Texas Medicaid does not pay for assisted living the way most families expect. The gap between what STAR+PLUS covers and what a Houston-area facility actually charges can run $1,000 to $2,500 per month. This gap remains even after official approval. The spend-down path for assisted living runs through the STAR+PLUS Home and Community Based Services waiver. This is a managed care program with its own eligibility math and strict benefit limits. Most families do not discover these limits until they are already signing a lease. Getting that math right before assets run low is the difference between a planned transition and a financial crisis. In this guide, we explain exactly how Medicaid spend down works for Houston assisted living costs.

Key Takeaways

  • STAR+PLUS covers personal care services, not room and board. Texas Medicaid for assisted living does not pay the facility's monthly rate. Families still owe $1,000 to $2,500 per month in housing costs after approval.
  • The countable asset limit is $2,000. Community spouses may retain up to $137,400. A person with $50,000 in assets must spend down $48,000. This equals roughly 9 to 11 months of private-pay costs at Harris County rates.
  • STAR+PLUS enrollment takes 45 to 90 days in Harris County. Start the application well before assets run out. Do not wait until the bank account is empty.
  • Your county determines how fast assets disappear. Monthly assisted living costs range from $3,100 in Galveston County to $5,200 in Harris County. You face the same spend-down math but very different timelines.

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 assisted living facilities in Houston, TX?
No, the Texas STAR+PLUS Medicaid waiver covers personal care services but explicitly excludes room and board in assisted living settings. Families must budget roughly $1,000 to $2,500 per month out-of-pocket for housing costs even after approval. This is completely different from nursing home Medicaid, which covers the full daily rate including your room.
Q: What is a Medicaid spend-down for senior care?
A Medicaid spend-down is the process of legally reducing a senior's countable assets to meet the strict $2,000 limit required for Texas Medicaid eligibility. Local families typically use excess funds to pay for medical bills, home modifications, or pre-paid funeral expenses before applying for care. It is highly recommended to consult a local elder law attorney to ensure you do not violate the state's five-year look-back period.
Q: What is the STAR+PLUS waiver program?
STAR+PLUS is a Texas Medicaid managed care program that pays for medical and personal care services for adults who are elderly or have disabilities. For seniors transitioning to assisted living, this waiver provides essential financial assistance for daily living support like bathing and dressing. Because there are often waitlists for this waiver across the state, families should start the application process well before their private funds run out.

Spend Down for Assisted Living Is Not the Same as Nursing Home Medicaid

The single most expensive mistake in Houston senior care planning is treating STAR+PLUS like nursing facility Medicaid. They are structurally different programs with completely different benefit scopes. Nursing facility Medicaid covers the full per-diem cost of a licensed nursing home. This includes room, board, nursing care, and ancillary services. STAR+PLUS is the only Medicaid pathway for assisted living in Texas. It covers personal care services and select health services delivered inside the facility. It does not pay the facility's monthly room rate.

A Houston-area family that receives STAR+PLUS approval will still owe the facility a significant amount of money. Expect to pay $1,000 to $2,500 per month in room and board costs. This depends on the provider's structure and the specific county. Most families assume Medicaid approval means zero out-of-pocket costs. That assumption is completely false for assisted living in Texas. Acting on that assumption is financially dangerous.

Feature STAR+PLUS HCBS Waiver (Assisted Living) Nursing Facility Medicaid
What Medicaid pays Personal care services, some health services Full per-diem (room, board, nursing, ancillary)
Room and board covered? No: family still owes $1,000 to $2,500/month Yes: fully covered
Income limit (2026) 300% of SSI ($2,742/month); Miller Trust required above this 300% of SSI ($2,742/month); Miller Trust required above this
Countable asset limit $2,000 individual $2,000 individual
MCO involvement Yes: Molina, UnitedHealthcare, or Aetna; prior auth required No MCO layer for most institutional placements
Wait list risk Yes: waiver slots are capped No: nursing home Medicaid is an entitlement

Texas licenses assisted living facilities as either Type A or Type B. Type A is for ambulatory residents who do not require overnight awake staff. Type B is for non-ambulatory or cognitively impaired residents requiring 24-hour awake staff. This facility license type determines whether a memory care resident can even be placed on STAR+PLUS at a given location. Verifying the license before initiating spend down matters immensely. Check the HHSC Long-Term Care Regulatory inspection database for any facility you are considering before you start liquidating assets.

"In Harris County, we consistently see families deplete savings faster than expected because they planned for Medicaid to eliminate the facility bill entirely. STAR+PLUS changes the care equation but not the housing bill. That distinction must dictate your entire financial strategy."

