Under Texas STAR+PLUS, your Social Security income does not disappear into a government account. But it does not stay in your pocket either. Most of it goes directly to the assisted living facility. This covers room and board. Meanwhile, STAR+PLUS Medicaid pays separately for your personal care services. A managed care organization handles those care payments. The split between Medicaid coverage and your monthly check causes massive confusion. It is the most misunderstood senior care financing question in Texas. In this guide, our team breaks down the exact math. You will learn what you get to keep. We also cover what families in Harris County, Fort Bend County, and Montgomery County must know before signing a contract.

Key Takeaways

  • STAR+PLUS pays for personal care services, not room and board. Bathing, dressing, and medication management are covered. The monthly rent is not.
  • Your Social Security check goes to the facility. It pays for room and board costs, not to the state or your managed care organization.
  • You keep at least $60 a month as a Personal Needs Allowance. This amount is protected under Texas HHSC rules. It cannot be applied to room and board.
  • Income above the Medicaid limit may require a Qualified Income Trust. You might know this as a Miller Trust. Consult an elder law attorney if your monthly Social Security exceeds approximately $2,742.
  • Contact your STAR+PLUS plan provider. Amerigroup, Molina Healthcare, or UnitedHealthcare Community Plan can confirm which services are covered at your specific facility.

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 STAR+PLUS Medicaid pay for room and board at a Houston, TX assisted living facility?
No, STAR+PLUS does not cover room and board at any assisted living facility in Texas. According to the Texas HHSC handbook, the program only pays for personal care services, such as help with bathing and medication management. You will need to use your own income, like Social Security or pensions, to cover your monthly rent and food costs.
Q: What is the Texas STAR+PLUS waiver program for assisted living?
STAR+PLUS is a Texas Medicaid managed care program designed to help eligible older adults and people with disabilities pay for long-term care services. Instead of moving into a nursing home, approved seniors can use this waiver to receive personal assistance and health services within a licensed assisted living community. To apply, contact your local Area Agency on Aging or the Texas Health and Human Services Commission to begin the medical and financial eligibility process.
Q: What is a managed care organization (MCO) under the STAR+PLUS program?
An MCO is a private health insurance provider, such as Amerigroup, Molina Healthcare, or UnitedHealthcare, that contracts with the state to deliver your Medicaid benefits. When you enroll in STAR+PLUS, you will select an MCO to coordinate your care and pay the assisted living facility directly for your personal assistance services. Always verify which specific MCOs your preferred community is contracted with before signing a residency agreement.

How Texas STAR+PLUS Uses Your Social Security Income to Pay for Assisted Living

STAR+PLUS splits the cost of assisted living into two completely separate buckets. Understanding which bucket is which will save you a genuinely painful surprise. The managed care organization enrolled in your STAR+PLUS plan pays the facility directly for personal care services. These plans include Amerigroup, Molina Healthcare, or UnitedHealthcare Community Plan. They cover bathing, dressing, grooming, and medication management. They also cover transportation to medical appointments. Room and board is a separate charge entirely. That bill comes out of the resident's own income. Social Security, SSI, or a pension goes to the facility. It pays for housing and meals. The state never touches that money directly.

Your Social Security check is not garnished or rerouted by the state. The resident receives it and pays the facility. Think of it as two parallel billing relationships. The health plan pays the facility for services. The resident pays the facility for housing. The Texas HHSC STAR+PLUS Handbook makes this distinction explicit. The facility must be STAR+PLUS-approved. Texas HHSC licenses all assisted living facilities under either Type A or Type B standards. Both license types can accommodate STAR+PLUS residents. However, approval is not automatic. Are you searching for Houston assisted living facilities that accept STAR+PLUS? Confirming that specific approval status before touring is a step most families skip.

Many families assume Medicaid covers the entire facility bill. This is simply not true. You must be prepared to hand over your Social Security check to cover the rent. If you do not pay your room and board, the facility can evict you. They operate just like a standard landlord in that regard. Knowing exactly how these payments divide up helps you budget correctly from day one.

