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 who have disabilities or are age 65 or older, 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) program adds, and how to use 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 Texas Medicaid launched it as a pilot in Harris County (Houston) in 1998, expanded it statewide by September 2014, and folded in nursing facility care in March 2015.9

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, provides person-centered service planning and coordination, and authorizes and manages your services, including attendant care.7

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 Spousal Protected Resource Amount that shields a community spouse's share of the couple's countable resources.10

The $994/month figure is the 2026 SSI federal benefit rate, the maximum federal SSI payment for an individual, not the amount any given recipient gets.11 For HCBS and nursing facility programs, the income limit is $2,982/month for an individual and $5,964 for a couple (300% of the SSI rate).3 The test is countable income, not gross, so run the count before assuming you are over. If countable income does exceed the limit, a Qualified Income Trust (QIT, sometimes called a Miller Trust) can divert income into a trust, after which it is not counted for institutional or waiver eligibility. A QIT settles the income test and nothing else: citizenship, residency, medical necessity, and your countable resources are all still tested.3

A single applicant's countable assets must stay at or below $2,000; the $3,000 couple limit applies to married adults living in the same household, while an institutional spouse is measured against the individual limit.4 Your home is an exempt resource when it is your or your spouse's principal place of residence, and one automobile and household goods and personal effects are exempt as well.4 The Spousal Protected Resource Amount is the greater of half the couple's countable resources or $32,532, capped at $162,660, but that cap binds only the standard calculation. A larger allowance ordered through a fair hearing or a court order is lawful, and HHSC publishes a worksheet for expanding the SPRA on appeal.10

Home equity works differently from the asset count. Equity above $752,000 does not make your home a countable asset; it makes you ineligible for Medicaid services in an institutional setting and denies you HCBS waiver services. A denial on this basis does not disqualify you from Qualified Medicare Beneficiary (QMB) or Specified Low-Income Medicare Beneficiary (SLMB) benefits, and a person already receiving Medicaid-certified long-term care facility services stays eligible for all other Medicaid benefits.12 The equity limit does not apply at all if your spouse, or your child who is under 21 or is blind or permanently and totally disabled, lawfully lives in the home.12 Two other routes lead past it: HHSC policy does not stop you from using a reverse mortgage or home equity loan to bring the equity down, and federal law requires a hardship-waiver process.4

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.

HHSC revises its service-area map as the lineup shifts; the August 2026 revision shows the same seven plans serving clients as of September 2026.2 Treat the pairings above as the September 2024 contract picture, and confirm your own area's choices against your enrollment packet before you pick a plan.

Choosing and Changing Your MCO

When you become eligible, the Enrollment Broker mails you a packet listing the MCOs in your area; if you don't choose within the enrollment window, one is assigned for you.

To change your health or dental plan, call the Enrollment Broker Helpline at 1-800-964-2777. A plan change takes 15 to 45 days to take effect.13

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.5 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

HHSC lists eight criteria for the STAR+PLUS HCBS program, not one:

• Nursing Facility Level of Care certification: an approved medical necessity for nursing-facility-level care1
• Age 21 or older. The 21-and-up floor is an HCBS rule, not a rule for base STAR+PLUS1
• Full Medicaid financial eligibility, U.S. citizenship, and Texas residency1
• Same income limit: $2,982/month3
• Same asset limit: $2,0004
• An unmet need for at least one STAR+PLUS HCBS service, an individual service plan whose services stay under the established cost limit, and an appropriate living situation1

Services Covered

STAR+PLUS Handbook §6113 sets the array of services your MCO must coordinate and deliver under your Individual Service Plan. A defined subset of them can be self-directed through the Consumer Directed Services option (see below):5

