Texas STAR+PLUS: Who Qualifies and How to Enroll (2026)

If you are 65 or older in Texas and need long-term care, STAR+PLUS is most likely the Medicaid program you will be enrolled in.1 It is the state's managed care system for adults 21 and older who have disabilities or are age 65+, delivering acute medical care and long-term services through private managed care organizations (MCOs) across 13 service areas statewide.1 This guide covers how the program works, who qualifies, what the STAR+PLUS Home and Community-Based Services (HCBS) waiver adds, and how to get the most out of your benefits.

In This Guide

• Key Takeaways
• The Texas Star Plus Program
• Texas STAR+PLUS Eligibility
• Managed Care Organizations
• The STAR+PLUS HCBS Waiver
• How Services Get Authorized
• Consumer Directed Services
• Appeals and Fair Hearings
• Moving Between Settings
• Frequently Asked Questions
• Next Steps

The Texas Star Plus Program

STAR+PLUS (State of Texas Access Reform Plus) combines acute care and long-term services and supports (LTSS) under a single managed care organization.1 Before STAR+PLUS, Texas Medicaid used a fee-for-service model where no entity coordinated a member's care across different providers. STAR+PLUS launched as a pilot in Harris County (Houston) in 1998, expanded statewide by September 2014, and absorbed nursing facility care in March 2015.1

Under STAR+PLUS, your MCO:

• Receives a monthly capitation payment from HHSC for each member
• Builds a network of doctors, hospitals, pharmacies, and home health agencies
• Assigns you a service coordinator
• Authorizes and manages all your services, including attendant care

Base STAR+PLUS covers physician visits, hospital care, prescriptions, behavioral health, vision, personal attendant services, and day activity and health services.1 See our guide to Texas Medicaid covered services for the full list. The HCBS waiver (covered below) adds services for those who need nursing-home-level care at home.

Texas STAR+PLUS Eligibility

To qualify for STAR+PLUS as a senior, you must be approved for Texas Medicaid and meet one of these criteria: age 65 or older, receiving SSI, or have a qualifying disability.1 The 2026 financial limits are summarized below, including the Community Spouse Resource Allowance that protects a married couple's assets.8

The $994/month figure is the 2026 SSI Federal Benefit Rate.9 For HCBS waiver and nursing facility programs, the income limit rises to $2,982/month (300% of SSI).3 If income exceeds this, a Qualified Income Trust (Miller Trust) can redirect excess income to establish eligibility.

A single applicant's countable assets must stay at or below $2,000.4 Your home is exempt from the asset count if equity is at or below $752,000, or if a spouse or qualifying family member lives there.10 One vehicle, household goods, and pre-paid irrevocable funeral contracts are also exempt.

Managed Care Organizations

Seven MCOs serve STAR+PLUS as of September 1, 2024.2 Each of the 13 service delivery areas (SDAs) has at least two MCOs to choose from.

Choosing and Changing Your MCO

When you become eligible for STAR+PLUS, the Enrollment Broker (Maximus) mails you an enrollment packet listing available MCOs in your area. If you don't choose within the enrollment window, one is assigned automatically.

You can change MCOs during the first 90 days. After that, you can switch monthly by calling the Enrollment Broker at 1-800-964-2777 (8 a.m. to 6 p.m. CT, Monday through Friday).11 Changes take effect the first of the following month or the month after, depending on timing.

The STAR+PLUS HCBS Waiver

The STAR+PLUS HCBS waiver (sometimes called the "starplus waiver Texas" or STAR+PLUS Home and Community-Based Services program) is a 1915(c) Medicaid waiver that provides additional services beyond base STAR+PLUS.1 It's designed for members who meet Nursing Facility Level of Care (NFLOC) but can be safely served at home or in the community. For a comparison of all Texas HCBS waiver programs (including CLASS, DBMD, HCS, and others), see our comprehensive waiver guide.