Cost Category Paid by STAR+PLUS Plan Paid from Resident's Income
Personal care services (bathing, dressing, grooming) Yes No
Medication management Yes No
Room and board (rent and meals) No Yes (from Social Security)
Transportation to medical appointments Yes No
Quick Answers
Q: How much of my Social Security check can I keep when moving into a Houston assisted living facility under STAR+PLUS?
Under Texas Health and Human Services rules, you are guaranteed a Personal Needs Allowance of at least $60 per month. This money is legally protected from being used for your room and board costs at the facility. While nursing home Medicaid rules differ, this allowance ensures you have funds for personal hygiene items, clothing, and entertainment in your Houston community.
Q: How long does the approval process take for the STAR+PLUS waiver program?
The timeline to get approved for the STAR+PLUS waiver typically takes anywhere from 30 to 90 days in Texas. This process includes both a financial eligibility check by Medicaid and a medical necessity assessment to evaluate your daily care needs. To prevent processing delays, gather your bank statements, income proof, and medical records before submitting your application.
Q: Does Texas cap how much an assisted living facility can charge for room and board under Medicaid?
Yes, Texas sets strict limits on what participating STAR+PLUS facilities can charge for room and board to protect residents. The maximum allowable monthly charge is tied to the federal Supplemental Security Income (SSI) rate, ensuring it remains affordable. You will pay this fixed amount directly to the facility from your own income, while the waiver covers your personal care services.

The Personal Needs Allowance: What You Get to Keep Each Month

Texas STAR+PLUS protects a minimum of $60 per month as a Personal Needs Allowance. That money cannot be applied to room and board. After paying the facility for housing and meals, the resident keeps $60. This pays for personal hygiene items, clothing, and entertainment. It covers anything else that keeps daily life dignified. This is different from nursing home Medicaid in Texas. Skilled nursing uses a completely separate allowance formula. If someone tells you the rules are the same across care settings, that is not accurate. Many families assume STAR+PLUS will cover everything, including rent. It does not. Facilities are not always upfront about drawing that line clearly before a contract is signed.

In higher-cost Houston submarkets, the gap between a resident's Social Security income and the facility's room and board rate can be massive. A senior receiving $1,400 a month in Social Security benefits may find a major shortfall. Assisted living in The Woodlands carries room and board rates that easily exceed that figure. The same dynamic applies in Fort Bend County. Assisted living in Sugar Land often reflects that suburb's higher cost of living. When room and board costs exceed monthly income, families must explore supplemental support options. This means private pay from family members or Veterans benefits. In some cases, you can negotiate a lower room and board rate with the facility directly. The $60 minimum is protected. Nothing above it is guaranteed.

The facility cannot force you to spend your $60 allowance at their in-house salon or store. That money belongs to the resident. You can save it up over several months. You can use it to buy birthday gifts for grandchildren. It is your money. Keep a close eye on the facility billing statements to ensure they are not dipping into this protected fund to cover late fees or arbitrary surcharges.

What to do next:

  1. Ask the facility for their current room and board rate. Get it in writing before signing anything.
  2. Call your STAR+PLUS health plan to confirm covered services. Contact Amerigroup at 1-800-600-4441, Molina at 1-866-449-6849, or UnitedHealthcare at 1-888-887-9003.
  3. Contact Texas HHSC through 2-1-1. Verify your monthly income against the room and board cost before the contract is signed.

"The most common mistake we see in Houston-area STAR+PLUS cases is families assuming Medicaid covers room and board. It never has under STAR+PLUS, but that detail rarely comes up at the facility tour. By the time the first bill arrives, it is too late to renegotiate the contract."

HALF Publishing Team

Quick Answers
Q: What if my income is too high to qualify for STAR+PLUS assisted living benefits in Houston, TX?
If your monthly income exceeds the Texas Medicaid limit, you may still qualify by setting up a Qualified Income Trust, commonly known as a Miller Trust. This legal arrangement funnels your excess income into a specific account so you can meet the strict financial requirements. It is highly recommended to consult a local elder law attorney to establish this trust correctly and avoid benefit delays.
Q: Should we choose a private pay facility initially if our savings will only last a few years?
Many families choose to spend down their assets at a private pay facility first because it provides a wider selection of communities and amenities. If you take this route, you must plan your eventual transition to a STAR+PLUS facility well in advance before the funds completely run out. Always ask private pay facilities upfront about their discharge policies for residents who eventually transition to Medicaid.
Q: How do we decide between supplementing the room and board gap or moving to a cheaper care setting?
When Social Security doesn't cover the full room and board cost, families must weigh pooling their own money against finding a more affordable environment. You should compare the monthly out-of-pocket gap at larger assisted living centers with the rates of smaller residential care homes, which are often less expensive. Working with a local senior care advisor can help you compare these options and make a sustainable long-term financial decision.

