Texas Medicaid for senior care is one of the most misunderstood parts of the long-term care system. Families hear the word “Medicaid” and assume it only pays for nursing homes — or that they have to give up everything they own to qualify. Neither is accurate. Texas’s STAR+PLUS program funds care in homes, assisted living communities, and nursing facilities for eligible Texans. This guide explains how it actually works — who qualifies, what it covers, what it doesn’t, and how to navigate the application process.

What Is STAR+PLUS?

STAR+PLUS (State of Texas Access Reform Plus) is the Texas Medicaid managed care program for adults aged 21 and older who are disabled, aged, or blind. It combines medical benefits (doctor visits, medications, hospital care) with long-term services and supports (LTSS) — which is the component that funds in-home care, assisted living, and nursing home care.

STAR+PLUS is administered through managed care organizations (MCOs) — private insurers contracted by Texas HHSC to coordinate benefits for Medicaid members. The major MCOs in Texas include Molina Healthcare, Superior HealthPlan, Aetna Better Health, and UnitedHealthcare Community Plan. Your MCO determines which specific services you receive and which providers are in network.

Who Qualifies for STAR+PLUS Long-Term Care?

STAR+PLUS LTSS eligibility requires meeting two separate sets of criteria: financial eligibility and functional (clinical) eligibility. Both must be met.

Financial Eligibility

For the long-term services component, a single individual can generally have no more than $2,000 in countable assets and income at or below 300% of the federal poverty level (approximately $2,742/month in 2026 for an individual). The family home, one vehicle, personal property, and pre-paid burial arrangements are typically exempt from the asset limit. Married couples have different calculations that protect the community spouse’s resources.

Functional (Clinical) Eligibility

In addition to financial criteria, STAR+PLUS LTSS applicants must meet “nursing facility level of care” — meaning their care needs are significant enough that without community services, they would need to live in a nursing facility. A Texas HHSC assessor evaluates functional status, cognitive status, medical needs, and caregiver availability to determine whether this threshold is met.

The 5-Year Look-Back Period

Texas Medicaid reviews asset transfers made in the 5 years before application. If assets were transferred for less than fair market value during this period, Medicaid imposes a penalty period of ineligibility calculated based on the value transferred. This is why Medicaid planning with an elder law attorney — done well before a crisis — is so important. Transfers made during a crisis often create penalty periods that leave families without coverage precisely when they need it.

What STAR+PLUS Covers for Long-Term Care

STAR+PLUS LTSS covers a range of community-based and institutional services. The specific services available depend on which waiver program a member is enrolled in.

Community First Choice (CFC)

CFC is the primary personal care benefit under STAR+PLUS — it funds personal attendant services (help with bathing, dressing, meal prep, mobility) for members who live at home or in an assisted living community and meet the nursing facility level of care standard. CFC is an entitlement — every eligible person who applies and qualifies must be served (no waiting list).

HCBS Waiver (Home and Community-Based Services)

The HCBS waiver funds a broader range of services including assisted living room and board support, adult day services, cognitive rehabilitation, and supported employment. Unlike CFC, HCBS waiver services may have waiting lists — particularly in major Texas metros where demand is high. The STAR+PLUS HCBS waiver is what funds Medicaid-reimbursed assisted living placements.

Medicaid-Certified Nursing Facility Care

For members who need nursing facility level care and choose or require institutional placement, STAR+PLUS covers Medicaid-certified nursing facility costs (minus a small personal needs allowance the resident keeps). Most Texas SNFs have Medicaid-certified beds. This is traditional Medicaid nursing home coverage.

What STAR+PLUS Does NOT Cover

STAR+PLUS does not cover room and board in assisted living beyond what the HCBS waiver specifically funds (i.e., it doesn’t pay the full assisted living rate at all facilities — only those with STAR+PLUS contracts). It doesn’t cover “luxury” services or amenities. It doesn’t cover facility rates at communities without STAR+PLUS contracts.

How to Apply for STAR+PLUS Long-Term Care in Texas

Applying for STAR+PLUS LTSS involves several steps and typically takes 30–90 days from application to enrollment. Starting the process early — before a crisis forces a rushed placement — produces significantly better outcomes.

Step 1: Apply for Medicaid through HHSC

Submit a Medicaid application through Texas HHSC — online at yourtexasbenefits.com, by phone, or in person at your local HHSC office. You will need to provide financial documentation, identification, proof of residency, and information about your care needs.

Step 2: Financial and Functional Assessment

HHSC will review financial eligibility and schedule a functional assessment. A nurse assessor visits the applicant to evaluate care needs using the STAR+PLUS assessment tool. This assessment determines whether the applicant meets nursing facility level of care.

Step 3: MCO Enrollment

Once approved, HHSC assigns the applicant to a managed care organization. You may have the option to choose your MCO. The MCO then contacts you to complete enrollment, assign a service coordinator, and develop a service plan.

Step 4: Service Plan and Provider Selection

Your MCO service coordinator develops a service plan with you — identifying which LTSS services you need and how they will be delivered. You work with the service coordinator to select providers (home care agencies, assisted living communities with STAR+PLUS contracts, etc.).

Medicaid Planning: Why an Elder Law Attorney Is Essential

Medicaid planning — structuring assets and income to qualify for Medicaid while protecting as much as legally possible for a spouse or family — requires an elder law attorney with specific Texas Medicaid expertise. The 5-year look-back, spousal impoverishment protections, exempt asset rules, and income diversion trusts are areas where mistakes are expensive and often irreversible.

Many families try to do Medicaid planning on their own or with a general estate planning attorney and make transfers or decisions that create penalty periods or disqualify them from benefits they would otherwise receive. The cost of an elder law attorney consultation — typically $300–$500/hour — is a fraction of the cost of a Medicaid penalty period.

A placement specialist and an elder law attorney working together can coordinate the care planning and the legal planning so that placement timing aligns with Medicaid eligibility — avoiding coverage gaps and unnecessary private-pay periods.

STAR+PLUS is a valuable program, but it requires navigation. The eligibility rules, the MCO system, the waiver enrollment process, and the practical reality of what Medicaid-funded care looks like in specific Texas markets — these are things a placement specialist and elder law attorney team can help you understand before you’re in the middle of a crisis. If you’re trying to figure out whether Medicaid could fund your parent’s care, start with a consultation — it costs nothing and clarifies everything.