Eligibility Beyond Base STAR+PLUS

The STAR+PLUS HCBS waiver requires everything base STAR+PLUS does, plus:

• Nursing Facility Level of Care certification (your care needs must be significant enough to justify nursing home placement)
• Same income limit: $2,982/month3
• Same asset limit: $2,0004
• Ability to be safely served in the community

Services Covered

The waiver covers 19+ services, many of which can be consumer-directed:1

The Interest List

The STAR+PLUS HCBS waiver is not an entitlement. It's capped at approximately 24,000 slots.5 As of late 2025, roughly 15,850 people were on the interest list, which operates first-come, first-served.5

Texas doesn't screen for eligibility before adding you to the list.5 Some applicants are denied when they reach the top. To get on the list, call 1-877-438-5658 and provide your name, address, phone, date of birth, and Social Security number.11

While waiting, look into Community First Choice (CFC), a Medicaid entitlement with no waitlist that provides personal assistance and habilitation services to anyone meeting institutional level of care.12

How Services Get Authorized

Your Service Coordinator

Every STAR+PLUS member is automatically assigned a service coordinator by their MCO.6 The coordinator assesses your goals and needs and develops your Individual Service Plan (ISP) with you, your family, and your providers, then authorizes your long-term services and supports.6 If you receive STAR+PLUS HCBS or have a complex medical condition, your MCO must visit you face-to-face at least twice a year.6

Your ISP is reviewed and updated on a recurring basis. If your needs change between assessments, contact your service coordinator to request a reassessment and ISP revision.

Requesting More Hours

If denied, see the appeals section below.

Getting a New Service Coordinator

To request a different service coordinator, call your MCO's member services line (on your Medicaid card). If your MCO is unresponsive, contact the HHSC Ombudsman at 1-866-566-8989.11

Consumer Directed Services

Under the CDS option, STAR+PLUS members hire and manage their own attendants instead of using an agency.13 The service coordinator must present the CDS option to every member annually.

CDS participants can:

• Recruit, hire, train, and supervise their attendants
• Set work schedules
• Hire adult children, grandchildren, or other adult relatives as paid caregivers
• Your spouse can't be hired as a paid attendant, and a legally authorized representative of a minor recipient (or that representative's spouse) is also barred13

For pay rates, step-by-step enrollment, and which family members qualify, see our guide to getting paid as a family caregiver in Texas.

A Financial Management Services Agency (FMSA) handles payroll, taxes, and workers' compensation. The member directs the care; the FMSA handles the paperwork.13

Appeals and Fair Hearings

When your MCO denies, reduces, or terminates services, you have the right to appeal.7

Appeals can be filed verbally, in person, or in writing. State Fair Hearings are typically conducted by conference call.

Keeping Your Services During an Appeal

If your MCO is reducing or terminating existing services and you request a fair hearing, you can ask for continuation of services at the current level while the hearing is pending.7 If the hearing upholds the MCO's decision, you may need to pay back the cost of continued services.

Moving Between Settings

From Nursing Facility to Community

STAR+PLUS Transition Assistance Services (TAS) helps members move from a nursing facility back home.14 Once a member decides to transition, the MCO service coordinator works with them on available living arrangements.

TAS covers non-recurring setup expenses: security deposits, utility hookups, basic furnishings, cleaning supplies, and moving costs.14

Texas also participates in the federal Money Follows the Person (MFP) demonstration, which helps Medicaid members move from institutions into community living and places MFP participants at the top of the STAR+PLUS HCBS interest list.14

From Community to Nursing Facility

If a member's needs can no longer be safely met at home, the service coordinator works with them to arrange nursing facility admission. The member stays enrolled in STAR+PLUS (nursing facility care has been part of the program since March 2015).1 HCBS waiver services stop, but acute care benefits continue.

What to Expect Your First 90 Days

The first three months in STAR+PLUS set the tone for your experience. Early on, your MCO's service coordinator reaches out to conduct an assessment.6 They'll ask about your daily routine, what activities you need help with, and your medical conditions, and use that to build your ISP.

During these first 90 days, you can also change MCOs freely if you're not satisfied with the provider network or service coordinator quality. After 90 days, plan changes still happen monthly through the Enrollment Broker.

If you're applying for the HCBS waiver, make sure to get on the interest list as early as possible. The wait can be long, and you can use CAS or CFC in the meantime.

Next Steps

Learn More

Find personalized help with the STAR+PLUS waiver 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.