The Interest List

The STAR+PLUS HCBS program is not an entitlement, and Texas maintains an interest (wait) list for it.6 As of July 31, 2026, HHSC's published Rider 17 data put 13,519 people on that list, part of an unduplicated 200,128 Texans waiting across HHSC's six interest-list programs.6 HHSC republishes these counts monthly, so pull the current figure from its Interest List Reduction page rather than relying on this one. HHSC does not publish how it orders this particular list; first-come, first-served is the pattern MACPAC reports for 1915(c) waivers, and STAR+PLUS HCBS runs under Texas's 1115 demonstration instead.6

The list is not every applicant's door. HHSC's handbook routes the request by who you are. If you already receive SSI or another full Medicaid benefit, you never go on the STAR+PLUS HCBS interest list: if you are enrolled with a STAR+PLUS MCO, you are referred to that plan for the program, and a nursing facility resident enrolled with an MCO is referred to the plan for an upgrade. A nursing facility resident who is not enrolled is placed on the list under Money Follows the Person and immediately assigned. The applicant HHSC actually leaves waiting is the medical assistance only (MAO) applicant, someone not already on full Medicaid.6 While you wait for managed care enrollment, you are entitled to services from the Community Care for Aged and Disabled program, and HHSC must refer every full Medicaid recipient to it.6

Texas doesn't screen for eligibility before adding you to the list, so some applicants are denied when they reach the top.6 To get on the list, call 1-877-438-5658 and provide your name, address, phone, date of birth, and Social Security number.13

While waiting, look into Community First Choice (CFC). CFC is a Medicaid State Plan benefit under section 1915(k), not a 1915(c) waiver, and HHSC does not list it among the Texas programs that have interest lists; the six it does name are CLASS, DBMD, HCS, TxHmL, MDCP, and STAR+PLUS HCBS.14 It covers personal assistance, habilitation, emergency response services, and support management for people who are enrolled in Medicaid, qualify for an institutional level of care, and need help with activities of daily living or instrumental activities of daily living. HHSC says people already on a 1915(c)-waiver interest list may be able to get CFC services if they meet its requirements.14

How Services Get Authorized

Your Service Coordinator

Your MCO has to provide person-centered service planning and coordination for every STAR+PLUS and STAR+PLUS HCBS member, and everyone who applies for or receives long-term services and supports gets service coordination from the plan.7 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.7 How often your coordinator must contact you depends on which group you fall into. Every member gets at least one contact a year. 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. If you receive other long-term services and supports, have a history of behavioral health or substance use issues, or are dual-eligible with Medicare, you get at least one phone contact and at least one face-to-face contact a year. If you live in a nursing facility, you get at least four face-to-face visits a year, except when you are receiving hospice care or living outside the MCO's service area.7

Your ISP is reassessed annually, and your MCO must complete those annual assessment activities within 45 days of the ISP's expiration date. Your person-centered service plan must also be reviewed and revised at least every 12 months based on a reassessment of functional need, whenever your circumstances or needs change significantly, or at your own request.7

Requesting More Hours

If denied, see the appeals section below.

Getting a New Service Coordinator

To request a different coordinator, call your MCO's member services line (on your Medicaid card). If the MCO is unresponsive, call the HHSC Ombudsman at 1-866-566-8989.13

Consumer Directed Services

Under the CDS option, STAR+PLUS members hire and manage their own attendants instead of using an agency. The member or their legally authorized representative becomes the employer of record.15 Two limits matter up front. CDS is not available to members living in an adult foster care home or an assisted living facility, even though the waiver pays for both settings. And within STAR+PLUS HCBS, the services you can self-direct are a defined subset: in-home respite, skilled nursing, employment assistance, supported employment, physical therapy, occupational therapy, cognitive rehabilitation therapy, and speech-language therapy.5

CDS participants can:

• Recruit, hire, train, manage, and terminate their own service providers15
• Set attendant wages and benefits, within the funds allocated in the authorized service plan15
• Hire adult children, grandchildren, or other adult relatives as paid caregivers. HHSC lets a CDS employer hire family members, friends, and other people they know, and those relatives are not on its list of people barred from hire; that is a reading of the list rather than an HHSC statement about relatives, so confirm with your FMSA what your specific program allows. Every employee has to clear the same criminal history and background checks an agency's employees do15
• Some people cannot be hired: the person receiving services; that person's spouse (except in the Consumer Managed Personal Attendant Services program); the person's legally authorized representative, meaning a parent, guardian, managing conservator, or stepparent of someone under 18, or the guardian of a person of any age, plus that representative's spouse; and an appointed designated representative and their spouse15

For pay rates and enrollment steps, see our guide to getting paid as a family caregiver in Texas.

