Texas Medicaid covers some assisted living services. It will not pay your parent's rent, meals, or housekeeping. That gap runs $2,400 to $6,800 or more per month depending on where in Houston you look. The specific program is called STAR+PLUS. Most families only learn how it actually works after they tour three facilities and assume Medicaid handles the entire bill. Understanding the coverage split before you commit to a facility changes everything about your financial plan. In this guide, the Houston Assisted Living Facilities team breaks down exactly what STAR+PLUS covers. We explain what it excludes, how Houston-area costs compare, and how to start the application process before a crisis hits.

Key Takeaways

  • STAR+PLUS covers services, not room and board. Texas Medicaid pays for personal attendant services, medication management, and case management inside a licensed assisted living facility. It does not pay for rent or meals. Federal rules under 42 CFR 435.1009 prohibit room-and-board coverage in assisted living settings.
  • Families still owe $2,400 to $6,800+ per month out of pocket. This applies even after STAR+PLUS service credits ($800 to $2,200 per month) are factored in, depending on the facility type and Houston suburb.
  • Texas has no standalone dementia Medicaid waiver. Memory care residents qualify through STAR+PLUS by meeting Nursing Facility Level of Care (NFLOC) on the Form 2060 assessment. Cognitive scoring in Section Q often becomes the deciding factor for advanced dementia patients.
  • Small residential care homes frequently accept STAR+PLUS. These 4- to 16-bed homes are invisible on national search platforms. Houston has dozens of these homes, and they often provide the most affordable Medicaid-compatible option available.

Reviewed by the HALF Publishing Team. Houston Assisted Living Facilities maintains an independent directory of licensed senior care communities across Greater Houston, with facility data sourced from the Texas HHSC, CMS quality ratings, and Google Reviews, updated regularly.

Quick Answers
Q: Does Texas Medicaid pay for room and board at an assisted living facility?
No, federal Medicaid rules strictly prohibit coverage for room and board in assisted living settings. While programs like STAR+PLUS cover personal care services, families remain responsible for rent, meals, and housekeeping. In the Greater Houston area, these out-of-pocket room and board costs typically range from $2,400 to over $6,800 per month.
Q: What is the STAR+PLUS waiver program for seniors in Houston, TX?
STAR+PLUS is a Texas Medicaid managed care program for adults over 21 who need nursing-facility-level care but want to live in an assisted living setting. It covers essential support services like personal attendant care, medication management, and physical therapies. Families should contact their local Texas Health and Human Services Commission (HHSC) office to begin the application and assessment process.
Q: What is a Medicaid-compatible residential care home?
A residential care home is a smaller, house-like facility that typically serves up to six seniors, offering a more intimate environment than large apartment-style communities. Many of these smaller homes are licensed to accept Medicaid waivers for care services, making them a highly affordable option. Families can use the Texas HHSC provider directory to find and verify licensed care homes across local neighborhoods.

The Short Answer: Yes for Services, No for Room and Board

STAR+PLUS covers what staff do for your parent. It does not cover where your parent sleeps or what they eat. Under federal Medicaid rules, room and board costs in assisted living facilities are explicitly excluded from Medicaid coverage. STAR+PLUS is the Texas Medicaid managed care waiver for adults over 21 who need nursing-facility-level care. It will pay for personal attendant services, medication management, case management, certain therapies, and some medical supplies when your parent lives in a licensed assisted living facility.

It will not touch rent, meals, housekeeping, laundry, activities, or social programming. For most Houston-area families, that distinction wipes out the assumption that Medicaid will cover everything. The portion Medicaid covers is typically $800 to $2,200 per month. The part it does not cover runs $2,400 to $6,800 or more per month depending on facility type and location.

Not every facility that accepts Medicaid will accept your specific Managed Care Organization plan, and admissions directors rarely volunteer this detail upfront. You have to ask the right questions. A facility might be fully licensed by the state and accept STAR+PLUS in theory. If they do not hold a contract with your parent's specific health plan, those benefits are useless there.

Qualifying for Medicaid: The Financial and Medical Tests

Qualifying for STAR+PLUS requires passing two separate tests. You must pass a financial screen and a functional assessment. Financial eligibility runs through the Medicaid for the Elderly and People with Disabilities (MEPD) program. Countable assets must be at or below $2,000 for an individual. Income rules also apply based on monthly income versus the facility's private rate. If your parent's income exceeds the Texas Medicaid cap, you will likely need to establish a Qualified Income Trust. Houston elder law attorneys commonly refer to this as a Miller Trust.

The functional eligibility test is a Form 2060 assessment. This is conducted by the enrollee's assigned Managed Care Organization (MCO). The applicant must meet Nursing Facility Level of Care (NFLOC) to proceed. The MCO nurse evaluates Activities of Daily Living (ADLs). They look at bathing, dressing, toileting, transferring, and feeding. They also score cognitive impairment.

