Texas Medicaid Guide 2026: STAR+PLUS, Eligibility & Costs

For Texas adults 65 and older and adults with disabilities, long-term Medicaid runs through STAR+PLUS, a managed-care program combining medical care with home and nursing-facility long-term services in one plan. To qualify for nursing-facility or waiver care in 2026, countable income must be at or below $2,982 a month, and an applicant above that cap can qualify by diverting the excess into a Qualified Income Trust (Miller Trust).1,2,3

The Texas Health and Human Services Commission (HHSC) administers it, handling financial eligibility, managed-care enrollment, and the long-term-care programs older adults rely on. This guide maps each question families ask to the article that answers it.1

How This Guide Is Organized

Each row links to the guide that goes deep on that topic.

What Texas Medicaid Covers

Texas Medicaid covers the mandatory federal benefit categories plus state-elected optional services:

• Hospital care: Inpatient and outpatient
• Physician, clinic, and specialist visits
• Prescription drugs
• Behavioral health: Mental health and substance use disorder services
• Home health and long-term care: Nursing facility coverage plus home and community-based services through STAR+PLUS and the §1915(c) waivers
• Medicare Savings Programs (MSPs): Premium and cost-sharing help for dual-eligible beneficiaries
• Non-emergency medical transportation (NEMT)
• Dental: limited for adults, and it depends on the setting; full EPSDT dental for children under 21

For older adults, long-term care is the most financially significant benefit. In Texas, a semi-private nursing home room runs a median of about $67,525 a year and a private room about $91,250, according to the CareScout 2025 Cost of Care Survey. Once a resident meets the financial and clinical standards, Medicaid pays the facility, and the resident applies nearly all their monthly income toward the bill.9,5

Who Qualifies for Texas Medicaid

For long-term services and supports, the most-used pathway is the Special Income Limit, set at 300% of the SSI Federal Benefit Rate. The 2026 parameters:2

• Income limit: $2,982/month for a single applicant, $5,964/month for a couple, for nursing-facility and HCBS-waiver coverage. This equals 300% of the 2026 SSI Federal Benefit Rate.2
• Asset limit: $2,000 for an individual; $3,000 for a married couple who live in the same household. Texas applies the $2,000 limit to a single person, to a person whose spouse lives elsewhere, and to the institutional spouse under spousal-impoverishment policy, so a couple separating because one enters a facility should plan against $2,000, not $3,000. Countable assets exclude the principal residence, one automobile regardless of value, and household goods and personal effects.4
• Home equity limit: A person whose home equity exceeds $752,000 for 2026 (the federal minimum, which Texas adopts) is denied Medicaid for institutional and HCBS waiver services. This is not a resource test: the home is still treated as it always was, and a denial on this basis does not disqualify the person from Qualified Medicare Beneficiary or Specified Low-Income Medicare Beneficiary coverage.4 The limit does not apply at all when the person's spouse, or a child under 21 or blind or permanently and totally disabled, lawfully lives in the home.10 Otherwise, HHSC says the policy does not prevent using a reverse mortgage or home equity loan to reduce the equity, and HHS maintains a hardship waiver process. Someone already receiving Medicaid-certified facility services keeps every benefit other than the vendor payment for that care.4
• Miller Trust: Texas sets a hard income cap for these programs, and an applicant whose countable income runs above $2,982/month can qualify by establishing a Qualified Income Trust and diverting the excess into it each month. The test is countable income, not gross: HHSC works out the need for a trust only after determining what counts, and certain Veterans Affairs benefits do not.2,3

For income limits, asset rules, and the Miller Trust mechanics in full, see Texas Medicaid Income & Asset Limits (Spend Down).

Texas Medicaid Long-Term Care

STAR+PLUS Managed Care and Waiver

STAR+PLUS is Texas's managed-care program for adults 65 or older or with disabilities. (The age-21 floor belongs to the HCBS waiver, not to STAR+PLUS itself.) It delivers acute care, behavioral health, pharmacy, and long-term services and supports (LTSS) through one managed-care organization (MCO), across 13 service delivery areas with 7 MCOs and at least two plans in each area.1,11