Financial management services are a required part of the CDS option, delivered by a Financial Management Services Agency (FMSA) under contract with your MCO.5 The FMSA processes payroll, pays employer taxes to the IRS and the Texas Workforce Commission on the employer's behalf, runs criminal history and registry checks on applicants, verifies each one against program requirements including Medicaid fraud exclusions, and files the employer tax and withholding reports. That does not move the liability off you: under IRS rules both the agent and the employer remain liable for the employment taxes, so you are still on the hook if the FMSA fails to pay.15

Appeals and Fair Hearings

When your MCO denies, reduces, or terminates services, you have the right to appeal.8

Appeals can be filed verbally, in person, or in writing; hearings are typically by conference call.

Keeping Your Services During an Appeal

If your MCO is reducing or terminating existing services and you appeal, you can ask for continuation of services at the current level while the appeal and hearing are pending. You must file that request by the later of 10 calendar days after the MCO sends its notice, or the intended effective date of the action.8 That is not simply a 10-day deadline: if the effective date falls after those 10 days, you still have until the effective date. Continuation only applies when the plan is cutting services it had already authorized; a first-time denial does not qualify.8

Then a second, much shorter clock starts. Once the MCO issues an adverse decision on your appeal, your continued services stop unless you request the State Fair Hearing and continuation of benefits within 10 calendar days of that notice. The deadline to request the hearing itself is 120 days, so a member who files on day 40 keeps the hearing and loses the service in the meantime.8 If the final resolution upholds the MCO, the plan may recover the cost of the services it continued while the appeal and hearing were pending.8

Moving Between Settings

From Nursing Facility to Community

STAR+PLUS Transition Assistance Services (TAS) helps members move from a nursing facility back home; once you decide to transition, your MCO service coordinator works with you on available living arrangements.16

TAS covers non-recurring setup expenses in five categories: security deposits, utility set-up fees and deposits, essential furnishings, moving expenses, and services that make the home safe to occupy, such as pest eradication or a one-time cleaning before you move in. It does not cover relocation services and will not help you find the residence itself.16 A nursing facility resident discharged into a waiver program can receive up to $2,500 in TAS, on a one-time-only basis.16

That $2,500 is not the ceiling. Supplemental Transition Services (STS), offered through the MCOs, adds a second one-time payment of up to $2,500 for a resident discharged into a waiver program, and it reaches items TAS cannot: a damage deposit, food, clothing, and other household start-up costs. Ask your MCO relocation specialist: STS normally comes only after TAS is exhausted, but it can be used alongside unspent TAS for items TAS cannot fund.16 TAS is not available to residents moving from a nursing facility into assisted living or adult foster care.16

Texas also participates in the federal Money Follows the Person (MFP) demonstration, which helps Medicaid beneficiaries living in institutions move into the community. Nursing facility residents who apply for STAR+PLUS HCBS through MFP are placed on the interest list by intake staff and immediately assigned, rather than waiting their turn on it.16

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).9 HCBS waiver services stop, but acute care benefits continue.

What to Expect When You Start

Early on, your MCO's service coordinator reaches out to assess your daily routine, the activities you need help with, and your medical conditions, and builds your ISP from that.7 If the network or the coordination disappoints you, you can change plans through the Enrollment Broker; the change takes 15 to 45 days.13 And if you are applying for HCBS without already being on full Medicaid, get on the interest list as early as you can, and use CAS or CFC while you wait.

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.