This cognitive scoring is critical for families seeking memory care. Texas HHSC does not offer a separate waiver just for Alzheimer's or dementia. Instead, memory care facilities serve dementia residents through the standard STAR+PLUS program. Section Q of the Form 2060 measures cognitive function and behavioral challenges. High needs in this section frequently push advanced dementia patients over the NFLOC threshold, even if their physical mobility remains intact.

Quick Answers
Q: How long does the STAR+PLUS Medicaid approval process take for memory care in Houston, TX?
Due to high caseload volumes in Harris County, the STAR+PLUS approval process typically takes a minimum of six to eight weeks. Families must wait for Texas HHSC to process the financial application and complete the Form 2060 medical assessment. To avoid paying out-of-pocket during this waiting period, you should start the Medicaid application long before your loved one needs to move.
Q: What are the financial limits for dementia residents applying for the STAR+PLUS waiver?
Applicants must meet strict Medicaid for the Elderly and People with Disabilities (MEPD) financial criteria, which includes a $2,000 countable asset limit for individuals. If your loved one's assets exceed this cap, you may need to consult a Texas elder law attorney to discuss legal spend-down strategies. Meeting these financial thresholds is required alongside the medical and cognitive scoring on the Form 2060.
Q: Will Medicaid pay for any memory care community in the Houston area?
No, Medicaid does not cover every community; you must specifically look for a facility contracted with a STAR+PLUS managed care organization. Additionally, the facility must hold an official HHSC Memory Care Endorsement (MCE) to legally house residents with advanced dementia. Because waitlists for these Medicaid-certified beds in Houston can be extensive, families should begin touring facilities as early as possible.

"In Harris County, the families who get STAR+PLUS benefits fastest are the ones who applied before they found the facility. The Form 2060 queue does not move faster because you are in a hurry, and Houston's caseload volume means six weeks is optimistic."

HALF Publishing Team

How STAR+PLUS Works in Harris, Fort Bend, and Montgomery Counties

Harris County has over 600 HHSC-licensed assisted living facilities. This represents the highest concentration in Texas. That volume creates real assessment backlogs that families routinely underestimate. The realistic timeline from initial inquiry to the first covered service day in Harris County is six to twelve weeks. The Form 2060 functional assessment alone consumes two to six weeks due to heavy MCO caseloads.

In Harris County, the three active STAR+PLUS MCOs are Molina Healthcare, UnitedHealthcare Community Plan, and Aetna Better Health of Texas. Fort Bend and Montgomery counties operate under similar MCO networks. Families apply through Texas HHS or by calling 2-1-1.

That timeline gets longer if the application is incomplete. It also drags if the assigned MCO has a heavy queue. The practical lesson is simple. Start the STAR+PLUS application process at the exact same time you begin touring facilities. Do not wait until you have signed a lease. Enrollment is handled at Texas HHS or through 2-1-1, and the MCO assigned to your parent determines which facilities are in-network. For families comparing licensed assisted living in Houston, MCO network status is a practical filter that most people miss entirely.

Quick Answers
Q: Which Medicaid plans cover assisted living in Houston, TX?
In Harris County, the STAR+PLUS waiver program is administered through three main Managed Care Organizations (MCOs): Molina Healthcare, UnitedHealthcare Community Plan, and Aetna Better Health of Texas. When comparing facilities, you must verify which specific MCO network they accept, as this dictates your coverage options. You can apply through Texas HHS or by calling 2-1-1 to start the required functional assessment.
Q: How should I decide between a Type A and Type B assisted living facility?
Your decision should be based entirely on your loved one's mobility and nighttime care needs. Type A facilities are designed for seniors who can evacuate independently and do not need routine overnight assistance. If your parent uses a wheelchair, struggles with mobility, or requires nighttime care, you must limit your search to Type B facilities to ensure they receive the appropriate level of support.
Q: When comparing standard assisted living to memory care, how do I know which is right for my parent?
If your parent has a formal dementia diagnosis or exhibits wandering behaviors, you should specifically look for facilities holding a Texas Memory Care Endorsement (MCE). Standard assisted living communities are often not equipped or legally permitted to secure residents who might wander into unsafe areas. Comparing facilities with an MCE ensures your loved one receives specialized cognitive programming and a secure, monitored environment.

What STAR+PLUS Covers and Houston's Real Out-of-Pocket Gap

Texas HHSC licenses Houston facilities under three categories that directly affect Medicaid compatibility. Type A facilities are for ambulatory residents who do not need routine nighttime attendance. Type B facilities serve non-ambulatory residents or those requiring nighttime evacuation assistance. Finally, facilities can hold a Memory Care Endorsement (MCE). STAR+PLUS service coverage applies inside all three. The MCE designation matters specifically for dementia residents. Facilities with an MCE must meet additional HHSC standards under TAC Title 26, Chapter 553, making them the appropriate Medicaid-compatible setting for residents with dementia.