HALF Publishing Team

Quick Answers
Q: How long does a Medicaid spend down take at average assisted living costs in Houston, TX?
With Harris County average assisted living rates running between $4,200 and $5,200 per month, a senior with $50,000 in countable assets will take about 9 to 11 months to reach the $2,000 limit. Because STAR+PLUS enrollment can take an additional 45 to 90 days to process locally, families must start applying well before their funds completely run out. Always maintain a small financial buffer to cover room and board during this transition period.
Q: Will the STAR+PLUS waiver cover my entire assisted living bill once my assets are depleted?
No, the Texas Medicaid waiver program only pays for the cost of your personal care services, not the physical room and board. Families are still responsible for the monthly housing portion, which must be paid using the resident's remaining income like Social Security. You should clarify this base room and board rate with your facility manager long before your private-pay funds are fully exhausted.
Q: How far back does the state look at my finances when applying for assisted living Medicaid?
Texas Health and Human Services enforces a strict 60-month (5-year) look-back period from the date you apply for long-term care Medicaid. Any assets gifted or sold below fair market value during this timeline will result in a penalty period where you must pay out-of-pocket for your care. To avoid costly delays, consult a Harris County elder law attorney before transferring any property or large sums of cash.

2026 Asset and Income Limits: What Houston Families Must Spend Down To

Texas HHSC sets a $2,000 countable asset ceiling for individual STAR+PLUS applicants. Everything above that number must be spent before Medicaid eligibility begins. The community spouse resource allowance (CSRA) for 2026 is $137,400. This means a married applicant's spouse may retain up to that amount in countable assets. Monthly income cannot exceed 300% of SSI, which is $2,742 in 2026.

If a senior's income exceeds that figure, a Qualified Income Trust must be established under Texas law. This is commonly called a Miller Trust. It channels excess income to preserve eligibility. Social Security, pensions, and required minimum distributions all count toward this income limit. Harris County probate court may be involved in the setup process. Consult a Texas elder law attorney before attempting this on your own. The Minimum Monthly Maintenance Needs Allowance (MMMNA) for 2026 ranges from $2,555 to $3,853.50 per month. This protects a portion of the community spouse's income from being counted against the applicant.

At Harris County's average assisted living rate of $4,200 to $5,200 per month, the math is sobering. A person with $50,000 in countable assets must spend down $48,000. That covers roughly 9 to 11 months of private-pay costs before reaching the $2,000 threshold. The Harris County median home value sits near $310,000. This makes the primary home exemption question the most pressing asset issue for most local applicants. A primary residence is exempt while the applicant intends to return home or a spouse lives there. However, that protection is not permanent. HHSC evaluates specific conditions during the application review.

  • Countable assets: Checking and savings accounts, CDs, brokerage investments, second vehicles, non-primary real estate, most retirement accounts.
  • Exempt assets: Primary home (under qualifying conditions), one vehicle, prepaid funeral, HHSC-approved burial account up to $1,500.
  • Miller Trust required when: Monthly income exceeds $2,742 (300% of SSI, 2026 rate).
  • MMMNA range: $2,555 to $3,853.50 per month retained by the community spouse.

The 60-Month Look-Back Period Complicates the Process

Many families think they can simply give money to their children to reach the $2,000 limit faster. Texas enforces a strict 60-month look-back period for all Medicaid long-term care applications. HHSC reviews all financial transactions from the five years prior to your application date. Giving cash to a grandchild in Sugar Land will trigger a penalty. Transferring a property deed to a relative in Katy will also trigger a penalty.

When HHSC finds a violation of the look-back rule, they issue a penalty period. This is a specific amount of time where Medicaid will not pay for care, even if your assets are already below $2,000. The penalty is calculated based on the amount given away divided by the state's average daily cost of care. You cannot cheat the spend-down process. You must spend the money on allowable expenses like facility private pay, medical bills, or home modifications. Paying off debt is also generally acceptable. Gifting is not.

Quick Answers
Q: What is a Miller Trust and when does a Houston, TX senior need one for STAR+PLUS?
If a senior's monthly income exceeds the Texas Medicaid limit (currently 300% of SSI, or $2,742 per month in 2026), they need a Qualified Income Trust, commonly called a Miller Trust, to qualify for STAR+PLUS. This trust legally channels excess income to maintain eligibility and must be established under Texas law, sometimes involving Harris County probate courts. You should always consult a local elder law attorney to set this up properly, as this information does not constitute legal advice.
Q: How should we decide between spending down assets in Harris County versus Montgomery County?
Deciding where to spend down depends on your family member's care needs and how quickly you want to reach the Medicaid asset limit. Because average assisted living costs are often higher in Montgomery County compared to certain parts of Harris County, seniors will generally burn through their countable assets faster there. Compare the monthly rates of specific facilities in both areas to accurately project your family's spend-down timeline.
Q: Is it better to pay off my parent's debt or gift money to family to meet Texas Medicaid limits?
You should always choose paying off debt over gifting money to family members when trying to reach Medicaid asset limits. Gifting triggers a Medicaid penalty period that delays financial assistance for assisted living, whereas paying off credit cards or a mortgage is considered an allowable spend-down expense. Review all outstanding debts and consult a financial advisor to strategically clear them before applying for STAR+PLUS.

