Medicaid Waiver Waitlist Texas: How Long and What to Do While You Wait

How Long the Wait Actually Is

The STAR+PLUS HCBS waiver interest list in Texas had over 14,400 people waiting as of mid-2026. Wait times vary significantly by Service Delivery Area:

• Dallas-Fort Worth: 8–14 months typical
• Houston/San Antonio: 6–12 months
• Other areas: plan around a broader estimate of 6–18 months; HHSC does not publish a verified county-specific range, and provider availability may affect the actual start date

These are estimates based on recent throughput — HHSC doesn't publish official wait time projections. The interest list operates first-come, first-served within each Service Delivery Area. Your parent's position depends on when they registered, not on how severe their needs are.

Why the Wait Exists

Unlike Primary Home Care and Community Attendant Services, which are Medicaid state-plan entitlements (everyone who qualifies gets served), the STAR+PLUS HCBS waiver is a federal waiver program with a legislative funding cap. Texas only has slots for a fixed number of waiver recipients at any given time. New slots open as existing recipients leave the program — through death, transition to a nursing facility, loss of eligibility, or voluntary disenrollment.

The mismatch between demand and capacity is structural. Texas's population over 65 is growing faster than waiver funding, and each legislative session decides whether to add new slots.

Get on the List Immediately — Even If You're Not Sure

Register on the interest list on Day 1 of the planning process. Even if your parent doesn't need waiver services right now, the clock only starts when you register. Families who wait until the need is urgent find themselves facing a 6–14 month gap with no waiver-level services.

To register:

1. Log into the Your Texas Benefits portal (yourtexasbenefits.com) and complete the initial application, or
2. Call 1-877-438-5658 and request placement on the STAR+PLUS HCBS waiver interest list

Registration establishes the official file date. When a slot opens, HHSC contacts families in file-date order.

Three Programs You Can Access While Waiting

The interest list wait doesn't mean your parent gets nothing. These Medicaid programs are entitlements with no waitlist:

Primary Home Care (PHC): Covers personal attendant services for SSI-linked Medicaid recipients. Requires a documented functional limitation certified by a doctor on Form 3052. No asset test beyond existing SSI eligibility.

Community Attendant Services (CAS): Covers personal care for individuals with physical disabilities meeting the $2,982 income cap and $2,000 asset limit. Requires a minimum score of 24 on the Form 2060 functional assessment. No waitlist — qualifying individuals must be authorized once eligibility is confirmed.

Community First Choice (CFC): A federal entitlement program for Medicaid-eligible individuals who meet an institutional level of care. CFC covers personal attendant services, habilitation, and backup emergency response systems. Like PHC and CAS, there's no interest list — it's available to anyone who qualifies.

All three programs allow the Consumer Directed Services option, so your parent can hire family members as paid caregivers while waiting for the waiver slot to open.

The Money Follows the Person Bypass

If your parent is currently in a nursing facility — whether on a private-pay stay, a Medicare-covered post-hospital stay, or a Medicaid-funded placement — the Money Follows the Person (MFP) program can bypass the interest list entirely. MFP allows nursing facility residents to transition directly to home-based STAR+PLUS HCBS services as soon as clinical and financial eligibility are confirmed.

For a resident in a nursing facility, this is a direct-transition route that may bypass the interest list. The resident must meet HCBS eligibility (NFLOC, income cap, asset limit) and have a safe discharge plan; ask the nursing facility social worker or MCO to confirm the current MFP requirements, including any required length of stay.

MFP was designed to reduce institutional placement, so the state actively facilitates these transitions. Ask the nursing facility social worker or your parent's MCO about MFP eligibility.

What Happens When Your Slot Opens

When your parent's name reaches the top of the list, HHSC sends a notification letter. The family must respond by the deadline in that notice; if the family does not respond, contact HHSC immediately to confirm whether the offer remains available.

After accepting:

1. The MCO assigns a service coordinator for an in-home assessment
2. The service coordinator develops an Individual Service Plan (ISP) authorizing specific services and hours
3. The family chooses between agency-directed care and CDS
4. Services begin after the ISP is approved; the MCO will provide the service start date

Planning for the Wait

The Aging in Place in Texas guide covers the full waitlist management strategy — registering for the interest list, applying for bridge programs like PHC and CAS, setting up CDS so a family member gets paid while waiting, and the MFP bypass pathway for families with a parent currently in a facility. It also includes the MCO appeal process in case authorized hours are cut once services begin.

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