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 that combines 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 per month, and an applicant above that cap can qualify by diverting the excess into a Qualified Income Trust (Miller Trust).,,

Texas Medicaid is administered by the Texas Health and Human Services Commission (HHSC), which handles financial eligibility, managed-care enrollment, and the long-term-care programs older adults rely on. This guide maps every key question Texas families ask to the dedicated article that answers it.

How This Guide Is Organized

This pillar covers everything Texas families need to know about Medicaid for older adults and adults with disabilities, organized around the questions families ask first. Each row links to the dedicated guide that goes deep on that topic.

Your Question	Dedicated Guide
Do I qualify?	Income & Asset Limits (Spend Down)
How do I apply?	How to Apply
What is STAR+PLUS?	STAR+PLUS Waiver Program
Which managed-care plans serve my area?	Managed Care Plans
What other HCBS waivers exist?	HCBS Waivers
What's covered?	Covered Services
Dental coverage?	Dental Coverage
Medicare vs Medicaid?	Medicare vs Medicaid
Nursing home Medicaid?	Long-Term Care: Nursing Home
All Texas Medicaid programs?	Programs Hub
Caregiver pay & support?	Texas Caregiver Pillar

What Texas Medicaid Covers

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

Hospital care: Inpatient and outpatient services
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: Emergency-only for adults (pain relief, infection, extractions); 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 per year and a private room about $91,250 per year, according to the CareScout 2025 Cost of Care Survey. Once a resident meets the financial and clinical eligibility standards, Medicaid pays the facility for that care, and the resident applies nearly all of their own monthly income toward the bill.,

Who Qualifies for Texas Medicaid

Texas covers older adults and adults with disabilities through several categorical pathways. 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 key financial parameters in 2026:

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.
Asset limit: $2,000 for an individual; $3,000 for a married couple who live in the same household. Texas applies the $2,000 individual limit to a single person, to a person whose spouse lives elsewhere, and to the institutional spouse under spousal-impoverishment policy, so a couple splitting up because one enters a facility should plan against $2,000, not $3,000. Countable assets exclude the home that is the person's or spouse's principal residence, one automobile regardless of value, and household goods and personal effects.
Home equity limit: A person whose equity in the home exceeds $752,000 for 2026 (the federal minimum, which Texas adopts) is denied Medicaid for services in an institutional setting and denied HCBS waiver services. This is not a resource test: the home is still treated as it always was for resource purposes, and a denial on this basis does not disqualify the person from Qualified Medicare Beneficiary or Specified Low-Income Medicare Beneficiary coverage. The equity limit does not apply at all when the person's spouse, or a child who is under 21 or is blind or permanently and totally disabled, lawfully lives in the home.
Miller Trust: Texas sets a hard income cap for these programs. An applicant whose countable income runs above $2,982/month can qualify by establishing a Qualified Income Trust (Miller Trust) and diverting the excess into it each month. Note that the test is countable income, not gross: HHSC works out the need for a trust only after determining what income counts, and certain Veterans Affairs benefits do not count toward Medicaid eligibility.,

For full details on income limits, asset rules, and the Miller Trust mechanics, 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 who are 65 or older or who have disabilities. (The age-21 floor belongs to the STAR+PLUS HCBS waiver, not to STAR+PLUS itself.) It delivers acute care, behavioral health, pharmacy, and long-term services and supports (LTSS) through a single managed-care organization (MCO). The program operates across 13 service delivery areas with 7 MCOs, and members choose from at least two plans in each area.,

The STAR+PLUS HCBS Waiver is the §1915(c) waiver embedded inside STAR+PLUS. It provides personal attendant services, adult day care, respite, home modifications, and consumer direction so a member can receive care at home instead of in a nursing facility. Eligibility for this waiver additionally requires the applicant to be 21 or older, and the MCO the member selects begins the HCBS eligibility determination. The waiver has an interest list (waitlist); families should call the LTSS Waiver Interest List at 1-877-438-5658 to be screened and added as early as possible.,

STAR+PLUS began as a Harris County pilot in 1998 and expanded statewide on September 1, 2014; nursing-facility care was carved into the program in March 2015. It is one of the more fully integrated managed long-term-care programs in the country, combining medical and long-term-care coverage in a single contract.

