Medicaid Assisted Living Texas: How STAR+PLUS Covers Facility Care

Your parent needs assisted living but can't afford $5,666 per month out of pocket. You've heard Medicaid can help, but the details are unclear — does Texas Medicaid actually pay for assisted living? What does it cover? And how long is the wait?

The short answer: yes, Texas Medicaid covers assisted living, but only the care component, through a specific waiver program with a significant waitlist. Here's exactly how it works.

STAR+PLUS HCBS Waiver: The Only Medicaid Path to Assisted Living

Texas does not cover assisted living under its standard Medicaid program. The coverage comes through the STAR+PLUS Home and Community-Based Services (HCBS) waiver — a separate program with its own enrollment limits.

The STAR+PLUS HCBS waiver covers the cost of care services delivered in an assisted living facility:

• Personal attendant services (bathing, dressing, transfers, medication management)
• Nursing services
• Adaptive aids and medical supplies
• Service coordination

What it does not cover: Room and board. This is the biggest surprise for most families. The waiver pays for the care — the aides, the nursing, the services — but the facility's housing, meals, utilities, and housekeeping are the resident's responsibility.

Room and board in a Texas assisted living facility typically runs $1,500-$2,500/month. Families pay this from the resident's Social Security income, pension, or other personal funds. After Medicaid takes its share for the care costs (through the patient share calculation), the remaining income goes toward room and board.

Financial Eligibility

To qualify for the STAR+PLUS HCBS waiver, your parent must meet Texas Medicaid financial criteria:

Income limit: $2,982/month gross (300% of the SSI Federal Benefit Rate for 2026). This is a hard cap — there is no "spend-down" option in Texas where medical expenses reduce countable income.

If income exceeds $2,982: A Qualified Income Trust (QIT), commonly called a Miller Trust, must be established. The QIT is a dedicated bank account that receives the specific income sources causing the excess. This is the only legal mechanism to overcome the income cap.

Asset limit: $2,000 in countable assets for an individual. Exempt assets include the primary home (equity up to $752,000), one vehicle, personal belongings, and irrevocable burial trusts.

Spousal protections: If your parent is married, the community spouse retains a Community Spouse Resource Allowance of up to $162,660 in 2026. The community spouse's monthly income is protected up to $4,066.50 through the Monthly Maintenance Needs Allowance.

Clinical Eligibility

Financial eligibility alone is not enough. The applicant must also meet the Nursing Facility Level of Care (NFLOC) clinical standard — essentially proving they need the level of care a nursing home provides, even though they're choosing assisted living instead.

The clinical assessment evaluates functional limitations in ADLs, cognitive impairment, and behavioral health needs. Managed Care Organizations (MCOs) like UnitedHealthcare, Molina, and Superior conduct these assessments and must complete them within 45 days of referral.

The Waitlist Reality

Unlike nursing home Medicaid (which is an entitlement — if you qualify, you get it), the STAR+PLUS HCBS waiver is capped by state funding. Texas maintains a Community Services Interest List (CSIL) for applicants waiting for waiver slots.

Current wait times by region:

These timelines mean you should apply as soon as your parent shows signs of decline — not when they actually need placement. Getting on the interest list is free and commits you to nothing. Waiting until the need is urgent means your parent will spend months paying private rates while the application processes.

Choosing a Participating Facility

Not all Texas assisted living facilities accept STAR+PLUS waiver payments. Before touring, ask two questions:

1. Do you have a contract with any STAR+PLUS MCO? The facility must have an active provider agreement with the Managed Care Organization assigned to your parent.
2. What is your Medicaid bed capacity? Some facilities limit the number of Medicaid-funded residents they accept, even if they participate in the program. A facility with a "waitlist for Medicaid beds" is a separate queue on top of the state waiver waitlist.

Starting with a facility that accepts STAR+PLUS from day one prevents a forced move later. If your parent enters a private-pay facility and later needs Medicaid, they may have to relocate to a participating facility — an enormously disruptive transition for someone with declining cognitive function.

Nursing Home Medicaid: The Alternative

If the STAR+PLUS waiver waitlist is too long and your parent's care needs justify it, nursing home Medicaid is an entitlement with no waitlist. Same financial criteria (income under $2,982 or with QIT, assets under $2,000), but the clinical threshold is higher — the applicant must need 24-hour nursing supervision.

Nursing home Medicaid covers everything — care, room, and board. No separate housing payment. Semi-private rooms average $5,627/month in Texas.

The trade-off is obvious: assisted living preserves more independence and autonomy, but the waiver coverage has gaps (no room and board) and delays (the waitlist). Nursing home Medicaid is comprehensive and immediate, but the setting is more institutional.

How to Position Your Family

The strategic sequence: apply for the STAR+PLUS waiver interest list as early as possible, plan privately for the waiting period, and use Community Attendant Services (CAS) as a bridge if your parent qualifies for non-medical home care while waiting.

The Texas Care Decision Toolkit includes a waiver pathway guide, a financial snapshot worksheet for calculating Medicaid eligibility, and a facility comparison checklist that identifies which facilities in your target area accept STAR+PLUS waiver payments.

See more Texas guides →