What Happens If Your Income Cannot Cover Room and Board in Houston?

This is the biggest hurdle for Houston families relying on STAR+PLUS. The state caps how much a facility can charge for room and board if they accept Medicaid. However, that capped rate is often still higher than a senior's monthly Social Security check. If your mom receives $900 a month in Social Security, but the facility's Medicaid room and board rate is $1,200, you have a $300 shortfall. Medicaid will not pay that difference. The health plan will not pay it either. The family must figure out how to cover it.

Families usually handle this gap in three ways. First, family members chip in to cover the difference out of pocket. Second, they apply for Veterans Aid and Attendance benefits if the senior qualifies. Third, they look for residential care homes instead of large assisted living centers. A residential care home in Katy or Spring might be willing to negotiate a lower room and board rate than a massive corporate facility in the Galleria area. These smaller, residential settings still accept STAR+PLUS for care services. They just have lower overhead costs.

Not every facility accepts STAR+PLUS, and most will not tell you about alternatives. Do not let a glossy brochure convince you to sign a contract you cannot afford. Always calculate the room and board shortfall before moving in. If the math does not work, look at smaller care homes in less expensive Houston zip codes.

Quick Answers
Q: Which STAR+PLUS health plans currently operate in Houston, TX?
In Harris County, the primary Managed Care Organizations (MCOs) are Amerigroup, Molina Healthcare, and UnitedHealthcare Community Plan. Because plan availability can vary across the greater metro area, you should verify the options for your specific zip code. Contact Texas HHSC or dial 2-1-1 to confirm which plans cover the assisted living facilities you are considering.
Q: How do I begin the STAR+PLUS application process for an assisted living facility?
Your first step is to apply for Texas Medicaid through the YourTexasBenefits website or by visiting a local HHSC office. Once financially approved, a caseworker will schedule a Medical Necessity and Level of Care (MN/LOC) assessment to evaluate the senior's clinical needs. If they meet the state's criteria, you can then select an approved health plan and choose a participating care home.
Q: How can I verify if a smaller residential care home accepts my specific health plan?
Always ask the facility's administrator for a direct list of the Managed Care Organizations (MCOs) they are currently contracted with. You can also call your health plan's member services department to verify that the specific care home is in-network before signing any residency agreements. Taking this step ensures your care services will be fully covered without unexpected out-of-pocket fees.

STAR+PLUS Eligibility and Income Limits in Harris County

To qualify for STAR+PLUS in Harris County, a senior must be enrolled in Texas Medicaid. They must also meet the clinical care threshold set by HHSC. Income alone does not determine eligibility. On the financial side, monthly income for a single individual has a strict cap. It must be at or below 300% of the SSI Federal Benefit Rate. This is approximately $2,742 a month under current federal rates. You can verify this through the Social Security Administration and Medicaid.gov. The clinical assessment determines whether the resident actually needs a nursing facility level of care. That medical threshold must be met even if you pass the income test. Both tests must pass. See the Texas HHSC STAR+PLUS program overview for official rules.

If Social Security income exceeds the $2,742 limit, Texas law offers a solution. You can use a Qualified Income Trust, commonly called a Miller Trust. This legal mechanism satisfies the income test. A Miller Trust channels the excess income into a trust account each month. This brings the countable income figure below the required threshold. Setting one up requires the help of an elder law attorney. This is not a project you can do yourself. Do not try to download forms online to handle it.

Beyond income, the Houston metro adds a geographic layer. Harris County has the widest plan selection. Fort Bend County and Montgomery County may have more limited health plan availability. Families comparing options near Katy or Pearland should verify plan participation at the county level. Houston covers over 10,000 square miles and features 32 distinct senior care markets. The choices in one suburb do not automatically apply in another.

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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.