Nursing Facility Coverage

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

Other HCBS Waivers

Beyond STAR+PLUS, Texas operates several programs for specific populations. Two run under state-plan authority and carry no interest list; the rest are §1915(c) waivers with interest lists:

Community First Choice (CFC): a Medicaid State Plan option under §1915(k) rather than a waiver, and federal rules require a state that elects it to offer it statewide, so Texas CFC has no interest list. It provides personal assistance, habilitation, emergency response, and support management to a person who is enrolled in Medicaid, qualifies for care at an institutional level (hospital, nursing facility, ICF/IID, or a qualifying psychiatric institution), and needs help with activities of daily living or instrumental activities of daily living.
Community Attendant Services (CAS): a state-plan program under §1929(b)(2)(B) of the Social Security Act, not a waiver, and not an interest-list program (HHSC intake screeners must assign a request for personal attendant services from a non-SSI applicant to a caseworker as a CAS application rather than list it). It covers non-technical, medically related attendant services: up to 50 hours of service a week, or no more than 42 hours for a recipient with priority status. Functional eligibility normally takes a score of at least 24 on Form 2060 and a need for at least six hours of service a week, though listed exceptions can qualify someone who needs fewer hours.
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 CFC and CAS carry no interest list while the §1915(c) waivers do, the single most important step for a family is to get on the lists early. Call 1-877-438-5658 to be added to a waiver interest list; for the HCS and TxHmL waivers, contact your Local Intellectual and Developmental Disability Authority (LIDDA) instead, because that number does not handle those two. For personal attendant services, HHSC intake screeners must route a request from someone who does not already have SSI or SSI-related Medicaid to a caseworker as a CAS application rather than put the person on an interest list.

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 within that window create a penalty period, calculated by dividing the total uncompensated value of the transferred assets by the daily penalty divisor of $262.37 (for case actions disposed on or after September 1, 2025) and rounding partial amounts down to whole days. In Texas the penalty starts on the first day of the month of the medical effective date, provided the person meets every other eligibility rule. Certain transfers of the home are exempt from the penalty: the caregiver-child exemption covers a transfer to a son or daughter who lived in the home for at least two years immediately before the parent became institutionalized and provided care that let the parent stay at home, and a transfer of the home to a child who is blind or permanently and totally disabled is exempt as well.

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 (life insurance with a named beneficiary, payable-on-death accounts, and property held in joint tenancy with right of survivorship) generally bypass MERP. 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 nursing-facility and estate-recovery rules.

Texas Medicare Savings Programs

Medicare Savings Programs (MSPs) help low-income Medicare beneficiaries pay their Medicare costs. Three of them matter to most older Texans, and they use the federal income brackets, the same nationwide:

Program	What It Covers	2026 Income Limit (Single)
QMB (Qualified Medicare Beneficiary)	Part A & B premiums plus all Medicare deductibles, coinsurance, and copays	Up to $1,350/month
SLMB (Specified Low-Income Medicare Beneficiary)	Part B premium only	$1,350 to $1,616/month
QI (Qualifying Individual)	Part B premium only	$1,616 to $1,816/month

Federal resource standard for all three: $9,950 for one person, $14,910 for a couple.

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

See Texas Medicare vs Medicaid for how dual-eligible coverage works for older Texans.

Spousal Impoverishment Protections

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

Key 2026 figures:

Community Spouse Resource Allowance (CSRA): $32,532 minimum to $162,660 maximum; the community spouse retains 50% of combined countable assets within that floor and ceiling.
Minimum Monthly Maintenance Needs Allowance (MMNA): $2,705.00 minimum to $4,066.50 maximum per month in income the community spouse may keep.
Home: Exempt from the eligibility calculation while the community spouse lives there.

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

How to Apply for Texas Medicaid

Applying for Texas long-term-care Medicaid follows a defined sequence. Gather your paperwork first, then submit through one of the HHSC pathways.

Step 1

Gather your documents

Collect income statements, asset and bank records covering the full 60-month lookback period, proof of citizenship and Texas residency, insurance cards, and any trust paperwork. Long-term-care applications are document-heavy, and missing records are the most common cause of delay.

Step 2

Set up a Miller Trust if your countable income is over the cap

If countable monthly income exceeds $2,982, establish a Qualified Income Trust (Miller Trust) before or alongside your application and begin diverting the excess into it each month. The trust must be irrevocable, hold only the person's income, and name the State of Texas as residuary beneficiary. It works for nursing-facility and HCBS-waiver Medicaid; it cannot overcome income ineligibility for Community Attendant Services.,

Step 3

Submit the application

Apply online through Your Texas Benefits. For questions about Medicaid or an application in progress, call HHSC Medicaid and benefits information at 1-800-252-8263.

Step 4

Get on the long-term-care interest list

For STAR+PLUS HCBS or the §1915(c) waivers, call 1-877-438-5658 to be screened and added. For the HCS and TxHmL waivers, contact your Local Intellectual and Developmental Disability Authority instead.

Step 5

Complete the level-of-care screening and await the decision

Long-term-care applicants receive a clinical level-of-care assessment alongside the financial review. Respond promptly to any requests for verification, then watch for the written eligibility determination.

If Texas Medicaid Denies or Cuts Your Coverage

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

Texas gives you 90 calendar days, counted from the date of the action or the effective date on your Notice of Case Action, not from the day the envelope arrives. Federal law guarantees every Medicaid applicant and beneficiary the right to a fair hearing before the state agency, whether the dispute is about eligibility or about a specific service being reduced or ended. That 90-day figure 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. If a managed care plan took the action, you have 120 days instead, running from the plan's decision on your internal appeal., A late request is reviewed for good cause, so file anyway and say why it is late.

