentation for at least five years. Who may and may not be hired, and how CDS compares with taking services through a provider agency, are covered in our STAR+PLUS waiver guide.

Other Texas Waiver Programs

Texas operates six other waivers. Most serve people with an intellectual or developmental disability (IDD) or a related condition and have long interest lists. The counts below come from HHSC's interest-list data as of August 31, 2026, republished monthly. Do not add them together: one person can sit on several lists, so the six hold an unduplicated 199,471 Texans, not the 374,531 they sum to.

CLASS (Community Living Assistance and Support Services)

The CLASS waiver serves Texans with a "related condition" as an alternative to an Intermediate Care Facility for Individuals with an Intellectual Disability or Related Conditions (ICF/IID). HHSC summarizes a related condition as a disability other than intellectual disability that began before age 22 and affects daily functioning; the federal test is narrower, requiring a severe, chronic condition with substantial limits in at least three of six major life areas. The CLASS cost limit is 210% of the annualized cost of ICF/IID care, and the waiver is capped and reached through an interest list. As of August 31, 2026, 99,475 people were on that list. CLASS can apply to an older adult whose related condition began before age 22 and who 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), with mild to severe deficits in adaptive behavior. Texas HHS states a four-part list, not a clinical test alone: that IQ criterion, the adaptive-behavior deficits, eligibility for Medicaid, and not being enrolled in any other Medicaid waiver program. HCS is for a Texas resident not living in an institutional setting, and an offer depends on individual need, the date of placement on the list, and available funding. Its interest list is the longest of the six HHSC tracks, at 135,497 people as of August 31, 2026. You join the HCS interest list through your local LIDDA (Local Intellectual and Developmental Disability Authority).

TxHmL (Texas Home Living)

TxHmL shares HCS's four-part eligibility but provides a smaller package: its annual cost limit is 50% of the annualized cost of ICF/IID care, and residential services are not part of the TxHmL array at all, where HCS covers a three- or four-person group home or a host home and companion care setting. TxHmL is for a person living in their own home or a family member's home. It is coordinated through the local LIDDA, and its interest list is the second longest, at 117,404 people as of August 31, 2026.

DBMD (Deaf Blind with Multiple Disabilities)

DBMD serves Texans of all ages who are deaf-blind with multiple disabilities. Like the other ICF/IID-alternative waivers, it uses the ICF/IID level-of-care test and is capped and accessed through an interest list. That list is the smallest of the six, at 2,708 people as of August 31, 2026.

Youth-Focused Waivers

Two waivers serve children and young adults exclusively:

  • MDCP (Medically Dependent Children Program): Ages 0 to 20, an alternative to nursing-facility placement. Its interest list held 7,347 people as of August 31, 2026.
  • YES (Youth Empowerment Services): Ages 3 to 18, an alternative to care in an institution for mental diseases.

The table summarizes all seven waivers, who each serves, and its level-of-care test.

Waiver Ages Who It Serves Level-of-Care Test Managed By
STAR+PLUS HCBS 21+ Seniors and adults with disabilities who need nursing-facility-level care Nursing facility (NFLOC) MCO
CLASS All ages People with a related condition (a disability other than intellectual disability) ICF/IID Not listed
HCS All ages People with an intellectual disability (IQ 69 or below) or related condition ICF/IID Interest list via LIDDA
TxHmL All ages Same as HCS, smaller service package (cost cap 50% of ICF/IID care) ICF/IID Interest list via LIDDA
DBMD All ages People who are deaf-blind with additional disabilities ICF/IID Not listed
MDCP 0-20 Children who are medically dependent and would otherwise need nursing-facility care Nursing facility Not listed
YES 3-18 Youth who would otherwise need care in an institution for mental diseases Institution for mental diseases Not listed

The Interest List: How Waitlists Work

Texas calls its waiver waitlists "interest lists," tracked in HHSC's Community Services Interest List (CSIL) database. HHSC's explanation is that demand for community-based services often outweighs the resources available, so a name goes on a list until services open up. The lists run first-come, first-served: allocations depend on available funding, and the people who have been waiting longest are enrolled first. When a name reaches the top, a state office or LIDDA representative makes contact, so keep your phone number and address current with HHSC or your LIDDA. While you wait, you can get Medicaid or other community services if you qualify, and using them does not cost you your place on the list.

