Texas Medicaid Programs for Seniors: Which One Is Right?

Texas runs five main Medicaid programs for seniors 65 and older, ranging from basic managed care to full-coverage nursing home stays.1 Which one fits depends on how much help your family member needs, whether they can stay at home, and where in Texas they live. If you're trying to figure out which one your parent or loved one qualifies for, you're not alone.

In This Guide

• Key Takeaways
• STAR+PLUS: The Main Program
• Community Attendant Services: No Waitlist
• STAR+PLUS HCBS Waiver: Extra Help at Home
• PACE: All-Inclusive Care in Select Cities
• Nursing Facility Medicaid
• 2026 Income Limits for Texas Medicaid Programs for Seniors
• Which Texas Medicaid Program Fits Your Family?
• Frequently Asked Questions
• Next Steps

STAR+PLUS: The Main Program

Most Texas seniors on Medicaid are in STAR+PLUS.1 It's the state's managed care program for adults 21 and older who have disabilities or are 65+. If you qualify for Texas Medicaid as a senior, this is where you'll land. See our deep dive into STAR+PLUS for the full details on eligibility, MCOs, and the HCBS waiver.

STAR+PLUS covers your medical needs through a managed care organization (MCO). That includes doctor visits, hospital stays, prescriptions, behavioral health, vision care, and personal attendant services.1

Choosing an MCO

Seven MCOs operate across 13 service areas statewide.7 The major ones are United Healthcare, Molina, Superior HealthPlan, and Amerigroup. A few serve specific regions: Community First Health Plans covers San Antonio, El Paso Health serves El Paso, and Community Health Choice operates in Houston.7 For help comparing plans, see our guide to Texas Medicaid managed care plans.

You pick your MCO when you enroll. Not happy with it? You can switch during the first 90 days and during annual open enrollment. Call the Enrollment Broker at 1-800-964-2777.8

Your Service Coordinator

Every STAR+PLUS member gets a service coordinator from their MCO.9 This person visits within 30 days of enrollment, assesses your needs, and builds your Individual Service Plan (ISP). After that, you'll get at least two face-to-face visits per year.9

Calling your service coordinator directly is usually faster than the MCO's general helpline. Most families find the first month after enrollment the hardest, since you're still figuring out who to call and what's covered under your plan. If you're not getting the help you need, the HHSC Ombudsman line at 1-866-566-8989 handles managed care complaints.8

Community Attendant Services: No Waitlist

Here's something many families miss: Community Attendant Services (CAS) is a Medicaid entitlement. There's no waitlist.2 If your parent qualifies, services start as soon as they're approved. That makes CAS the fastest way to get in-home care through Medicaid in Texas.

What You Get

CAS provides up to 50 hours per week of non-medical personal care, though most participants receive 15 to 20 hours.2 Services include:

• Bathing, grooming, dressing, toileting, and eating assistance
• Cleaning, laundry, shopping, and meal prep
• Transportation to medical appointments

Do You Qualify?

You'll need:

• Income at or below $2,982/month4
• Assets under $2,0005
• A physician's statement of medical need
• A score of at least 24 on Form 2060 (the state's functional assessment) and a minimum need of 6 hours per week2

Hiring a Family Member

Under the Consumer Directed Services (CDS) option, participants hire and manage their own attendants.10 Adult children and grandchildren can serve as paid caregivers. Spouses and parents can't.10 A Financial Management Services Agency handles payroll and taxes so you don't have to. Our guide on how to get paid as a family caregiver in Texas covers the full process, pay rates, and restrictions.

To start the process, call the Aging & Disability Resource Center at 1-855-937-2372.8 The income verification step is where most applications get delayed, so have your bank statements and Social Security award letter ready before you call.

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 top of regular STAR+PLUS and is designed for people who need nursing-home-level care but want to remain in the community.1

But there's a waitlist. The program is capped at roughly 24,000 slots, and approximately 15,850 people were on the interest list as of late 2025.3 The list is first-come, first-served, and Texas doesn't screen for eligibility before placing you on it.3

Services Covered

The waiver covers 19+ services that go well beyond what base STAR+PLUS offers:1

Who Qualifies

You must be on Texas Medicaid, meet the same income and asset limits ($2,982/month income, $2,000 assets), and be certified as needing Nursing Facility Level of Care (NFLOC).4,5 That means your care needs are significant enough that you'd otherwise require a nursing home.

