Texas runs five main Medicaid programs for seniors 65 and older, from managed care to nursing home care. The broadest is STAR+PLUS, the state's Medicaid managed care program for adults who have disabilities or are 65 and older. Which one fits depends on how much help your family member needs, whether they can stay at home, and where in Texas they live.

In This Guide

STAR+PLUS: The Main Program

STAR+PLUS covers your medical needs through a managed care organization (MCO): checkups, hospital care, medicine and vaccines, specialists and mental health care, plus long-term services and supports. See our deep dive into STAR+PLUS for eligibility and MCOs in full.

Choosing an MCO

Seven MCOs serve STAR+PLUS across 13 service areas, and you can choose from at least two in your area: Superior, Wellpoint (Amerigroup's Texas plans rebranded to Wellpoint on January 1, 2024), Molina, UnitedHealthcare, Community First Health Plan, El Paso Health, and Community Health Choice. See our guide to managed care plans to compare them.

You pick your MCO at enrollment, and can change plans at any time; the change takes 15 to 45 days. Call the Enrollment Broker at 1-800-964-2777.

Your Service Coordinator

Service coordination is an MCO duty, but how often you are seen is tiered. The floor for every member is contact at enrollment and yearly after. Everyone who applies for or receives long-term services and supports gets service coordination, including an Individual Service Plan (ISP) built with you. Beyond that floor:

  • On the STAR+PLUS HCBS waiver, or with a complex medical condition: at least two face-to-face visits a year
  • Receiving LTSS, dual-eligible, or with a history of behavioral health issues or substance use disorder: at least one phone contact and one face-to-face contact a year
  • Living in a nursing facility: at least four face-to-face visits a year (quarterly, per handbook section 1210), except for members in hospice or outside the MCO's service area. You can ask the MCO for documentation that those visits happened; it must produce it on request

Start with your service coordinator. If you are not getting the help you need, the HHSC Ombudsman line at 1-866-566-8989 handles managed care complaints.

Not sure which MCO to choose? Chat with Brevy's care navigator to compare plans.

Community Attendant Services

The intake step for Community Attendant Services (CAS) works in your favor. When someone who isn't already on SSI or SSI-related Medicaid asks for personal attendant services, HHSC intake screeners must assign that request to a caseworker as a CAS application. They are barred from screening the person toward a specific service or putting anyone on the Family Care interest list at that stage; the caseworker decides later whether the person goes on one. That doesn't mean CAS has no interest list; nothing we've read from HHSC says so.

What You Get

CAS provides up to 50 hours per week of non-technical attendant services, or up to 42 hours for a recipient with priority status (fewer hours, not more). Priority status is a specific finding: the recipient cannot do one or more of these without hands-on help: transfer, feed, toilet or prepare a meal; nobody else capable and willing is available during a scheduled shift, and their health or safety would be at risk if a shift went uncovered. Services include:

  • Activities of daily living, such as bathing, grooming, meal preparation and housekeeping
  • Shopping for items your parent needs
  • Escort to a clinic or doctor's office for medical care

Anything requiring professional or technical training is excluded: tube feedings, injections, and administering medication, plus catheter and body-cavity irrigation, sterile dressings involving prescription medications, and anything else an HHSC nurse identifies as skilled. An attendant also cannot maintain the whole household unless everyone in it receives services, though shopping may include items the household shares.

Do You Qualify?

You'll need:

  • Financial eligibility, established for CAS through Medicaid for the Elderly and People with Disabilities (MEPD); living outside an institution is part of the test
  • Countable assets at or below $2,000 for a single applicant, or $3,000 for a married couple living together
  • A practitioner's statement of medical need (Form 3052)
  • A score of at least 24 on Form 2060 (the state's functional assessment) and, normally, a need for at least 6 hours of service per week

Needing fewer than 6 hours doesn't automatically disqualify you: Texas lists exceptions, including needing CAS to support a caregiver, receiving VA aid and attendance, or being assessed as at high risk of institutionalization without it. One difference from the waiver programs below: a Miller Trust can't fix income ineligibility for CAS.

Hiring a Family Member

Under the Consumer Directed Services (CDS) option, which HHSC lists for CAS, your parent (or their designated representative) becomes the employer: they recruit, hire, train, manage and fire their employees (including family, friends or neighbors), set wages from a service budget, and pick a financial management services agency that runs payroll and pays employment taxes as their agent. Hires must meet the same requirements as agency employees, including criminal history and background checks, and six categories of people are barred (see the FAQ below). In STAR+PLUS, the handbook adds that CDS works in the member's own home or a family member's home, not in adult foster care homes or assisted living facilities.

