Does Medicaid Cover Memory Care in Texas? STAR+PLUS and Eligibility

Yes, Medicaid does cover memory care in Texas, but what it pays depends entirely on where the care is delivered. In a nursing home, Medicaid pays for everything: room, board, nursing, personal care, medications, and the specialized services of a secure Alzheimer’s unit, for anyone who meets the financial and medical rules. In a standalone memory care community, which Texas licenses as assisted living, Medicaid pays only for care services through the STAR+PLUS waiver program. The resident still owes room and board out of pocket, and the waiver has a waiting list.

That split is the single most important thing to understand before you choose a setting or sign a contract.

Nursing Home Memory Care Through Medicaid

Nursing home Medicaid is an entitlement in Texas. If your family member qualifies, coverage is guaranteed; there is no waiting list for the benefit itself. The only practical limit is finding a nursing facility that accepts Medicaid and has a bed open.¹

For a qualifying resident, Texas Medicaid covers room and board, skilled nursing, personal care, physician visits, prescription medications, and mental health counseling in the facility.¹ Many Texas nursing homes operate secure units for dementia residents with activities designed for different stages of the disease. You can identify these in the official Texas HHS nursing facility directory by searching for the designation “Cert AlzhCapacity.”²

A few caveats. Medicaid generally pays for a shared room, not a private one, and it will not pay for comfort items or services that aren’t medically necessary. Residents must also hand over nearly all of their monthly income toward the cost of care, keeping only a $75 personal needs allowance.¹

STAR+PLUS: Memory Care in an Assisted Living Setting

Most communities that market themselves as “memory care” in Texas are licensed as assisted living facilities, not nursing homes. The Medicaid rules are different, and this is where families most often misunderstand what the program will do.

Texas Medicaid does not directly pay for a room in an assisted living memory care community the way it does in a nursing home. Instead, it uses the STAR+PLUS Home and Community-Based Services waiver to fund care services while the resident keeps paying for the room itself.³

Through STAR+PLUS, Medicaid covers personal care assistance, nursing, occupational and physical and speech therapy, medical supplies, adaptive aids, emergency response systems, and respite care for someone who needs a nursing-home level of care but chooses an assisted living setting.⁴ The facility must provide 24-hour supervision, three daily meals, transportation to medical appointments, and planned social activities.³

The Room-and-Board Charge

STAR+PLUS members pay their own room and board, and the waiver cannot waive this cost. The amount is calculated as the federal Supplemental Security Income benefit rate minus an $85 personal needs allowance, roughly $909 per month as of 2026.⁵ A resident who refuses to pay room and board can be evicted and lose services.³ A copayment may also apply based on the member’s income.

Only Certain Facilities Qualify

STAR+PLUS covers assisted living only in facilities that hold a Type B license and contract with the member’s managed care organization.³ Type B is the license category for residents who may need staff help to evacuate during an emergency, may be unable to follow directions, and may require nighttime supervision.⁶ Any facility that advertises itself as memory care must hold a Type B license and specific Alzheimer’s certification.⁷ Not every community participates in STAR+PLUS, and residents cannot be permanently bedridden.

The Interest List

Unlike nursing home Medicaid, STAR+PLUS HCBS is not an entitlement. Enrollment slots are limited, and when they fill, applicants land on an interest list. Waits run from months to years.⁸ For the 2022–23 biennium, the legislature funded only 107 new STAR+PLUS HCBS slots.⁹ You do not need to prove eligibility when you join the list; the state reviews eligibility only when your name reaches the top.¹⁰ Get on the list early.

Medicare Will Not Pay for Memory Care

Families frequently assume Medicare covers memory care. It does not. Medicare pays for up to 100 days of skilled nursing after a hospital stay, and it covers medically necessary doctor visits, diagnostic assessments, and prescription drugs for someone with dementia.¹¹ Once those 100 days end, Medicare stops paying for the facility.¹² That is the point at which Medicaid, if the person qualifies, becomes the long-term payer.¹³

Financial Eligibility in 2026

Qualifying financially for Texas Medicaid long-term care is strict. For 2026, nursing home Medicaid and the STAR+PLUS waiver use the same thresholds:¹⁴

Single applicant: monthly income up to $2,982, countable assets of $2,000 or less.
Married couple, both applying: combined monthly income up to $5,964, assets of $3,000 or less.
Married couple, one applying: applicant income up to $2,982 and $2,000 in assets; the non-applicant spouse may keep up to $162,660 under the Community Spouse Resource Allowance.

The applicant’s primary home is generally exempt if a spouse, a child under 21, or a disabled child lives there. Even with none of those people present, the home is exempt as long as the applicant intends to return and equity does not exceed $752,000.¹⁴ One vehicle is excluded regardless of value, and up to $1,500 in burial funds per person can be set aside.¹⁵

When Income Is Over the Limit

Being over the income cap doesn’t automatically disqualify an applicant. A Qualified Income Trust, often called a Miller Trust, lets an applicant deposit income above $2,982 into an irrevocable trust so that it doesn’t count against the Medicaid income test.¹⁶ The State of Texas must be named as the residuary beneficiary, which means the state is reimbursed from any trust funds remaining after the beneficiary dies.¹⁷ The entire amount of each income stream directed to the trust must go in; partial deposits are not allowed.