How to Get on the Interest List

Where you call depends on the waiver: most use the statewide HHSC interest-list line, but HCS and TxHmL are joined through your local authority., You do not need to prove eligibility to get on a list, because eligibility is not determined until a slot opens, though you will need to qualify for Medicaid before you can enroll.

STAR+PLUS HCBS Adds a name to the STAR+PLUS HCBS interest list. You apply for Medicaid itself separately, at Your Texas Benefits. 1-877-438-5658 yourtexasbenefits.com
HCS and TxHmL Waivers Your local LIDDA (Local Intellectual and Developmental Disability Authority) manages the interest lists for these IDD waivers; call 2-1-1 if you are not sure which authority serves your county. 2-1-1 Texas LIDDA directory
CLASS, DBMD, and MDCP Adds a name to the interest list for these waivers through the statewide HHSC LTSS interest-list line. 1-877-438-5658 hhs.texas.gov

Because the people who have waited longest are enrolled first, the date you call is the one thing you control. Don't wait until care needs are urgent.

Texas HCBS Waivers vs. Regular Medicaid

If your parent is already on STAR+PLUS, they are getting base Medicaid: doctor visits, hospital care, prescriptions, personal attendant services, and behavioral health. The waiver adds services not on HHSC's list of base STAR+PLUS benefits, such as minor home modifications, home-delivered meals, respite, assisted living, and adult foster care.,,

A second structural difference matters: waiver eligibility requires an institutional level-of-care determination, meaning HHSC finds the person needs services to the same extent they would if they lived in an institution (ICF/IID, nursing facility, or inpatient facility). Level of care is not the only test. Across the IDD waivers HHSC lists four requirements: financial eligibility, which varies by program; not being enrolled in another waiver; institutional level of care; and citizenship and residency. That second one matters: while you can sit on several interest lists at once, for these IDD waivers you cannot be enrolled in one while enrolled in another waiver. And states may cap how many people a waiver serves and open interest lists when demand exceeds that capacity, which regular Medicaid does not do.

Meanwhile, Community First Choice (CFC) is a Medicaid State Plan option under Section 1915(k), not a waiver. HHSC's Interest List Reduction page names CLASS, DBMD, HCS, TxHmL, MDCP, and STAR+PLUS HCBS as the Texas programs that have interest lists, and CFC is not among them. Be careful how far you take that: HHSC does not say in terms that CFC has no interest list, and that page enumerates waiver programs, so CFC's absence follows partly from its being a State Plan benefit. Treat CFC as a benefit HHSC does not list as having a waitlist, not as a guaranteed way around one. To get it, a person must be enrolled in Medicaid, qualify for care in an institution (a hospital, nursing facility, ICF/IID, or certain psychiatric institutions), and need help with activities of daily living or instrumental activities of daily living. CFC covers personal assistance, habilitation, emergency response, and support management (training in how to select, manage, and dismiss your own attendants), and cannot be delivered in a nursing facility, hospital, ICF/IID, or any institution-like setting. HHSC says people on a 1915(c) waiver interest list may be able to get CFC if they meet its own eligibility and coverage rules, so it can bridge the gap for someone who needs personal care but has no waiver slot yet.

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.