Know what you are taking on. The STAR+PLUS Handbook is blunt: the CDS employer "assumes all liability related to employment," is solely responsible for negligent acts by their employees, is ultimately responsible for payroll taxes owed to the IRS and the Texas Workforce Commission (and liable if the FMSA fails to pay), finds their own back-up attendants, cannot stretch authorized hours by cutting a wage, and must keep the paperwork five years or longer. If that is more than your family wants to run, CDS is not the only way to pay a relative. The FAQ below covers the agency alternative. Our guide on getting paid as a family caregiver in Texas covers pay rates.

To start, call the Aging & Disability Resource Center at 1-855-937-2372.

STAR+PLUS HCBS Waiver: Extra Help at Home

The Home and Community-Based Services (HCBS) waiver is one of several Texas Medicaid waiver programs seniors use to stay out of nursing homes. It builds on regular STAR+PLUS, for people who need nursing-home-level care but want to remain in the community.

12,100 people were on the interest list as of August 31, 2026, part of an unduplicated 199,471 Texans across HHSC's six interest-list programs (people can be on several lists). HHSC publishes these counts monthly, so pull the current number from its Interest List Reduction page.

Check this before you settle in to wait: the interest list is not everybody's door. HHSC's handbook says SSI or other full Medicaid recipients never go on the STAR+PLUS HCBS interest list, whether or not they are enrolled with STAR+PLUS; the handbook sends them to the enrollment broker or their MCO instead. A nursing facility resident enrolled with a STAR+PLUS MCO is referred to the MCO for an upgrade, and Money Follows the Person individuals are placed on the list and immediately assigned. Find out which your parent is first. And while anyone waits for managed care enrollment, referrals to Community Care for Aged and Disabled are mandatory for all full Medicaid recipients.

Two things about the list. Texas does not screen for eligibility before adding a name, so not everyone on it will qualify. And HHSC says it places people first-come, first-served, enrolls those who have waited longest first, and releases slots as funding allows; getting other services while you wait, if you're eligible, doesn't cost you your place.

Services Covered

Services, delivered by your MCO under your service plan, include personal assistance services; nursing services; physical, occupational, speech and cognitive rehabilitation therapy; respite care, in the home or out of it; emergency response services; home-delivered meals; minor home modifications, adaptive aids and medical supplies; adult foster care or assisted living; dental services; employment assistance and supported employment; and transition assistance to move home from a nursing facility.

Who Qualifies

Age 21 or older is one of eight criteria HHSC lists. The full set: full Medicaid financial eligibility, U.S. citizenship, Texas residency, age 21 or older, approved medical necessity for a nursing-facility level of care, a service plan under the cost limit, an unmet need for at least one STAR+PLUS HCBS service, and an appropriate living situation. The financial limits are the same $2,982/month income and $2,000 in countable assets as the other long-term-care programs, and a Miller Trust can redirect excess income, as described below.,

You don't apply directly. HHSC's handbook says an individual is eligible to be assessed "when their name reaches the top of the STAR+PLUS HCBS program interest list," and only then does the person pick an MCO, which begins the eligibility determination. To join the list, call HHSC's number for interest-list information on waiver programs (1-877-438-5658), or your MCO if you're already in STAR+PLUS. Two documented ways round it: someone on Medicaid and enrolled with an MCO may bypass the list through the upgrade process, and a nursing facility resident may qualify through Money Follows the Person.,

PACE: All-Inclusive Care in Select Cities

PACE (Program of All-Inclusive Care for the Elderly) is for people 55 and older who meet nursing-facility criteria but can still live safely in the community. There is no copayment for PACE in Texas unless the participant is admitted to a nursing facility.

The limitation: it's only in three Texas cities.

Provider City Service Area Phone
Bienvivir Senior Health Services El Paso Call to confirm (915) 562-3444 (McKinley Ave.); (915) 599-8812 (N. Carolina Dr.)
The Basics at Jan Werner Amarillo Amarillo and Canyon (806) 374-5516 (intake)
Silver Star PACE Lubbock Call to confirm (806) 740-1500 (main)

Only one of the three is published as an intake line: at The Basics at Jan Werner, (806) 374-5516 reaches the Intake Department. Silver Star's (806) 740-1500 is a main number (TTY 1-800-658-6198), and the only labelled use of Bienvivir's (915) 562-3444 is grievances and appeals, so start from Bienvivir's eligibility page.

To qualify in Texas you must be 55 or older, have chronic medical problems and functional impairments, meet nursing facility medical necessity criteria, live in a PACE service area, and be eligible for Supplemental Security Income (SSI) or for Medicaid under the institutional special income limit. CMS adds that you must be able to live safely in the community at enrollment.

