STAR+PLUS Waiver Texas: Eligibility, How to Apply, and the Interest List

STAR+PLUS is Texas's most comprehensive home care program for seniors — and the hardest one to get into. It covers personal attendant services, home modifications, medical equipment, respite care, and even assisted living through Medicaid. The catch is a waitlist that runs 6 to 18 months in most parts of the state. Here's how the program works, who qualifies, and what to do while you wait.

What STAR+PLUS Covers

STAR+PLUS is Texas's mandatory Medicaid managed care program for adults 65+ and adults with qualifying disabilities. The base program covers primary and acute medical care — doctor visits, prescriptions, hospitalizations. The STAR+PLUS Home and Community Based Services (HCBS) waiver adds the intensive home-based services that keep people out of nursing facilities:

• Personal attendant services — bathing, dressing, grooming, meal preparation, medication reminders
• Minor home modifications — grab bars, wheelchair ramps, widened doorways, roll-in showers (up to $7,500 lifetime benefit)
• Adaptive aids and medical equipment — hospital beds, wheelchairs, personal emergency response systems
• Respite care — up to 30 days (720 hours) per year for caregiver relief, delivered at home or in a facility
• Adult day care through Day Activity and Health Services (DAHS) centers
• Assisted living for individuals who need more support than home care alone provides but don't require skilled nursing
• Consumer Directed Services (CDS) — hire and manage your own attendants, including adult children, through an FMSA

HHSC divides the state into 13 Service Delivery Areas (SDAs). Within each SDA, at least two Managed Care Organizations (MCOs) — Molina, UnitedHealthcare Community Plan, Superior HealthPlan, or others — build provider networks and coordinate care.

Eligibility: Two Gates

Qualifying for the STAR+PLUS HCBS waiver requires passing both a financial and clinical gate:

Financial eligibility:

• Gross monthly income at or below $2,982 (2026 limit). Income above this requires a Miller Trust.
• Countable assets at or below $2,000 for a single applicant. Exempt assets: primary residence (equity under $752,000), one vehicle, personal effects, irrevocable burial funds.

Clinical eligibility:

• Must meet the Nursing Facility Level of Care (NFLOC) standard. This means the applicant's physical and cognitive needs are significant enough to justify nursing home placement — even though they'll receive services at home. The determination is made through a home-based functional assessment conducted by the MCO.

The Interest List: How It Works

The HCBS waiver is not an entitlement — it's capped by legislative funding. When all funded slots are full, applicants go on the statewide interest list. In mid-2026, over 14,400 individuals were waiting, with typical delays of 6–18 months depending on the metro area. DFW tends toward the longer end; smaller markets sometimes move faster.

Your place on the list is determined by your interest list date — the date HHSC records your request. This is why getting on the list early matters, even if your parent isn't ready for services yet. The date stamps your position; services start when your slot opens.

To get on the interest list: call 1-877-438-5658, visit a local HHSC benefits office, or apply through the Your Texas Benefits portal. Ask specifically for placement on the STAR+PLUS HCBS waiver interest list. You can also ask your local Area Agency on Aging or ADRC to submit the request during options counseling.

Your MCO Service Coordinator

Once a waiver slot opens and your parent is enrolled, the MCO assigns a service coordinator — a case manager who:

• Conducts the initial home-based functional assessment
• Develops the person-centered service plan (hours, services, delivery model)
• Authorizes care hours and equipment
• Reviews and adjusts the service plan at least annually or when needs change
• Acts as your primary point of contact for questions, changes, and problems

The service coordinator determines how many personal care hours your parent receives per week based on the functional assessment. If you disagree with the authorized hours — a common friction point — you can file an internal appeal with the MCO within 60 days. If the MCO upholds its decision, you can request a State Fair Hearing through HHSC within 120 days. To keep current services running during the appeal, request continuation of services within 10 days of the MCO's notice.

What to Do While You Wait

The interest list doesn't have to mean a gap in care. Three immediate alternatives:

1. Community First Choice (CFC) — a no-waitlist Medicaid entitlement covering personal attendant services. Same NFLOC clinical threshold, same CDS option, but without home modifications or respite. Learn more about CFC.

2. Community Attendant Services (CAS) — a Title XIX Medicaid entitlement for individuals with physical disabilities. No waitlist. Same income cap ($2,982) and asset limit ($2,000).

3. Primary Home Care (PHC) — another no-waitlist Medicaid entitlement for individuals already enrolled in SSI-linked Medicaid.

Apply for the waiver to lock in your interest list date, then apply for any qualifying program that can be authorized while you wait. When the waiver slot opens, coordinate with the MCO to move into the broader STAR+PLUS service package.

The Aging in Place in Texas guide includes the complete STAR+PLUS application checklist, MCO coordination timeline, appeal letter templates, and the bridge-strategy workflow for covering care during the waitlist period.

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