If income exceeds $2,982/month, a Qualified Income Trust (Miller Trust) can redirect excess income to establish eligibility.4

To get on the interest list, call 1-877-438-5658.8

PACE: All-Inclusive Care in Select Cities

PACE (Program of All-Inclusive Care for the Elderly) bundles all of a participant's Medicare and Medicaid services into one program run by a single provider organization. That includes doctor visits, hospital care, prescriptions, dental, home care, adult day programs, therapies, transportation, and nursing facility care when it's needed.11 For seniors who are dual-eligible (Medicare + Medicaid), PACE carries no copays and no monthly premiums.11

The limitation: it's only available in three Texas cities.6

For current phone numbers and intake details, see Texas Health and Human Services' PACE provider directory.6

To qualify, you must be 55 or older, live within a PACE service area, and be certified as needing nursing facility level of care.11 You'll also need to give up any existing Medicare Advantage or Part D plan, since PACE becomes your sole source of care.11

If you're in Houston, Dallas, San Antonio, or Austin, PACE isn't available yet. The Texas PACE Authority oversees potential expansion, but no new sites have been announced for 2026.6

Nursing Facility Medicaid

When home-based programs can't meet your loved one's needs, Nursing Facility Medicaid covers the cost of care in a Medicaid-certified nursing home.4 See our guide to Medicaid long-term care in Texas for spousal protections, asset rules, and planning strategies.

The financial requirements match other long-term care programs: income at or below $2,982/month and countable assets of $2,000 or less.4 The resident must be certified as needing Nursing Facility Level of Care and live in the facility for at least 30 consecutive days.4

Protecting Your Spouse's Finances

If one spouse enters a nursing home and the other stays in the community, Texas has protections in place. The community spouse can keep between $32,532 and $162,660 in assets (the Community Spouse Resource Allowance).12 They're also entitled to a Monthly Maintenance Needs Allowance of $2,705.00 to $4,066.50 from the nursing home spouse's income.13

The resident keeps a $75/month personal needs allowance.14 All other income goes toward the cost of care.

Moving Back Home

If your family member is currently in a nursing home and wants to return to the community, STAR+PLUS Transition Assistance Services can help cover non-recurring setup costs like security deposits, utility hookups, and basic furnishings.15

2026 Income Limits for Texas Medicaid Programs for Seniors

These 2026 figures set who qualifies and how much a community spouse can keep: the SSI Federal Benefit Rate is $994/month for an individual, the special income limit is $2,982/month, the asset limit is $2,000 for a single applicant, and the personal needs allowance is $75/month.16,4,5,12,14

Your home is exempt if its equity is at or below $752,000, or if a spouse, child under 21, or blind/disabled child lives there.17 Other exempt assets include one vehicle, household goods, and a pre-paid irrevocable funeral contract.

If income exceeds $2,982/month, a Qualified Income Trust (Miller Trust) redirects excess income into a trust that Medicaid doesn't count.4 A Medicaid planning attorney can set one up, usually for a few hundred dollars.

Which Texas Medicaid Program for Seniors Fits Your Family?

Here's how to think about it:

• Your parent needs help at home but not round-the-clock care: Start with CAS. No waitlist, up to 50 hours per week.2
• Your parent needs nursing-home-level care but wants to stay home: Apply for the HCBS waiver and get on the interest list. Use CAS while you wait.3
• You're in El Paso, Amarillo, or Lubbock: Look into PACE. If your parent qualifies, it covers everything with no copays.6
• Your parent needs 24/7 skilled nursing: Nursing Facility Medicaid covers a certified nursing home.4

One more program worth knowing about: Community First Choice (CFC) is another entitlement with no waitlist.18 It's delivered through your STAR+PLUS MCO and provides personal assistance and habilitation services for members who meet nursing facility level of care.18 Your service coordinator should bring this up during your ISP meeting.

Next Steps

Learn More

Find personalized help with Texas Medicaid programs 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.