Texas STAR+PLUS: The Medicaid Long-Term Care Program Explained

STAR+PLUS delivers Medicaid long-term services and supports to seniors and adults with disabilities in Texas. This program provides care through a private managed-care health plan that families choose, moving away from old-style fee-for-service Medicaid. The entire point of STAR+PLUS is to offer a coordinated way for individuals who would otherwise need a nursing facility to receive their care within the community.

The Texas Health and Human Services Commission (HHSC) runs STAR+PLUS. On a day-to-day basis, the member selects and works with a managed care organization (MCO), such as Amerigroup, Molina, Superior, or UnitedHealthcare, depending on their specific service area. Each member is assigned a service coordinator to help manage their care.

Families often confuse two aspects of this program. First, STAR+PLUS, the managed-care program itself, is not the same as the STAR+PLUS Home and Community Based Services (HCBS) waiver. The HCBS waiver is a specific in-home benefit package available within the broader STAR+PLUS program, and it does have an interest list. Second, being enrolled in STAR+PLUS is distinct from qualifying for regular Medicaid. STAR+PLUS is the delivery system for long-term care once an individual has already qualified for Medicaid. While this guide primarily addresses families of seniors aged 65 and older, STAR+PLUS serves all eligible adults 21 and older.

STAR+PLUS combines a member's regular Medicaid medical care with long-term services and supports.

The program provides Coordinated medical care plus a service coordinator, who acts as the single point of contact for all care needs. This coordinator arranges assessments, identifies providers, and develops an individualized care plan. For families managing a parent's care remotely, this dedicated coordinator is a crucial benefit, streamlining communication and service delivery.

For individuals meeting a nursing-facility level of care, In-home attendant care through the HCBS waiver funds essential personal attendant services. This includes help with daily activities like bathing, dressing, transferring, and meal preparation, alongside nursing services, respite care, and adult day care. Texas offers the Consumer Directed Services option, allowing members to hire and manage their own attendants, potentially including certain relatives. A financial management agency handles payroll, but families must confirm specific eligibility for spouses, as limitations apply.

STAR+PLUS also offers The bigger supports that surprise families, extending beyond typical medical and attendant care. The HCBS waiver can cover the care and service portion of an assisted living facility. It also funds adaptive aids, home modifications like ramps and grab bars, emergency response systems, and minor home repairs. Dental services are included, providing a more comprehensive range of benefits than many families anticipate. The waiver's design prioritizes keeping individuals out of nursing facilities, meaning the service mix is broad, but each plan is uniquely tailored by the service coordinator.

Eligibility for STAR+PLUS in Texas involves three distinct gates. The first is the Financial gate, where income and assets are evaluated. Adults who receive SSI generally qualify automatically for Medicaid. For the STAR+PLUS HCBS waiver, Texas applies a special income limit, which for 2026 is $2,982 per month for a single applicant. The individual asset limit is $2,000. If an applicant is married, the at-home spouse is protected by the Community Spouse Resource Allowance. Texas is an income-cap state, so an applicant over the limit needs a Qualified Income Trust, or Miller Trust, to bring countable income below the threshold—a step that stalls many families.

The second is the Functional gate. To receive the in-home services of the HCBS waiver, the applicant must meet medical necessity for a nursing facility level of care, established by a state assessment.

The third is the Categorical gate. The applicant must be an adult (21+), a Texas resident, and eligible for Texas Medicaid; most readers of this guide are helping a parent 65 or older.

Meeting all three gates makes someone eligible, but the HCBS waiver's in-home benefits are not immediate—there is an interest list.

Texas Medicaid offers the STAR+PLUS program, which provides a pathway to long-term services and supports for eligible adults. There are two distinct entry points for families seeking assistance for a parent. A person already receiving Medicaid or Supplemental Security Income (SSI) is enrolled directly into STAR+PLUS and then selects a managed care plan for their benefits.

