STAR Plus Texas Medicaid: Eligibility, Enrollment, and What Families Need to Know

STAR+PLUS is how Texas delivers Medicaid long-term care services to seniors and people with disabilities. It covers both nursing facility care and the Home and Community-Based Services (HCBS) waiver — which is the program that lets your parent stay at home with paid support instead of moving to a nursing home.

Understanding how STAR+PLUS works is essential because it's the only state-funded pathway to in-home care for most Texas families who can't afford $7,000–$8,000 per month in private-pay nursing costs.

Eligibility Requirements (2026)

Income Limit

The applicant's gross monthly income must be $2,982 or less. This includes Social Security, pensions, retirement distributions, and any other income. If your parent earns even one dollar over this cap, they're disqualified — unless they establish a Qualified Income Trust (Miller Trust) to legally shelter the excess.

Asset Limit

Countable resources must be $2,000 or less for the applicant. The primary home (up to $752,000 in equity) and one vehicle are exempt.

Spousal Protections

If the parent has a spouse still living at home, federal spousal impoverishment rules apply:

• Community Spouse Resource Allowance (CSRA): The at-home spouse can keep 50% of the couple's combined countable assets, with a floor of $32,532 and a ceiling of $162,660
• Monthly Maintenance Needs Allowance (MMNA): The at-home spouse is entitled to income support ranging from $2,705 to $4,066.50 per month

Clinical Requirement

The applicant must meet nursing facility level of care — meaning their physical or cognitive condition requires the type of ongoing care a nursing home provides, even if they'll actually receive that care at home through the HCBS waiver.

The Interest List (Waiting Period)

STAR+PLUS HCBS has an interest list. You join by calling 2-1-1 or registering at YourTexasBenefits.com. HHSC does not pre-screen applicants when they join — eligibility is determined later when your name comes up.

Wait times vary significantly by region:

• Harris/Bexar County: 6–12 months
• Dallas-Fort Worth: 8–14 months
• Travis County (Austin): 8–16 months
• Rural areas: 3–8 months

Get on the list early, even if you're not sure your parent will need services immediately. There's no cost or obligation, and the wait time is dead time you can use to prepare the financial and legal groundwork.

What STAR+PLUS HCBS Actually Provides

Once enrolled, the parent is assigned to a Managed Care Organization (MCO) that coordinates their care plan. Services can include:

• Personal attendant services (bathing, dressing, mobility assistance)
• Skilled nursing visits
• Physical, occupational, and speech therapy
• Adaptive aids and medical equipment
• Home modifications (ramps, grab bars, widened doorways)
• Emergency response systems
• Adult day care
• Respite care for the primary caregiver

The care plan is built after a comprehensive 33-page Medical Necessity and Level of Care (MN/LOC) assessment conducted by an MCO nurse.

Consumer Directed Services (CDS)

If the family wants to hire a specific person as the caregiver — including an adult child, relative, or friend — they can select the Consumer Directed Services option during care plan development. Under CDS:

• The parent (or their representative) selects, trains, and supervises the attendant
• A Financial Management Services Agency (FMSA) handles payroll and tax withholding
• Caregiver pay typically ranges from $10–$17 per hour depending on the MCO and region

Restriction: Spouses and legal guardians cannot be hired as CDS attendants. Adult children can, which is one reason families pursue this option.

The Legal Authority You Need

Applying for STAR+PLUS, signing enrollment forms, and opening a Miller Trust all require legal authority to act on the parent's behalf if they've lost cognitive capacity. Without a valid Statutory Durable Power of Attorney (SDPOA) that specifically authorizes government benefits applications and trust creation, you'll hit a wall at the enrollment stage.

The Texas Power of Attorney & Guardianship Kit covers the complete legal setup — POA execution, Miller Trust establishment, and Medicaid application preparation — so you're ready to act the moment your parent's name reaches the top of the interest list.

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