If you're in Houston, Dallas, San Antonio, or Austin, PACE isn't an option today, but the roster changes, so check the HHS provider directory before ruling it out.

Nursing Facility Medicaid

When home-based programs can't meet your loved one's needs, Nursing Facility Medicaid covers care in a Medicaid-contracted nursing home. See our long-term care guide for planning strategies.

The financial requirements match the other long-term care programs: countable income at or below $2,982/month and countable resources of $2,000 or less for a single applicant, or $3,000 for a married couple living together; a spouse entering care while the other stays home is held to $2,000. Four non-financial requirements come with them: medical necessity; being 65 or older or meeting Social Security's definition of disability; Texas residency and U.S. citizenship or approved alien status; and 30 consecutive days in a Medicaid-contracted facility. The $2,000 caps countable resources, not net worth: a homestead the person plans to return to, one vehicle regardless of value, life insurance with face value up to $1,500, and $1,500 in separately identifiable burial funds (less any excluded life insurance; more if irrevocable) are excluded.

Protecting Your Spouse's Finances

If one spouse enters a nursing home and the other stays in the community, Texas protects part of the couple's resources as the Spousal Protected Resource Amount (SPRA): the greater of half their combined countable resources or $32,532, but not more than $162,660. But $162,660 is the assessment standard, not a ceiling on what a community spouse may keep: an allowance set by court order or fair hearing carries no dollar figure, and Texas lets the SPRA be expanded above it, by request on Form H1275 or at a hearing, up to the couple's combined countable resources. The community spouse may also keep part of the nursing home spouse's income. Texas sets the Minimum Monthly Maintenance Needs Allowance at $4,066.50/month, but that is a target, not a payment: if the community spouse has income of their own, they are allowed only the shortfall, and more is possible in exceptional circumstances. Our spousal impoverishment guide covers both.

The resident keeps a $75/month personal needs allowance, deducted ahead of guardianship fees, spousal and family maintenance needs, and incurred medical expenses; what's left is the co-payment toward care. One caveat for veterans: the $75 does not settle how a VA payment is treated for an institutionalized recipient, and HHSC points to separate rules on VA benefits and the $90 capped VA pension. Ask the caseworker about those.

Moving Back Home

If your family member is in a nursing home and wants to return to the community, STAR+PLUS Transition Assistance Services (TAS) covers non-recurring setup costs in five categories: security deposits to lease a home; utility set-up fees and deposits; essential furnishings such as a table, chairs, blinds, utensils, linens and toiletries; moving expenses; and services to make the home safe, such as pest eradication, allergen control, or a one-time cleaning before move-in. TAS does not cover relocation services or help find the residence. A nursing facility resident discharged into a waiver program can receive up to $2,500 in TAS, one time only, and it is not available to someone moving into assisted living or adult foster care.

$2,500 is not the ceiling. Supplemental Transition Services (STS), offered through the MCOs, provides a second amount of up to $2,500 for a nursing facility resident discharged into a waiver-authorized program. STS is also one-time-only and normally available only after TAS is exhausted, but the same handbook section allows it for essential items TAS cannot fund even when TAS money remains: a rental deposit plus a reasonable damage deposit where the landlord requires one, and other household start-up costs reviewed with the service coordinator. HHSC lists five criteria, including having no other resource for the expense, moving within 60 days of authorization, and showing a budget that carries the household costs afterward. STS cannot subsidize rent. Ask about it by name.

2026 Income Limits for Texas Medicaid Programs for Seniors

Limit Amount
SSI Federal Benefit Rate, maximum payment (individual) $994/month
SSI Federal Benefit Rate, maximum payment (couple) $1,491/month
Special income limit (300% SSI) $2,982/month
Asset limit (single) $2,000
Asset limit (married couple living together) $3,000
Community spouse resource standards (minimum to maximum) $32,532 to $162,660
Home equity limit $752,000
Personal needs allowance (nursing facility) $75/month

The $994/month SSI rate is the maximum federal payment, not what any given recipient receives.,,,,

Your home is generally excluded as a resource (for a nursing home resident, if they plan to return), but nursing facility and waiver Medicaid carry a separate home-equity limit: $752,000 in 2026. It doesn't apply if a spouse, child under 21, or blind/disabled child lawfully lives there. Over it, a nursing home resident loses Medicaid's payment to the facility (other benefits continue); a waiver applicant is denied waiver services and, if the waiver requires them, all Medicaid, pending HHSC's check of other programs. Being over that limit is not a dead end: a reverse mortgage or home equity loan may reduce equity, federal law provides for a hardship waiver, and it never costs Qualified Medicare Beneficiary or Specified Low-Income Medicare Beneficiary coverage. Our spend-down guide has the full resource rules.

