Texas runs seven home- and community-based services (HCBS) waiver programs, but only one is built specifically for seniors: the STAR+PLUS HCBS waiver. If you are trying to keep a parent at home instead of in a nursing facility, this guide covers which Texas HCBS waiver programs they might qualify for, what each covers, and how to get on the interest list. The hard part: every waiver is capped, and demand outruns the slots, so families wait until one opens.

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, are initially approved for three years and renewed every five after that, and require an institutional level of care. Texas designs the 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 not home modifications, home-delivered meals, in-home nursing, respite care, or assisted living. Waivers fill that gap for people who need more support to stay out of a nursing facility. The catch is the enrollment caps: unlike base Medicaid acute care, which is an entitlement, waiver slots are limited, and when they 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 (most enrollees are 65+)
  • Texas resident on Medicaid
  • 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). The test is countable income, not gross. 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
  • 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

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

  • 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

Access to STAR+PLUS HCBS is capped by available funding, so Texas maintains an interest list: 13,519 people as of July 31, 2026, part of an unduplicated 200,128 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. How HHSC orders this particular list is less settled than it looks: first-come, first-served is the method used most often for Section 1915(c) waivers, but STAR+PLUS HCBS runs under Texas's Section 1115 waiver, so treat that as the general pattern rather than a published rule here.

Before you join the list, check whether it is even your door. HHSC's STAR+PLUS Handbook routes a request by who the person is, and for a lot of older adults the interest list is the wrong path. An SSI recipient, or anyone on another full Medicaid program, never goes on the STAR+PLUS HCBS interest list at all: if they are already enrolled with a STAR+PLUS MCO, the handbook says to refer them to that MCO for the HCBS program. A nursing facility resident enrolled with an MCO is referred to it for an upgrade to the HCBS program; one who is not enrolled goes on the list under Money Follows the Person and is 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 Community Care for Aged and Disabled must be made for all full Medicaid recipients. So if your parent already has SSI, call the MCO rather than the interest-list line.

Texas does not assess eligibility before adding a name to the list. Some people are denied when they reach the top because they do not meet nursing-facility level of care, 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 assigns a service coordinator who develops your Individual Service Plan (ISP) and visits 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 July 31, 2026, republished monthly. Do not add them together: one person can sit on several lists, so the six hold an unduplicated 200,128 Texans, not the 374,960 they sum to.

CLASS (Community Living Assistance and Support Services)

The CLASS waiver serves Texans with a "related condition" (a disability, other than an intellectual disability, that originated before age 22 and affects daily functioning) as an alternative to an Intermediate Care Facility for Individuals with an Intellectual Disability or Related Conditions (ICF/IID). Its cost limit is 210% of the annualized cost of ICF/IID care. It is capped, has an interest list, and is delivered through contracted case management agencies. As of July 31, 2026, 99,251 people were on that list. CLASS can apply to an older adult with a related condition diagnosed earlier in life 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 134,931 people as of July 31, 2026. The local LIDDA (Local Intellectual and Developmental Disability Authority) provides service coordination and keeps the list.

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 117,344 people as of July 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 2,676 people as of July 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, now called the STAR Kids Medically Dependent Children Program. Its interest list held 7,239 people as of July 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 Contracted agency
HCS All ages People with an intellectual disability (IQ 69 or below) or related condition ICF/IID LIDDA
TxHmL All ages Same as HCS but lower support needs (cost cap 50% of ICF/IID care) ICF/IID LIDDA
DBMD All ages People who are deaf-blind with additional disabilities ICF/IID Contracted agency
MDCP 0-20 Children who are medically dependent and would otherwise need nursing-facility care Nursing facility MCO (STAR Kids)
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 slot opens, HHSC contacts you for an eligibility assessment; if you do not qualify, you come off the list.

  • 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 before placing you on it.
  • HHSC periodically releases interest-list-reduction slots by program, so pull any head count fresh from current HHSC data.
  • Nationally, average waits for HCBS waivers aimed at older adults and people with physical disabilities have run on the order of about 15 months, though waits vary widely by program and year.

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 a Medicaid determination to get on a list, 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

Families who wait until care needs are urgent face the hardest choices, because the wait stretches for years on some lists.

Texas HCBS Waivers vs. Regular Medicaid

If your parent is already on STAR+PLUS, they are getting base Medicaid: doctor visits, hospital care, prescriptions, limited personal attendant services, and behavioral health. The waiver unlocks what base Medicaid does not cover, the services listed above: in-home nursing, respite, meals, home modifications, emergency response, assisted living, adult foster care, dental, and therapies.,

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, because while you can sit on several interest lists at once, you cannot be enrolled in two waivers at once. 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, and need help with 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 already on a 1915(c) waiver interest list may be able to get CFC, 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 relocation costs, including 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): 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, such as a rental deposit plus a reasonable damage deposit, food, clothing, and other moving expenses agreed with your MCO service coordinator. 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

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, and anyone can make a referral, including family members. This is one of the most underused community-transition paths in Texas.

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 but can be safely served in the community. 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?

Texas does not publish a predicted wait. What HHSC does publish is how many people are waiting: 13,519 on the STAR+PLUS HCBS interest list as of July 31, 2026, out of an unduplicated 200,128 Texans across its six interest-list programs. Nationally, average waits for HCBS waivers serving older adults and people with physical disabilities have run on the order of about 15 months. 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?

Money Follows the Person (MFP) can transition a Medicaid-eligible nursing-facility resident into a waiver program, with up to $2,500 in Transition Assistance Services plus up to another $2,500 in Supplemental Transition Services. It has conditions: the person must have lived in the facility for at least 60 straight days, and must be approved for STAR+PLUS HCBS before discharging, or HHSC must deny the application. TAS is also unavailable to someone moving into assisted living or adult foster care. 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 already waiting on a 1915(c) list may be able to get CFC in the meantime.

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

Base STAR+PLUS covers medical care (doctors, hospitals, prescriptions) and limited attendant services. HCBS waivers add in-home nursing, respite care, home modifications, meals, assisted living, and therapies. Waivers require an institutional level-of-care determination, have enrollment caps, and use interest lists; base Medicaid acute care is an entitlement.

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 13,519 people sat on its interest list in July 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

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 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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Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.