For those needing in-home care through the Home and Community-Based Services (HCBS) waiver, the process begins by getting on the STAR+PLUS HCBS interest list. This is the primary route for individuals whose income exceeds standard Medicaid limits but is below 300% of the SSI Federal Benefit Rate, which is $2,982 per month for an individual in 2026. Families can apply for Medicaid at YourTexasBenefits.com or by calling 2-1-1 Texas. To place a parent's name on the STAR+PLUS HCBS interest list, contact the Texas Health and Human Services Commission (HHSC) at 1-877-438-5658.

Once a family contacts HHSC, the parent's name is added to the interest list with a dated request. Time then passes, as the interest list can have multi-year waits. When the parent's name reaches the top of the list, HHSC verifies financial eligibility. If the parent's income is above the cap, a Qualified Income Trust, also known as a Miller Trust, is drafted to help them qualify. A nurse assessment then confirms medical necessity, ensuring the parent requires a nursing-facility level of care. The family then chooses a Managed Care Organization (MCO), and a service coordinator from that MCO develops a personalized care plan. Services begin once providers are arranged.

Enrolling in STAR+PLUS itself is quick once Medicaid eligibility is established, but the HCBS interest list is the longest part of the process. A crucial tactical tip: if a parent is already in a nursing facility and is Medicaid-eligible, the Money Follows the Person (MFP) program can help them transition home on STAR+PLUS HCBS without waiting on the interest list. Always ask about Money Follows the Person.

Texas refers to its Medicaid waiver waitlist as an interest list, and for the STAR+PLUS Home and Community Based Services (HCBS) program, this list is a real factor in accessing care.

Wait times for the STAR+PLUS HCBS program can range from months to years, and they vary widely by service area — generally shorter in rural regions and longest in the big metros such as Dallas–Fort Worth and Austin, where they often run well over a year. To size the bottleneck: roughly 15,000 to 16,000 Texans were on the STAR+PLUS HCBS interest list in 2026, against about 24,000 program slots. These figures shift, so confirm the current wait for your area directly with the Texas Health and Human Services Commission (HHSC).

Placement on the STAR+PLUS HCBS interest list is largely determined by the date a request is made, not by the severity of an individual's need. This first-come, first-served approach is precisely why adding a parent's name to the list as early as possible, even before services are urgently needed, is critical.

Two legitimate pathways can help families bypass the standard wait. A parent already residing in a nursing facility may utilize the Money Follows the Person (MFP) process to transition home on STAR+PLUS HCBS without joining the interest list. Additionally, individuals needing attendant care immediately might qualify for Community First Choice (CFC), a separate Medicaid benefit that has no interest list because it is an entitlement program.

Ultimately, the existence of the STAR+PLUS HCBS interest list underscores why planning for long-term care works far better when initiated proactively, rather than during a crisis.

Community First Choice and the STAR+PLUS HCBS waiver both deliver attendant care in the home, but they are distinct legal programs. Community First Choice is a Medicaid state-plan benefit, an entitlement with no interest list. A Medicaid recipient who meets a nursing-facility level of care can access Community First Choice attendant and habilitation services without waiting.

Community First Choice fits when the immediate need is attendant care—help with daily activities—and the family cannot afford to wait on a list. Because it is an entitlement, it offers the fastest legitimate route to paid help at home for eligible individuals.

The STAR+PLUS HCBS waiver, by contrast, has an interest list but provides a broader package of services. This waiver is appropriate when the person needs a fuller menu that Community First Choice does not cover, such as assisted living facility services, home modifications, adaptive aids, respite care, or adult day care. Access can be gained by waiting on the interest list or by qualifying through the Money Follows the Person program.

Both programs are delivered through the member's STAR+PLUS managed-care plan and service coordinator, and both require the individual to meet a nursing-facility level of care. Many Texas families use Community First Choice to get attendant care immediately while their name moves up the STAR+PLUS HCBS waiver interest list. When discussing options, ask the STAR+PLUS service coordinator about both Community First Choice and the STAR+PLUS HCBS waiver by name.