If countable income exceeds $2,982/month, a Qualified Income Trust (Miller Trust) redirects the excess into a trust Medicaid doesn't count. Check countable income first: certain VA benefits don't count at all. A QIT settles the income test and nothing else; HHSC says it "will not address other eligibility requirements for institutional and home and community-based waiver services, such as: citizenship; residency; medical necessity; and the person's countable resources." It works for nursing facility and waiver Medicaid, not CAS.

Which Texas Medicaid Program for Seniors Fits Your Family?

Feature STAR+PLUS CAS HCBS Waiver PACE Nursing Facility
Setting Community or nursing facility Community Community Community Nursing home
On HHSC's interest-list roster? Not listed Caseworker decides Yes, unless already on full Medicaid Not listed Not listed
Care level Medical plus LTSS Personal care Nursing-home level at home All-inclusive Nursing facility care
Family paid as caregiver? Possible (see FAQ) Possible (see FAQ) Possible (see FAQ) Ask the provider N/A
Where Statewide Ask HHSC Statewide (capped) 3 cities Ask HHSC

One more program worth knowing about: Community First Choice (CFC) is a Medicaid state plan option under Section 1915(k), not a waiver. It covers personal assistance, habilitation, emergency response, and support management for someone enrolled in Medicaid who qualifies for institutional care and needs help with daily activities. CFC is not among the Texas programs HHSC reports as having interest lists: its Interest List Reduction page names CLASS, DBMD, HCS, TxHmL, MDCP and STAR+PLUS HCBS. That list covers waiver programs, so it doesn't say CFC has no waiting list. HHSC says people on a 1915(c) waiver interest list may still get CFC if they meet its eligibility and coverage requirements, so ask your service coordinator about it at your ISP meeting.

Frequently Asked Questions

Can I be on the HCBS waiver interest list while receiving CAS?

Yes. HHSC says getting other services while on an interest list doesn't affect your place, and a CAS request from someone not already on SSI or SSI-related Medicaid goes to a caseworker on its own track. Someone already on SSI or full Medicaid never goes on that list at all.

Can my adult child get paid to care for me through Medicaid?

Yes, and CDS is only one route. Under Consumer Directed Services (CDS), offered in both CAS and STAR+PLUS HCBS, your parent becomes the employer and can hire you directly. Adult children and grandchildren are not among the six categories HHSC's list bars: the person receiving services; their spouse (except in the Consumer Managed Personal Attendant Services program); the member's legally authorized representative and that representative's spouse; and an appointed designated representative and their spouse. That is a reading of the list rather than an HHSC statement about relatives, so confirm with your Financial Management Services Agency first. In CAS, HHSC's Form 1726 also bars the primary caregiver from being the paid CDS provider. If CDS shuts you out, ask the case manager or service coordinator whether a provider agency can employ you under your parent's program; the agency route may have different bars.

What if my income is over $2,982 per month?

Check countable income first, since certain VA benefits don't count at all. If you are still over, a Qualified Income Trust (Miller Trust) redirects the excess so it isn't counted, though it settles only the income test. It works for nursing facility and HCBS waiver Medicaid, not CAS.

Next Steps

1
Step 1

Check eligibility

For the HCBS waiver and Nursing Facility Medicaid, countable income must be at or below $2,982/month and countable assets at or below $2,000., Over the limit? Ask a Medicaid planning attorney about a Miller Trust.

2
Step 2

Apply for Medicaid

online at YourTexasBenefits.com, or send the paper form by mail, fax or in person at a benefits office. 2-1-1 answers questions and checks status. Our guide to applying has the walkthrough.

3
Step 3

Call the ADRC

The Aging & Disability Resource Center at 1-855-937-2372 helps you work through long-term care funding, intake and eligibility, and serves all 254 counties.

4
Step 4

Get on the HCBS interest list early, if the list is even your route

Call 1-877-438-5658, HHSC's number for interest-list information on waiver programs. Already on SSI or full Medicaid? Go through the enrollment broker or your MCO instead., Relay Texas is free at 7-1-1.

Learn More

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. 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. 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. MedicaidTexas STAR+PLUS HCBS WaiversTexas HCBS waiver programs help seniors stay home instead of a nursing facility. Learn how STAR+PLUS HCBS, CLASS, HCS, interest lists, and applying work. 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. MedicaidTexas Medicaid Spend-DownTexas allows no income spend-down for long-term care. As an income-cap state it uses a Qualified Income (Miller) Trust. See the 2026 income and asset rules. VA BenefitsVA Benefits You Can Use for Senior Care in TexasVA senior care benefits in Texas cover home care, nursing homes, and Aid and Attendance up to $34,488 a year for a veteran with a spouse. How to apply in 2026.

Find personalized help 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.

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