The STAR+PLUS HCBS Waiver is the §1915(c) waiver embedded inside STAR+PLUS. It provides personal assistance services, nursing and therapies, adaptive aids and medical supplies, minor home modifications, emergency response, home-delivered meals, respite, assisted living or adult foster care, and the option to direct your own attendant.12 Being 21 or older is one of eight criteria HHSC lists: an applicant must also have full Medicaid financial eligibility, be a U.S. citizen and Texas resident, have approved medical necessity for a nursing-facility level of care, have a service plan under the cost limit, have an unmet need for at least one STAR+PLUS HCBS service, and be in an appropriate living situation.1 The door is an interest list, not an application: HHSC assesses a person when their name reaches the top, and only then does the person select an MCO, which begins the eligibility determination. Call 1-877-438-5658 to be added early. Two documented routes go round the list: someone already on Medicaid and enrolled with an MCO may bypass it through the upgrade process, and a nursing facility resident may qualify through Money Follows the Person.12,8

STAR+PLUS began as a Harris County pilot in 1998 and expanded statewide on September 1, 2014; nursing-facility care was carved in during March 2015.13

Nursing Facility Coverage

For a stay of at least 30 consecutive days in a Medicaid-contracted facility, Texas requires countable income at or below $2,982/month (or a Miller Trust holding the excess), countable resources at or below $2,000 for a single applicant, and a nursing-facility level-of-care determination. The resident then contributes nearly all monthly income toward the cost of care, keeping the $75 Personal Needs Allowance plus allowed deductions for health-insurance premiums and any community-spouse income allowance.2,5

Other HCBS Waivers

Two of Texas's other programs run under state-plan authority rather than as waivers; the rest are §1915(c) waivers with interest lists:

• Community First Choice (CFC): a Medicaid State Plan option under §1915(k), not a waiver, which federal rules require an electing state to offer statewide and regardless of a person's age or disability. It provides personal assistance, habilitation, emergency response, and support management to a person enrolled in Medicaid who qualifies for institutional-level care and needs help with daily activities. HHSC does not name CFC among the Texas programs that have interest lists (its Interest List Reduction page lists CLASS, DBMD, HCS, TxHmL, MDCP and STAR+PLUS HCBS), and says people already on a §1915(c) waiver list may be able to get CFC if they meet the requirements. Read that for what it is: CFC is not one of the waiver interest lists, which is not the same as HHSC saying CFC has no waiting list.14
• Community Attendant Services (CAS): a state-plan program under §1929(b)(2)(B), not a waiver. When someone who does not already have SSI or SSI-related Medicaid asks for personal attendant services, HHSC intake screeners must assign the request to a caseworker as a CAS application; they may not screen the person toward a specific service or place the name on the Family Care interest list. It is the caseworker, not the screener, who determines whether the person goes on an interest list. CAS covers non-technical attendant services up to 50 hours a week, or 42 with priority status, and tasks requiring professional or technical training (tube feedings, injections, medication administration) may not be purchased through it.15
• CLASS (Community Living Assistance and Support Services), DBMD (Deaf-Blind with Multiple Disabilities), HCS (Home and Community-based Services), and TxHmL (Texas Home Living): §1915(c) waivers with interest lists.

Because every §1915(c) waiver runs an interest list, get on the lists early. Call 1-877-438-5658; for HCS and TxHmL, contact your LIDDA instead, because that number does not handle those two.8

For the full waiver catalog with service comparisons, see Texas Medicaid HCBS Waivers.

The 5-Year Lookback and Transfer Penalties

Texas applies a 60-month (five-year) lookback to asset transfers made for less than fair market value before a long-term-care application. Uncompensated transfers in that window create a penalty period, calculated by dividing the uncompensated value by the daily penalty divisor of $262.37 (for case actions disposed on or after September 1, 2025), rounded down to whole days. The penalty starts on the first day of the month of the medical effective date. Certain transfers of the home are exempt, and federal law names four recipients: the person's spouse; a child under 21, blind, or permanently and totally disabled; a sibling with an equity interest who lived there for at least a year before the person became institutionalized; and a son or daughter who lived there for at least two years before that and, as determined by the State, provided care that let the parent stay home. That last branch turns on a call HHSC makes, so expect to prove the caregiving to its satisfaction.16

Estate Recovery

Texas runs a limited estate recovery program (MERP) that pursues recovery only from the probate estate of deceased recipients age 55 or older who received long-term-care services. Non-probate assets generally bypass MERP, and the home is protected while a surviving spouse, minor child, or disabled child of any age resides there. See Texas Medicaid Long-Term Care & Nursing Homes for the full rules.