Cost Category Covered by STAR+PLUS?
Personal attendant services (bathing, dressing, grooming) Yes
Medication management Yes
Case management Yes
Certain therapies (PT, OT, speech as ordered) Yes
Some medical supplies Yes
Room and board (rent) No
Meals No
Housekeeping and laundry No
Activities and social programming No

The out-of-pocket gap after STAR+PLUS varies sharply across the Houston metro. Small residential care homes represent a Medicaid-compatible inventory that most families never find. In outer suburbs like Sugar Land and Katy, Type A base rates run $3,200 to $4,500 per month. That leaves a $1,000 to $3,700 monthly gap after STAR+PLUS service credits. In mid-tier corridors like the Galleria, Memorial, and Northwest Houston, Type B and MCE memory care facilities run $4,500 to $7,000 per month.

In premium markets like The Woodlands, luxury memory care can hit $9,000 or more per month. STAR+PLUS still only covers $800 to $2,200 of that total. Residential care homes scattered across Houston frequently accept STAR+PLUS and charge $2,800 to $4,500 per month total. This is often the most affordable Medicaid-compatible option available. These homes do not appear in large national databases. Families using only national aggregators miss a massive share of the affordable inventory.

Houston Sub-Market Facility Type Est. Monthly Total STAR+PLUS Service Credit Est. Out-of-Pocket Gap
Outer Harris/Fort Bend (Sugar Land, Katy, Pearland) Type A ALF $3,200–$4,500 $800–$2,200 $2,400–$3,700
Mid-tier (Galleria, Memorial, NW Houston) Type B ALF $4,500–$6,500 $800–$2,200 $3,700–$5,700
Premium (The Woodlands, Clear Lake) MCE Memory Care $7,000–$9,000+ $800–$2,200 $5,500–$6,800+
Greater Houston (all sub-markets) Residential Care Home $2,800–$4,500 $800–$2,200 $1,800–$3,700

Most families discover the room-and-board gap after they have already toured and fallen in love with a facility. That is exactly the wrong order of operations. Use the free care assessment to clarify the care level first. Then match your parent to a sub-market your family can actually fund after STAR+PLUS credits are applied.

What to do next:

  • Start the STAR+PLUS application now before you have chosen a facility. Call 2-1-1 or apply at hhs.texas.gov. The Form 2060 queue will not wait for you to finish touring.
  • Ask each facility you tour whether they are STAR+PLUS-in-network with your parent's assigned MCO. A facility can be HHSC-licensed and still be out-of-network for your plan.
  • Search Houston's residential care homes. Use the HALF directory to see licensed options the national aggregators miss.
Quick Answers
Q: How long does it take to get STAR+PLUS benefits approved for assisted living in Houston?
In Harris County, expect a realistic timeline of 6 to 12 weeks from your initial inquiry to the first covered service day. The required Form 2060 functional assessment alone can take 2 to 6 weeks due to high local MCO caseloads. Because Houston has over 600 licensed facilities driving assessment demand, you should apply for benefits before or while you are touring, rather than waiting until you select a home.
Q: What is the best next step after getting my parent's Form 2060 assessment started?
Once your assessment is in the queue, begin building a shortlist of facilities using an independent local directory to find both large communities and smaller residential care homes. When you contact these homes to schedule tours, immediately ask if they are in-network with your specific STAR+PLUS Managed Care Organization (MCO). This prevents you from wasting time touring facilities that cannot accept your parent's Medicaid plan.
Q: What should I do if my preferred assisted living facility in Houston, TX is not in my MCO network?
You have two practical options: you can either choose a different facility that is already in-network, or you can request to change your Managed Care Organization through Texas Health and Human Services. If you decide to switch MCOs to match the facility, be aware that this process can delay your parent's move-in date by another 15 to 45 days. Always verify network status before paying any non-refundable deposit or application fee.

Find the Right Facility on Houston Assisted Living Facilities

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What to do next:

  • Take the Care Assessment — Our Find Care page includes a free care-level assessment. Answer eight questions about daily living activities, get a recommended care level based on your answers, and browse matching facilities in Houston. The entire process takes about two minutes.
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About This Guide

Houston Assisted Living Facilities is a free, independent directory helping families find licensed assisted living, memory care, nursing, and residential care homes across the Greater Houston metro area. Our data is sourced from the Texas Health and Human Services Commission (HHSC) and updated regularly. We combine verified licensing data with neighborhood-level detail — the kind of local context that national directories cannot provide. Whether you're evaluating options in the Inner Loop or comparing suburbs, Houston Assisted Living Facilities exists to make that search faster and more informed.