The Texas STAR+PLUS program is the state's Medicaid managed care system for adults 21 and older who have disabilities or are age 65+. It delivers acute medical care and long-term services through private managed care organizations (MCOs) operating across 13 service areas statewide. This guide covers how the program works, who qualifies, what the STAR+PLUS 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
Key Takeaways
- STAR+PLUS is Texas's Medicaid managed care program for adults with disabilities or age 65+. Seven MCOs operate across 13 service areas.
- Income limit: $2,982/month (300% of SSI). Asset limit: $2,000 for a single applicant.
- The HCBS waiver adds 19+ home and community services for members who need nursing-home-level care. Roughly 15,850 people are on the interest list.
- Every member gets a service coordinator who visits within 30 days and develops an Individual Service Plan.
- If your MCO denies services, you can appeal within 60 days. A State Fair Hearing decision must come within 90 days.
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. 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.
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. 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.
| Requirement | Amount |
|---|---|
| Income limit (SSI pathway) | $994/month |
| Income limit (institutional/waiver programs) | $2,982/month (300% of SSI FBR) |
| Asset limit (single) | $2,000 |
| Asset limit (couple, both applying) | $3,000 |
| Community Spouse Resource Allowance | $32,532 to $162,660 |
| Home equity limit | $752,000 |
The $994/month figure is the 2026 SSI Federal Benefit Rate. For HCBS waiver and nursing facility programs, the income limit rises to $2,982/month (300% of SSI). If income exceeds this, a Qualified Income Trust (Miller Trust) can redirect excess income to establish eligibility.
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. One vehicle, household goods, and pre-paid irrevocable funeral contracts are also exempt.
Not sure if you meet the eligibility requirements? Ask Brevy's chatbot to check based on your specific situation.
Managed Care Organizations
Seven MCOs serve STAR+PLUS as of September 1, 2024. Each of the 13 service delivery areas (SDAs) has at least two MCOs to choose from.
| MCO | Service Areas |
|---|---|
| Molina Healthcare of Texas | Bexar, Dallas, El Paso, Harris, Hidalgo, Tarrant |
| UnitedHealthcare Community Plan | Bexar, Dallas, Harris, Hidalgo, Travis, Northeast MRSA |
| Superior HealthPlan | Central MRSA, Dallas, Hidalgo, Lubbock, Nueces, Travis, West MRSA |
| Wellpoint (formerly Amerigroup) | Jefferson, Lubbock, Nueces, Tarrant, West MRSA |
| Community First Health Plans | Bexar |
| El Paso Health | El Paso |
| Community Health Choice Texas | Harris |
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). 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. 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/month
- Same asset limit: $2,000
- Ability to be safely served in the community
Services Covered
The waiver covers 19+ services, many of which can be consumer-directed:
| Service | Description |
|---|---|
| Personal Assistance (PAS/CAS) | ADL help: bathing, dressing, grooming, toileting, eating |
| In-home nursing | Skilled nursing for long-term needs at home |
| Respite care (in-home) | Temporary relief for family caregivers |
| Respite care (out-of-home) | Respite in a facility setting |
| Emergency response services | Personal alert button/system |
| Home-delivered meals | Meal delivery for homebound members |
| Minor home modifications | Ramps, grab bars, widened doorways |
| Adaptive aids and medical supplies | Specialized equipment for daily living |
| Adult foster care | 24-hour care in a family-like home |
| Assisted living | Care in a licensed assisted living facility |
| Dental services | Dental care beyond regular Medicaid |
| Physical therapy | Physical rehabilitation |
| Occupational therapy | Functional rehabilitation |
| Speech-language therapy | Communication and swallowing therapy |
| Cognitive rehabilitation therapy | Therapy for cognitive impairments |
| Financial Management Services | Payroll/compliance for consumer-directed care |
| Transition assistance | Help moving from nursing facility to community |
| Employment assistance | Help finding and keeping a job |
| Supported employment | Ongoing support in a work setting |
The Interest List
The STAR+PLUS HCBS waiver is not an entitlement. It's capped at approximately 24,000 slots. As of late 2025, roughly 15,850 people were on the interest list, which operates first-come, first-served.
Texas doesn't screen for eligibility before adding you to the list. 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.
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.