A second, earlier clock matters more if you are already enrolled. To keep your 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., Miss that date and you may still appeal, but coverage can stop in the meantime.

See Texas Medicaid Appeals and Fair Hearings for how to file, what the hearing involves, and what happens after a decision.

Keeping Texas Medicaid Once You Have It

Coverage is not permanent once approved. Eligibility is re-checked on a recurring cycle, and missing that step is one of the most common ways 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. 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 to you.

If coverage does close because a form went unreturned, that is not the end of it. Federal rules require the agency to reconsider your eligibility without a new application if you return the renewal form within 90 days of the termination (required for MAGI-based coverage; a state option otherwise). So a MAGI renewal missed by a few weeks is usually recoverable; on any other pathway, ask HHSC before you assume it.

Keep your mailing address current, open anything from Texas Medicaid, and return the form by the deadline printed on it. See Texas Medicaid Recertification and Renewal for the full cycle and how to recover closed coverage.

Where to Get Help

Texas Health and Human Services Commission (HHSC) Administers Medicaid eligibility, managed care, and long-term-care programs. The client line answers Medicaid card, program, and benefits questions, and the same help is reachable through 2-1-1. 1-800-252-8263 hhs.texas.gov

Your Texas Benefits File and manage a Texas Medicaid application online, upload documents, and check case status. yourtexasbenefits.com

LTSS Waiver Interest List Get added to the STAR+PLUS HCBS or §1915(c) waiver interest lists. For the HCS and TxHmL waivers, contact your Local Intellectual and Developmental Disability Authority (LIDDA) instead. 1-877-438-5658

2-1-1 Texas A free, anonymous Texas HHSC hotline open 24 hours a day, 7 days a week, that connects families to Medicaid, long-term care, and community programs in their area. If 2-1-1 will not connect, call 1-877-541-7905 and choose Option 1. 2-1-1

Texas Medicaid FAQ

Frequently Asked Questions

What is the income limit for Texas Medicaid in 2026?

For nursing-facility and HCBS-waiver coverage, the 2026 limit is $2,982 per month for a single applicant and $5,964 per month for a couple, equal to 300% of the SSI Federal Benefit Rate. The test is countable income, not gross income: HHSC determines what income counts first, and certain Veterans Affairs benefits do not count toward Medicaid eligibility. An applicant whose countable income lands above the cap can qualify by diverting the excess into a Qualified Income Trust (Miller Trust).,

What is a Miller Trust and when does Texas require one?

A Miller Trust (also called a Qualified Income Trust, or QIT) lets an applicant whose countable income exceeds the $2,982 monthly cap still qualify for institutional or HCBS-waiver Texas Medicaid. Each month, the applicant diverts income above the cap into the trust; income properly directed into it is not counted in determining eligibility for those services. The trust must be irrevocable, hold only the person's income, and name the State of Texas as residuary beneficiary. Note the boundary: a QIT cannot be used to overcome income ineligibility for Community Attendant Services, one of the two Texas programs that carries no interest list.

What is the asset limit for Texas Medicaid?

$2,000 for an individual, $3,000 for a married couple who live in the same household. Texas applies the $2,000 individual limit to a single person, to a person whose spouse lives in a different household, and to the institutional spouse under spousal-impoverishment policy. Countable resources exclude the principal residence, one automobile regardless of value, and household goods and personal effects. Cash, bank accounts, and non-exempt investments all count. The $752,000 home-equity limit is a separate test: exceeding it denies institutional and HCBS-waiver services rather than making the home a countable resource.,

Will Texas Medicaid take my parent's house after they pass?

Texas pursues estate recovery (MERP) only against the probate estate of recipients age 55 or older who received long-term-care services. Non-probate assets (life insurance with a named beneficiary, payable-on-death accounts, and property held in joint tenancy with right of survivorship) generally bypass recovery, and the home is protected while a surviving spouse, minor child, or disabled child of any age lives there.

How does the community spouse protection work in Texas?

The community spouse keeps between $32,532 and $162,660 in countable assets (the CSRA) and may keep between $2,705.00 and $4,066.50 per month in income (the MMNA). If the community spouse's income falls below the floor, a portion of the applicant's income can be diverted to bring them up to it.,

Is Texas a Medicaid expansion state?

No. Texas is one of the ten states that have not adopted the Affordable Care Act Medicaid expansion (the "new adult group" covering adults with income up to 138% of the federal poverty level), so adults under 65 who are not disabled and have income below the poverty level can fall into a coverage gap: too much income for Medicaid, too little for Marketplace premium subsidies. Eligibility for older adults runs through the SSI-related, special-income-limit, and nursing-facility pathways described above.

Learn More

Find personalized help navigating Texas Medicaid at brevy.com.

References

Cited in this article

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Also reviewed

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