Texas Medicare Savings Programs

Medicare Savings Programs (MSPs) help low-income Medicare beneficiaries pay their Medicare costs; three matter to most older Texans. Texas's published limits sit $20 below the federal tables because HHSC states its figures "do not include the $20 general income disregard":17

None of these figures is an absolute cutoff: states can disregard certain income and resources, so apply if you are somewhat over. QI must be applied for every year. Federal law bars providers from billing a QMB enrollee for any Medicare cost-sharing, and QMB, SLMB, or QI enrollment automatically qualifies you for Part D Extra Help. A fourth MSP, Qualified Disabled and Working Individual (QDWI), pays the Part A premium for certain working people with disabilities who lost premium-free Part A; it uses higher income limits and does not confer Extra Help.18 See Texas Medicare vs Medicaid for dual-eligible coverage.

Spousal Impoverishment Protections

When one spouse applies for long-term-care coverage, federal spousal-impoverishment protections keep the community spouse from losing all of the couple's shared resources and income. The 2026 figures:

• Spousal Protected Resource Amount (SPRA, Texas's name for the CSRA): the greater of half the couple's combined countable resources or $32,532, and no more than $162,660. The homestead, household goods, personal goods, one car, and burial funds sit outside that computation. Those figures are the standards HHSC applies at the resource assessment, not a hard ceiling on what a community spouse may keep: Texas runs an "SPRA expansion" route, and an allowance set through a fair hearing or court order may lawfully exceed $162,660.6
• Monthly Maintenance Needs Allowance (MMNA): $2,705.00 minimum to $4,066.50 maximum per month. The minimum is a floor on the state's floor rather than the allowance itself: federal law requires a state's minimum to equal that figure plus an excess shelter allowance, so a community spouse with high housing costs is due more, up to the ceiling.10
• Home: Exempt from the eligibility calculation while the community spouse lives there.10

See Texas Medicaid Income & Asset Limits (Spend Down) for the snapshot and income-diversion process.

How to Apply for Texas Medicaid

Applying for Texas long-term-care Medicaid follows a defined sequence.

If Texas Medicaid Denies or Cuts Your Coverage

A denial is not the end of the road, but the clock is already running.

Texas gives you 90 days, counted from the date of the case action or the effective date on your Notice of Case Action, not from the day the envelope arrives.19 Federal law gives applicants and beneficiaries the right to a fair hearing, whether the dispute is about eligibility or about a service being reduced or ended, and it reaches a nursing facility resident facing a transfer or discharge they believe is wrong.20 That 90 days is 42 CFR 431.221(d)'s ceiling on what a state may allow rather than a floor you are owed, and Texas allows the whole of it.21 If a managed care plan took the action, you file an internal appeal with the plan first, within 60 calendar days of the date on its notice, then have 120 days from the plan's decision to request a state fair hearing. Watch the shorter clock inside that one: to keep a service in place while the hearing is pending, you must request both the hearing and continuation of benefits within 10 calendar days of the plan's adverse appeal decision. File on day 40 and you keep the hearing but lose the service.19,22 A late request is reviewed for good cause, so file anyway.19

A second, earlier clock matters more if you are already enrolled. To keep benefits running during the appeal, request the hearing before the effective date shown on page 1 of your notice (Form 2065-A), and ask in writing that they continue, because it is never automatic.19 Miss that date and you may still appeal; coverage can stop meanwhile, but a request made within 10 days of the date of action lets the agency reinstate your services under 42 CFR 431.231. And if the agency cut services without the advance notice it owed you, 42 CFR 431.231(c) requires reinstatement, provided you request the hearing within 10 days of receiving the notice (receipt counts as five days after its date unless you show otherwise) and the action did not come from applying federal or state law or policy.23

See Texas Medicaid Appeals and Fair Hearings for how to file and what the hearing involves.

Keeping Texas Medicaid Once You Have It

Eligibility is re-checked on a recurring cycle, and missing that step is a common way people lose coverage they still qualify for.

Texas Medicaid must first try to renew your coverage automatically from information it already holds, and may only request documents if it cannot.24 If it does need paperwork, it must send a renewal form and give you at least 30 days from the date of the form to return it. That duty, and the 90-day reconsideration window below, cover eligibility based on modified adjusted gross income (MAGI). If you qualify through age, disability, long-term care, a Medicare Savings Program, or the medically needy pathway, Texas may offer the same windows but is not required to, so ask HHSC what applies.24

If coverage closes because a form went unreturned, federal rules require the agency to reconsider your eligibility without a new application if you return the form within 90 days of the termination (required for MAGI-based coverage; a state option otherwise).24 So a MAGI renewal missed by a few weeks is usually recoverable; on any other pathway, ask HHSC first. See Texas Medicaid Recertification and Renewal for the full cycle.

Where to Get Help

Texas Medicaid FAQ

Learn More

Find personalized help with Texas Medicaid 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.