Want help understanding the HCBS waiver interest list? Chat with Brevy for guidance on your options while you wait.
How Services Get Authorized
Your Service Coordinator
Every STAR+PLUS member is automatically assigned a service coordinator by their MCO. The coordinator visits within 30 days of enrollment, assesses your goals and needs, and develops your Individual Service Plan (ISP). After that, you'll receive at least two face-to-face visits per year.
The ISP is re-entered into the Service Authorization System Online (SASO) annually. If your needs change between assessments, contact your service coordinator to request a reassessment and ISP revision.
Requesting More Hours
- Contact your service coordinator and explain what changed
- The coordinator schedules a reassessment visit
- Based on the updated assessment, the coordinator develops a revised ISP documenting why additional services are medically necessary
- The MCO reviews and authorizes (or denies) the request
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.
Consumer Directed Services
Under the CDS option, STAR+PLUS members hire and manage their own attendants instead of using an agency. 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 or grandchildren as paid caregivers
- Spouses and parents can't be hired as paid attendants
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.
Interested in hiring a family member as a paid caregiver? Ask Brevy's chatbot how CDS works for your situation.
Appeals and Fair Hearings
When your MCO denies, reduces, or terminates services, you have the right to appeal.
| Step | Deadline | Resolution Time |
|---|---|---|
| MCO internal appeal | Within 60 days of notice | MCO has 30 days to decide |
| Expedited MCO appeal | For urgent situations | MCO has 4 business days |
| State Fair Hearing | Within 120 days of MCO decision | HHSC has 90 days to decide |
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. 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. Within 14 business days of learning a member wants to transition, the MCO service coordinator discusses available living arrangements.
TAS covers non-recurring setup expenses: security deposits, utility hookups, basic furnishings, cleaning supplies, and moving costs. After TAS is exhausted, Supplemental Transition Services (STS) provides up to $2,500 one time for additional setup expenses.
The federal Money Follows the Person program has helped over 49,000 Texans move from nursing facilities back to their communities. Post-relocation, a specialist contacts the member at least 7 times over 90 days to make sure the transition is working.
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). HCBS waiver services stop, but acute care benefits continue.
Frequently Asked Questions
STAR+PLUS is the base managed care program covering medical services for all eligible adults. The HCBS waiver is an add-on for members who need nursing-home-level care but want to stay at home. The waiver unlocks extra services like home modifications, adaptive aids, adult foster care, assisted living, and dental.
No waitlist for base STAR+PLUS. If you qualify for Medicaid, you're enrolled. The HCBS waiver does have a waitlist with approximately 15,850 people on it. Community First Choice (CFC) is an alternative with no waitlist for those who meet institutional level of care.
Compare provider networks in your area. Check if your current doctors are in the MCO's network. Call the Enrollment Broker at 1-800-964-2777 for help comparing options. You can switch MCOs during the first 90 days and monthly thereafter. Our managed care plan comparison guide breaks down what each MCO offers.
Only if your doctor is in your MCO's provider network. Before choosing an MCO, verify your preferred doctors participate. If you switch MCOs, check the new network before the change takes effect.
What to Expect Your First 90 Days
The first three months in STAR+PLUS set the tone for your experience. Within 30 days of enrollment, your MCO's service coordinator visits your home and conducts an assessment. During this visit, they'll ask about your daily routine, what activities you need help with, and your medical conditions. Based on this assessment, they 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.
Questions about getting started with STAR+PLUS? Brevy's chatbot can help you prepare for what comes next.
Next Steps
- Apply for Medicaid at YourTexasBenefits.com, by phone at 2-1-1, or at an HHSC office. See our guide to applying for Texas Medicaid.
- Choose an MCO when your enrollment packet arrives, or call the Enrollment Broker at 1-800-964-2777.
- Contact your service coordinator within the first week to start your Individual Service Plan.
- Get on the HCBS waiver interest list if you may need waiver-level services. Call 1-877-438-5658. Use CAS or CFC while you wait.
- Call the ADRC at 1-855-937-2372 for free help sorting through your options. They cover all 254 Texas counties.
For a broader view of all Texas Medicaid options for seniors, see our guide to Texas Medicaid programs.
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The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Medicaid rules vary by state and change frequently. Always verify eligibility and benefits with your state Medicaid agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.