The Texas STAR+PLUS waiver, explained

If you have read almost anything about paying for a parent's care in Texas, you have run into three words that never quite get explained: the STAR+PLUS waiver. It is the program that decides whether a parent can get Medicaid help at home or in assisted living, or whether the only funded option is a nursing home. It is worth understanding clearly, because getting on it early changes what is possible later.

What STAR+PLUS actually is

STAR+PLUS is the Texas Medicaid managed-care program for long-term services and supports. Most adults who qualify for Medicaid long-term care in Texas receive it through a STAR+PLUS health plan rather than through traditional fee-for-service Medicaid. You pick a plan, and it coordinates both the medical care and the long-term care.

The part everyone means when they say "the waiver" is STAR+PLUS Home and Community Based Services (HCBS). Standard Medicaid will pay for a nursing home for someone who needs that level of care. The waiver is what lets that same money pay for care outside a nursing home, at home or in an assisted living community, for people who would otherwise qualify for a nursing home but would rather not move into one. That is the whole point of it: to keep people in the least restrictive setting that is safe.

What the waiver covers

For a person who qualifies, STAR+PLUS HCBS can pay for a broad set of services that make staying out of a nursing home realistic:

• Personal attendant services, help with bathing, dressing, meals, and mobility at home.
• Adult day care, a supervised day program, which also gives a family caregiver a break.
• Respite care, short-term relief so a caregiver can rest or travel.
• Nursing and therapy services delivered in the community.
• Home modifications and adaptive aids, such as grab bars, ramps, or a shower chair.
• Assisted living services, the care and supervision inside a licensed assisted living or memory care community.

That last one is the piece that surprises families most, so it is worth being precise about it, because it is also where the biggest misunderstanding lives.

The assisted living catch: care yes, rent no

STAR+PLUS can pay for the care services inside an assisted living or memory care community, the personal attendant help, the supervision, the coordination. What it generally does not cover is the room and board, the housing portion of the monthly bill. Families usually still pay the rent, while the waiver covers the care on top of it.

That split is what makes assisted living reachable for a lot of people. Paying only the housing portion, often a few thousand dollars a month, is very different from paying for housing and round-the-clock care out of pocket. If your parent's needs are moderate rather than nursing-home-level, this is frequently the difference between affording a community and not. You can compare the monthly cost of assisted living, memory care, and nursing home care in your area on our cost-of-care pages, and we cover the full picture in how to pay for assisted living in Texas.

Who qualifies

There are two tests, medical and financial.

The medical test is a "nursing facility level of care" assessment. In plain terms, the state has to agree that your parent needs the kind of help a nursing home provides, even if you plan to deliver it at home or in assisted living instead. Many people with significant physical needs or with moderate-to-advanced dementia meet it.

The financial test mirrors Medicaid long-term care. The income limit for the waiver is about $2,901 a month in 2026 (300% of the SSI federal benefit rate), and there is an asset limit as well. Being over the income limit does not disqualify a parent automatically: a Qualified Income (Miller) Trust routes the excess income and preserves eligibility. Getting under the asset limit is done through a legitimate spend-down, not by giving assets away, which can trigger a look-back penalty.

The interest list: why "apply early" is the whole game

Here is the part that matters most and gets missed most. STAR+PLUS HCBS has an interest list, which is Texas's word for a waitlist. Because the community-based waiver has a limited number of slots, there is often a wait, sometimes a year or more, between signing up and getting services.

The interest list has one saving grace: getting on it is free, carries no obligation, and does not require you to prove eligibility yet. Your place in line simply starts when you sign up. So the single most valuable thing a family can do, often years before care is needed, is get the parent on the interest list now. Waiting until the crisis hits means waiting out the list from zero.

You add someone to the interest list by contacting your local Area Agency on Aging, calling 2-1-1 Texas, or contacting Texas Health and Human Services directly. It takes one phone call.

How STAR+PLUS fits the bigger picture

STAR+PLUS is one piece of how Texas families pay for care, and it slots in alongside the others:

• If a parent needs full nursing-home care, standard Medicaid covers it directly, no waiver or interest list required. See how to pay for a nursing home in Texas.
• If a parent has dementia and can stay in the community with help, STAR+PLUS is often the route, as we describe in how to pay for dementia and Alzheimer's care in Texas.
• If a parent is a wartime veteran or a surviving spouse, VA Aid and Attendance can stack on top to help with the housing portion the waiver does not cover.

When to get help

This is information, not legal or financial advice, and the rules and dollar figures change each year. Applying for STAR+PLUS is free and you can start the interest-list step yourself with a single call. But if your parent's income is over the limit, or there is a home or meaningful savings involved, a Texas elder-law attorney or a certified Medicaid planner is worth the cost before you make any transfers or spend down. An hour of good advice is small next to the cost of a mistake that delays eligibility. To see how the numbers play out for your family, use our cost calculator.