Who Qualifies for MFP

HHSC sets three participation requirements, and the middle one is easy to miss:

What You Get

  • Transition Assistance Services (TAS): A one-time benefit of up to $2,500 for essential services to relocate to the community, which can include new furniture. Two limits matter: TAS does not include relocation services and will not pay for the house hunt, and it is not available to residents moving from a nursing facility who are approved for assisted living or adult foster care
  • Supplemental Transition Services (STS): For a nursing facility resident moving into STAR+PLUS HCBS, up to an additional $2,500, one-time, normally after TAS is exhausted, though it can be used while TAS funds remain for essential items TAS cannot fund. A member must meet all five STS criteria: needing relocation help no other resource can meet; needing it for an item without which the move could not happen, documented on the transition plan; not having previously received Transition to Life in the Community benefits; being able to move within 60 days of authorization; and helping build a budget showing they can keep up household expenses once STS runs out

Who Can Help

If your parent is already enrolled with a STAR+PLUS MCO, ask the MCO; the MCO relocation specialist's transition plan documents what the move requires.

Frequently Asked Questions

Which Texas HCBS waiver is for seniors 65+?

The STAR+PLUS HCBS waiver. It serves adults 21 and older who need nursing-facility level of care and can be served at home under an individual service plan within the program's cost limit. The other waivers (CLASS, HCS, TxHmL, DBMD) serve all ages but require an intellectual or developmental disability or a related condition.

How long is the wait for a Texas HCBS waiver?

HHSC publishes how many people are waiting each month: 12,100 on the STAR+PLUS HCBS interest list as of August 31, 2026, out of an unduplicated 199,471 Texans across its six interest-list programs. Nationally, waits for HCBS waivers serving older adults and people with physical disabilities average about 15 months, a national figure, not a Texas wait time. Because allocations depend on available funding, a wait can be long. Get on the list as early as possible, and pull current counts from HHSC's monthly report.

Can my parent skip the waiver interest list?

Sometimes. Someone already on Medicaid and enrolled with an MCO may be able to bypass the list through the upgrade process, and a nursing facility resident can come in through Money Follows the Person. MFP requires at least 60 straight days in the facility and, for STAR+PLUS HCBS, approval before discharge, and a nursing facility resident may qualify for up to $2,500 in Transition Assistance Services plus up to $2,500 in Supplemental Transition Services. Community First Choice is a State Plan benefit rather than a waiver, and HHSC does not list it among the programs that have interest lists, so someone waiting on a 1915(c) list may be able to get CFC in the meantime if they meet CFC's own eligibility rules.

What's the difference between a waiver and regular Texas Medicaid?

Base STAR+PLUS covers medical care and attendant services; the waiver adds services not on HHSC's list of base STAR+PLUS benefits, such as respite, minor home modifications, home-delivered meals, assisted living, and adult foster care. Waivers also require an institutional level of care and can cap enrollment, which regular Medicaid does not.,,

Learn More

MedicaidTexas STAR+PLUS Waiver ProgramTexas 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. MedicaidMedicaid HCBS Waivers by StateMedicaid HCBS waivers pay for care at home instead of a nursing facility. How 1915(c) waivers work, who qualifies, why waitlists happen, and your state's guide. 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 Texas Medicaid CoversTexas Medicaid covered services for seniors 65+: doctor visits, hospital care, drugs, vision, limited dental. See what STAR+PLUS covers and what it won't. 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 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.

Next Steps

If your parent is not already on SSI or full Medicaid, get on the interest list now, because placement is by the date you call; if they are, contact their STAR+PLUS MCO or the enrollment broker. If your loved one is already in a nursing facility, ask about Money Follows the Person, and make sure the STAR+PLUS HCBS approval letter is in hand before anyone moves out. If you need attendant care while you wait, ask whether Community First Choice can start now.

Your next step To get on a Texas HCBS waiver interest list, call HHSC at 1-877-438-5658 for STAR+PLUS HCBS, CLASS, DBMD, or MDCP; for HCS or TxHmL, contact your local LIDDA or call 2-1-1. You apply for Medicaid itself separately, at Your Texas Benefits.

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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