Houston Assisted Living Costs by County: Your Spend-Down Starting Point

The countable asset limit is identical across all Texas counties. However, how fast you reach it depends entirely on where in Greater Houston you place your family member. A senior with $50,000 in countable assets faces the same $48,000 spend-down in every ZIP code. That gap closes in 9 months in Montgomery County. It could close in under 10 months in Harris County at higher-end facilities. County-level cost benchmarks give the spend-down calculation real weight. See the Greater Houston senior care markets overview for broader regional context. You can also explore assisted living options in Houston and memory care in Houston sorted by area.

County Avg. Monthly AL Cost Memory Care Cost Est. Spend-Down Gap (from $50K) STAR+PLUS MCOs Active
Harris County $4,200 to $5,200 $5,500 to $7,000 9 to 11 months private pay Molina, UnitedHealthcare, Aetna
Fort Bend County $3,800 to $4,800 $5,000 to $6,500 10 to 13 months private pay Molina, UnitedHealthcare, Aetna
Montgomery County $3,200 to $4,500 $4,800 to $6,200 11 to 15 months private pay Molina, UnitedHealthcare, Aetna
Galveston County $3,100 to $4,200 $4,500 to $6,000 11 to 15 months private pay Molina, UnitedHealthcare, Aetna

Each of the three active STAR+PLUS MCOs in the Houston MSA maintains a distinct provider network. These are Molina Healthcare of Texas, UnitedHealthcare Community Plan, and Aetna Better Health of Texas. Different facilities hold active STAR+PLUS provider agreements with different MCOs. Prior authorization timelines average 30 to 45 days for assisted living placements. Overall STAR+PLUS enrollment in Harris County typically runs 45 to 90 days. Longer delays are possible during MCO network saturation periods.

Before initiating spend down for any specific facility, confirm their contract status. The facility must hold an active STAR+PLUS provider agreement with at least one of these MCOs. A facility that looks perfect on paper provides zero Medicaid benefit if it is not contracted with your assigned MCO. Always verify this directly with the billing director before signing a lease.

The Step-by-Step Spend Down Process for Houston Families

Managing a Medicaid spend down requires exact timing. If you apply too early, HHSC will deny the application for excess resources. If you apply too late, your parent might face eviction because they cannot pay the room and board gap while waiting for MCO approval. Follow these steps to align the financial timeline with the care timeline.

First, identify a facility that accepts Medicaid and matches your parent's care needs. Make sure they offer the correct Type A or Type B license. Second, calculate the exact monthly burn rate. Subtract your parent's monthly income from the facility's private pay rate. This tells you exactly how many months their remaining assets will last. Third, initiate the Medicaid application about 90 days before the assets hit the $2,000 mark. This gives Texas HHSC and the chosen MCO time to process the paperwork while you still have funds to pay the facility privately.

Quick Answers
Q: Which Medicaid managed care plans cover assisted living under STAR+PLUS in Houston, TX?
In the Houston MSA, including Harris, Fort Bend, and Montgomery counties, the three active Managed Care Organizations (MCOs) are Molina Healthcare, UnitedHealthcare Community Plan, and Aetna Better Health. Because each has a unique provider network, you must verify that your chosen facility holds an active STAR+PLUS agreement with your specific MCO before initiating the spend-down process. Once your paperwork is submitted, expect prior authorization timelines to average 30 to 45 days.
Q: How do I verify if a facility holds the correct Type A or Type B license for my parent's needs?
You can confirm a community's specific licensing status by searching the Texas Health and Human Services (HHSC) long-term care provider directory online. Type A facilities are for residents who can evacuate unassisted, while Type B facilities are required for seniors who need nighttime assistance or help during an emergency. Verifying this license type is a critical first step before touring communities or starting the Medicaid application process.

What to do next:

  • Take the free care assessment to identify the right care level. This confirms whether Type A or Type B licensing applies to your family member before you start the STAR+PLUS application.
  • Use the Compare tool to evaluate facilities on cost and care types.
  • Verify STAR+PLUS provider status for any facility you are considering through the HHSC Long-Term Care Regulatory database before liquidating assets.

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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.