For Texas seniors who cannot afford private-pay senior care, Medicaid can be a lifeline — but the Texas Medicaid system for older adults is complicated. STAR+PLUS is the managed care program that covers most community-based long-term services for eligible Texans, including some assisted living and nursing home costs.
This guide explains how STAR+PLUS works, who qualifies, and how to navigate the application process in Houston.
What Is STAR+PLUS?
STAR+PLUS (State of Texas Access Reform Plus) is Texas’s Medicaid managed care program for adults who are aged, blind, or disabled. It is administered by private managed care organizations (MCOs) under contract with the Texas Health and Human Services Commission (HHSC).
Unlike traditional fee-for-service Medicaid, STAR+PLUS enrollees receive their benefits through a single MCO that coordinates all their medical and long-term services and supports (LTSS). The MCO pays providers directly.
What Does STAR+PLUS Cover?
STAR+PLUS covers two broad categories of care:
Standard Medicaid Services (all eligible enrollees)
- Physician and specialist visits
- Hospital care
- Prescription drugs
- Labs and radiology
- Mental health services
- Nursing facility care (long-term)
Home and Community-Based Services (HCBS) Waiver
The STAR+PLUS HCBS waiver allows eligible individuals to receive long-term services in the community — including their home or an assisted living facility — instead of a nursing home. HCBS waiver services may include:
- Personal attendant services (bathing, dressing, grooming)
- Assisted living facility services (if the facility is STAR+PLUS certified)
- Adaptive aids and medical equipment
- Adult day care
- Transitional assistance services
- Specialized therapies
Critical caveat: The HCBS waiver has limited slots and a waiting list. There is no guaranteed right to waiver services even if you are financially and functionally eligible. Contact 2-1-1 Texas to get on the waiting list as early as possible.
Eligibility Requirements
To qualify for STAR+PLUS, an individual must meet all three criteria:
1. Texas Residency and Immigration Status
Must be a Texas resident and U.S. citizen or qualified non-citizen.
2. Financial Eligibility
Income and asset limits apply (2026 figures):
- Income limit: 300% of the Federal Benefit Rate ($2,901/month for an individual in 2026) for nursing facility coverage. Assisted living via waiver has different income thresholds — confirm with your MCO.
- Asset limit: $2,000 in countable assets for individuals ($3,000 for couples). Primary home, one vehicle, and certain personal items are generally exempt.
Important: Medicaid has a 5-year look-back period. Gifts or transfers of assets within 60 months of applying can result in a penalty period of ineligibility. Consult a Medicaid planning attorney before restructuring assets.
3. Functional Eligibility (Nursing Facility Level of Care)
STAR+PLUS requires that the individual meet a “nursing facility level of care” determination — meaning they need a level of assistance that would qualify them for nursing home placement if community services were not available. HHSC conducts a functional assessment (MinimumDataSet or similar instrument) to make this determination.
How to Apply
- Contact 2-1-1 Texas: Call 211 (or visit 211texas.org) to speak with a benefits specialist and get on the HCBS waiver waiting list if appropriate.
- Apply for Medicaid: Apply at YourTexasBenefits.com or in person at your local HHSC benefits office.
- Complete a functional assessment: Once financially approved, HHSC will schedule a Functional Needs Assessment to determine your level of care.
- Choose an MCO: You will be offered a choice of STAR+PLUS MCOs operating in Harris County / Houston area (see below).
- Choose a provider: Your MCO will provide a list of STAR+PLUS-certified assisted living or nursing home providers in your area. Confirm that your preferred facility is in-network.
STAR+PLUS MCOs in the Houston Area (Harris Service Area)
As of 2026, the following MCOs offer STAR+PLUS coverage in the Houston area:
- Aetna Better Health of Texas
- Molina Healthcare of Texas
- Superior HealthPlan (Centene)
- UnitedHealthcare Community Plan
MCO enrollment can be changed once a year or during a qualifying event. Contact your MCO’s member services line for a current directory of in-network senior care providers.
Nursing Home Medicaid (Non-Waiver)
For individuals in nursing homes, STAR+PLUS covers the full cost of skilled nursing facility care for eligible members, with a small resident monthly personal needs allowance reserved for the individual (currently $60/month). The nursing home bills the MCO directly. Families do not pay monthly rates directly to the facility when Medicaid is active.
Tips for Houston Families
- Not all assisted living facilities in Houston accept STAR+PLUS — ask specifically whether a facility is STAR+PLUS certified before touring
- The HCBS waiver waiting list can be 2–5 years long in Harris County — apply before a placement crisis, not after
- A Medicaid planning attorney can legally restructure assets to achieve eligibility without penalty; costs $1,500–$5,000 but often saves far more
- HHSC Area Agencies on Aging (Houston-Galveston Area Council) provide free counseling to seniors and caregivers navigating the application process
Filter Houston facilities by Medicaid acceptance on our facility search, or use the cost calculator to compare costs with and without STAR+PLUS coverage.