When Assets Are Over the Limit

Families can spend down excess assets on exempt purchases: home repairs, paying off debt, or buying irrevocable burial trusts. These transactions have to respect the look-back rules below.¹⁴

Protection for the Spouse at Home

A community spouse in Texas may keep up to $162,660 in assets for 2026. If their half of the countable assets falls below $32,532, they may retain up to that minimum floor instead. The non-applicant spouse is also entitled to a Monthly Maintenance Needs Allowance of $4,066.50; if their own income falls short, income can be transferred from the applicant spouse to make up the difference.¹⁴

Medical Eligibility

Money is only half the test. The applicant must also demonstrate a “nursing facility level of care” through a Medical Necessity and Level of Care assessment.¹⁸ A diagnosis of Alzheimer’s alone is not enough. The applicant has to show that they need help with daily activities such as eating, bathing, dressing, toileting, and mobility, and that they need skilled nursing care or around-the-clock supervision.¹⁹

The Look-Back Period and Estate Recovery

Texas uses a 60-month look-back for nursing home Medicaid and Medicaid waivers. Assets given away or sold below fair market value during those five years before the application can trigger a penalty period of ineligibility. The IRS annual gift tax exclusion does not shield transfers from Medicaid penalties.¹⁴

After a beneficiary dies, Texas can seek reimbursement for long-term care costs through the Medicaid Estate Recovery Program. Recovery covers services received after age 55, including nursing facility care, waiver services, and related hospital and drug costs. The state will not pursue a claim if a surviving spouse is alive, if the deceased leaves a child under 21 or a disabled child of any age, if the estate is worth $10,000 or less, or if total Medicaid costs were under $3,000.²⁰

One tool families use to keep a home out of estate recovery is a Lady Bird deed, also called an enhanced life estate deed. The homeowner names a beneficiary who inherits the property at death while keeping full control during their lifetime, including the right to sell or cancel.²¹ Because the property passes outside probate and the recipient is considered not to own it at death for Medicaid purposes, the home is shielded from a MERP claim. Transfer on Death Deeds serve a similar function under Texas Estates Code 114.151.²²

How to Apply

Applications go through YourTexasBenefits.com. You can also call 2-1-1 or contact a local Aging and Disability Resource Center for help.²³ For nursing home Medicaid specifically, the applicant must reside in the facility for 30 consecutive days before becoming eligible to apply.²⁴ To join the STAR+PLUS HCBS interest list, apply online or call 1-877-438-5658.⁹

Federal rules require states to process Medicaid applications within 45 days. Texas has struggled with that standard. As of March 2024, the median processing time for a new Medicaid application was 88 days, with less than half processed within 45 days.²⁵ Plan for significant delays and start early.

Closing the Cost Gap

Memory care in Texas averages about $5,356 per month, below the national average of about $7,505. Even at the Texas average, the gap between what Medicaid pays and what a family owes is real. In an assisted living memory care setting, STAR+PLUS covers care services but not the roughly $909 monthly room-and-board charge, and the facility’s full rate will often exceed what Medicaid reimburses for services. Most Texas families begin with private funds and transition to Medicaid as savings run out.²⁶

Veterans and surviving spouses of wartime veterans have another resource. VA Aid and Attendance adds a monthly payment to a VA pension: $2,874 for a married veteran in 2026, $2,424 for a single veteran, and $1,558 for a surviving spouse.²⁷ It won’t cover memory care on its own, but with Social Security and other income it can close much of the gap. Aid and Attendance can be received alongside Medicaid, though the income it provides counts toward Medicaid eligibility calculations.

1
MedicaidLongTermCare.org. Eligibility for Medicaid Long-Term Care in Texas
2
Texas Department of State Health Services. Options for Care
3
Texas Health and Human Services. STAR+PLUS Handbook – Assisted Living Services
4
Texas Health and Human Services. STAR+PLUS
5
Brevy. Texas Assisted Living
6
Texas Health and Human Services. Assisted Living Facilities
7
American Health Care Association. Texas Assisted Living Regulatory Summary
8
MedicaidPlanningAssistance.org. Texas Medicaid STAR+PLUS
9
Texas Health and Human Services. Interest List Reduction
10
The Arc of Texas. Medicaid Waivers
11
Alzheimer’s Association. Medicare
12
MedicareResources.org. Does Medicare Cover Memory Care and Dementia Care
13
Centers for Medicare and Medicaid Services. Medicare and Medicaid Benefits for People with Dementia
14
MedicaidPlanningAssistance.org. Medicaid Eligibility in Texas
15
Texas Health and Human Services. MEPD Handbook – Appendix XXXIII
16
Texas Health and Human Services. Qualified Income Trust
17
Texas Law Help. Qualified Income Trusts
18
Cornell Law Institute. 1 Tex. Admin. Code § 354.1363
19
Texas Medicaid & Healthcare Partnership. Long-Term Care Forms
20
Texas Health and Human Services. Your Guide to the Medicaid Estate Recovery Program
21
Texas Law Help. Lady Bird Deeds
22
Texas Bar Association. Estate Recovery and Lady Bird Deeds
23
Texas Health and Human Services. Medicaid for the Elderly and People with Disabilities
24
Texas Health and Human Services. Long-Term Care
25
Every Texan. Tracking Texas Medicaid and SNAP Delays
26
Brevy. Cost of Senior Care in Texas
27
U.S. Department of Veterans Affairs. Aid and Attendance and Housebound Benefits