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. The one most seniors land in is STAR+PLUS, the state's Medicaid managed care program for adults who have disabilities or are 65 and older.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

STAR+PLUS is Texas's Medicaid managed care program for adults who have disabilities or are 65 and older.1 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 regular checkups at the doctor, hospital care, medicine and vaccines, access to medical specialists and mental health care, plus long-term services and supports.1

Choosing an MCO

Seven MCOs operate across 13 service areas statewide, and you can choose from at least two in your area.9 The major ones are UnitedHealthcare, Molina, Superior HealthPlan, and Wellpoint, which is the plan Amerigroup rebranded to on January 1, 2024.9 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.9 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 1-800-964-2777.10

Your Service Coordinator

Every STAR+PLUS member gets a service coordinator from their MCO. The MCO has to contact you when you enroll and at least once a year after that, and the coordinator assesses your needs and builds your Individual Service Plan (ISP).11

How often you're seen after that depends on which group you fall into, not on a single flat rule:

• On the STAR+PLUS HCBS waiver, or living with a complex medical condition: at least two face-to-face visits a year
• Receiving long-term services and supports, 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, stated in the handbook as at least quarterly face-to-face visits for assessment purposes, except for members receiving hospice care or living outside the MCO's service area11

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.10

Community Attendant Services: No Waitlist

Here's something many families miss: Community Attendant Services (CAS) has no interest list. When someone who isn't already on SSI or SSI-related Medicaid asks for personal attendant services, HHSC intake staff must assign that request to a caseworker as a CAS application rather than put the person on an interest list.3 If your parent qualifies, services start as soon as they're approved. That makes CAS one of the fastest routes to in-home care through Medicaid in Texas. (Community First Choice, further down, is the other route with no interest list.)

What You Get

CAS provides up to 50 hours per week of non-technical, medically related attendant services, or up to 42 hours per week for a recipient with priority status.3 Services include:

• Personal care: bathing, grooming, dressing, toileting, transfer, ambulation, meal preparation, and feeding
• Home management: cleaning, laundry, and shopping
• Escort, including accompanying the person to a clinic or doctor's office for medical care

Do You Qualify?

You'll need:

• Financial eligibility, which for CAS is established by applying to Medicaid for the Elderly and People with Disabilities (MEPD)3
• Assets under $2,0006
• A practitioner's statement of medical need
• 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 week3

Needing fewer than 6 hours a week doesn't automatically disqualify you. Texas lists exceptions, including needing CAS to provide caregiver support, receiving VA aid and attendance benefits, or being assessed as at high risk of institutionalization without it.3

One important difference from the waiver programs below: a Qualified Income Trust (Miller Trust) can't be used to fix income ineligibility for CAS, even though it works for nursing facility and HCBS waiver Medicaid.3

Hiring a Family Member

Under the Consumer Directed Services (CDS) option, the member (or their legally authorized representative) becomes the employer of record: you recruit, hire, train, manage, and if needed terminate your own attendants, and you set their wages within the funds allocated in the service plan.12 HHSC says a CDS employer may hire family members, friends, and other people they know, and adult children and grandchildren aren't on the list of people barred from hire.12 That list does bar 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 any appointed designated representative and their spouse.12 A Financial Management Services Agency handles payroll, employer taxes, and the tax filings so you don't have to.12 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 1-855-937-2372.13 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.14

But there's a waitlist. Access to the program is capped by available funding, and 14,470 people were on the interest list as of May 31, 2026, part of an unduplicated 199,426 Texans waiting across HHSC's six interest-list programs. HHSC republishes these counts monthly, so pull the current number from the HHSC interest-list page before you plan around it.4 The list is first-come, first-served: your place is set by how long you have been waiting, and the people who have waited longest are enrolled first as slots open. Texas doesn't screen for eligibility before placing you on it.4

Services Covered

The waiver covers 19+ services that go well beyond what base STAR+PLUS offers:14

Who Qualifies

You must be on Texas Medicaid, be 21 or older (an added requirement the waiver carries that base STAR+PLUS does not)1, 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).5,6 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.5

To get on the interest list, call 1-877-438-5658.10

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.7 There is no copayment for the PACE program in Texas unless the participant is admitted to a nursing facility, and that holds whether or not the participant is dual-eligible for Medicare and Medicaid.7 If you don't qualify for Medicaid, ask the PACE organization directly what enrolling would cost you.

The limitation: it's only available in three Texas cities.8

Those are the intake numbers the three organizations publish; at The Basics at Jan Werner, (806) 374-5516 reaches the Intake Department, which is who to ask about eligibility or starting enrollment.15 Contact lines change, so if a number doesn't connect, check Texas Health and Human Services' PACE provider directory.8

To qualify for PACE 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.7 CMS adds that a person must also be able to live safely in the community at the time of enrollment.7 That SSI-or-institutional-income-limit rule is a financial test, so meeting the age, medical, and service-area criteria is not enough on its own.

If you're in Houston, Dallas, San Antonio, or Austin, PACE isn't an option: the three providers above are the only ones operating in Texas. Check the HHS directory before ruling it out, since the roster is the kind of thing that changes.8

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.5 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.5 The resident must be certified as needing Nursing Facility Level of Care and live in the facility for at least 30 consecutive days.5

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 keeps half of the couple's combined countable assets as the Community Spouse Resource Allowance, subject to a floor of $32,532 and a ceiling of $162,660.16 They may also draw a Monthly Maintenance Needs Allowance from the nursing home spouse's income: the minimum allowance is $2,705.00/month (effective July 1, 2026) and the maximum is $4,066.50/month (effective January 1, 2026).17

The resident keeps a $75/month personal needs allowance, which HHSC deducts first, ahead of guardianship fees, spousal and family maintenance needs, and incurred medical expenses.18 What's left after those deductions is the resident's co-payment 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 (TAS) can help cover non-recurring setup costs like security deposits, utility hookups, essential furnishings, and moving expenses. A nursing facility resident discharged into a waiver program can receive up to $2,500 in TAS, one time only.19 TAS is not available to someone moving from a nursing facility into assisted living or adult foster care.19

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.20,5,6,16,18

Your home is exempt if its equity is at or below $752,000, or if a spouse, child under 21, or blind/disabled child lawfully lives there.17 Other exempt resources include one automobile regardless of value, plus household goods and personal effects.6

If income exceeds $2,982/month, a Qualified Income Trust (Miller Trust) redirects excess income into a trust that Medicaid doesn't count.5 A Medicaid planning attorney can set one up. One limit to know: a Miller Trust works for nursing facility and HCBS waiver Medicaid, but it can't be used to overcome income ineligibility for CAS.3

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 interest list, and up to 50 hours a week (42 with priority status).3
• 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.4
• You're in El Paso, Amarillo, or Lubbock: Look into PACE.8 If your parent qualifies and is dual-eligible, there are no copays outside a nursing facility admission.7
• Your parent needs 24/7 skilled nursing: Nursing Facility Medicaid covers a certified nursing home.5

One more program worth knowing about: Community First Choice (CFC) is a Medicaid state plan option under Section 1915(k), not a waiver, so federal rules require Texas to offer it statewide and it carries no interest list.2 It's delivered through your STAR+PLUS MCO and covers personal assistance services, habilitation, emergency response, and support management.2 To get it you must be enrolled in Medicaid, qualify for care in an institution such as a hospital or nursing facility, and need help with activities of daily living or instrumental activities of daily living.2 Being on a waiver interest list doesn't rule you out. 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.