Full Definition

HCBS waivers are federal Medicaid authorities that allow states to pay for long-term services delivered in home and community settings — not just nursing facilities. Texas operates several waivers that serve different populations, including the STAR+PLUS waiver (the largest, for seniors and people with physical disabilities), the Community Living Assistance and Support Services (CLASS) waiver, and others.

Waiver services typically include personal attendant services, home health aide support, adult day programs, respite care, and case management. The goal is to provide an alternative to institutional placement for individuals who meet nursing facility level of care but prefer to remain in the community.

Unfortunately, HCBS waivers in Texas have long waitlists — sometimes spanning years — because the number of available slots is capped by the state’s budget. Families seeking waiver services should apply as early as possible, even before a crisis occurs.

For seniors who are already Medicaid-eligible and meet medical criteria, the STAR+PLUS HCBS benefit delivered through managed care organizations is the most accessible pathway to community-based services in Texas today.