STAR+PLUS Medicaid: Eligibility, HCBS Waiver, and How to Apply

STAR+PLUS Medicaid is a Texas managed care program for adults age 65 and older and for adults 21 and older with a disability, combining standard Medicaid health coverage with long-term services and supports that help people stay in their homes instead of moving into a nursing facility.1Texas Health and Human Services. STAR+PLUS Every participant’s care runs through a single managed care organization (MCO) that handles doctor visits, prescriptions, and community-based services under one plan. Eligibility depends on both medical and financial criteria, and applications go through the Texas Health and Human Services Commission (HHSC).

Who Qualifies

You must be 65 or older, or 21 or older with a physical or mental disability. You also need to qualify for Medicaid through a recognized pathway, including Supplemental Security Income (SSI) eligibility or one of the “Social Security Exclusion programs” Texas recognizes.1Texas Health and Human Services. STAR+PLUS

If you want the home and community-based services (HCBS) waiver — the part of STAR+PLUS that pays for in-home care — you also need an approved medical necessity determination showing you require a nursing facility level of care, even though you’ll be living in the community.2Texas Health and Human Services. STAR+PLUS HCBS Program Eligibility

Income and Asset Limits

Financial eligibility is where most applications run into trouble. Monthly income generally cannot exceed 300% of the federal SSI benefit rate, which sits at approximately $2,973 per month for an individual in 2026. That figure adjusts each January with cost-of-living increases.

Countable resources are capped at $2,000 for a single applicant. Your primary home, one vehicle, and certain personal belongings are typically excluded. Nearly everything else counts, including bank accounts, investments, and additional property.

If You Have a Spouse Staying at Home

When one spouse applies and the other stays in the community, federal law protects the “community spouse” from being wiped out. For 2026, the community spouse can keep between $32,532 and $162,660 of the couple’s combined countable resources, depending on the total.3Medicaid.gov. 2026 SSI, Spousal Impoverishment, and Medicare Savings Program Resource Standards The community spouse also gets a monthly income allowance for basic living expenses. These rules mean the healthy spouse is not forced into poverty because their partner needs care.

What STAR+PLUS Covers

The program has two layers. Everyone enrolled gets standard Medicaid benefits. Participants who meet nursing-facility level of care and are approved for HCBS get an additional package of long-term services and supports.

Standard Medicaid Benefits

The baseline includes primary care, specialist visits, emergency and inpatient hospital care, prescription drugs, lab work, and preventive screenings. These are coordinated through your MCO rather than billed piecemeal.

HCBS Waiver Services

For people who qualify for the waiver, STAR+PLUS covers services aimed at keeping you safely at home or in a community setting:4Texas Health and Human Services. STAR+PLUS Handbook – Home and Community Based Services

  • Personal assistance with bathing, dressing, and meals
  • Skilled nursing in your home
  • Physical, occupational, speech, and cognitive rehabilitation therapy
  • Adaptive aids and medical supplies
  • Minor home modifications such as ramps, grab bars, and widened doorways
  • Emergency response systems
  • Assisted living and adult foster care as residential alternatives
  • Home-delivered meals
  • Respite care to give a primary caregiver a break
  • Dental services beyond the standard Medicaid dental benefit
  • Employment assistance and supported employment
  • Transition assistance for people moving out of a nursing facility

Each participant has an individual cost limit set by assessment, so the mix of services is tailored rather than unlimited. Your MCO assigns a service coordinator who builds and updates your individual service plan.

How to Apply

STAR+PLUS runs on the standard Texas Medicaid application, Form H1010 (Application for Assistance).5Texas Health and Human Services. Form H1010 – Texas Works Application for Assistance You can file online through the Your Texas Benefits portal, which lets you save progress, upload documents, and check status.6Your Texas Benefits. Your Texas Benefits You can also submit at a local HHSC benefits office or by mail or fax.7Texas Health and Human Services. Benefits Application Next Steps

Documents to Gather

Pull these together before you start:

  • Proof of identity and age: birth certificate, passport, or state ID
  • Citizenship or legal residency: Social Security card, naturalization certificate, or immigration documents
  • Income verification: pay stubs, Social Security award letters, pension statements
  • Asset documentation: bank and investment statements, property deeds, vehicle titles
  • Medical records supporting a disability, if applicable
  • Household information: size, monthly expenses, existing insurance

Picking an MCO

During the application you’ll choose a managed care plan. Options depend on where you live. The MCOs participating in STAR+PLUS include Community First, Molina, UnitedHealthcare, Superior, Wellpoint, El Paso Health, and Community Health Choice, though not every plan operates in every region.1Texas Health and Human Services. STAR+PLUS

Before choosing, check whether your current doctors are in the plan’s network and whether your medications are on its formulary. If you don’t pick, HHSC will assign one for you, and switching afterward is possible but creates administrative delays.

How Long Approval Takes

For applicants 65 and older, the standard processing deadline is 45 days, extendable to 135 days for complex cases. For applicants under 65 who have never had a disability determination, the baseline is 90 days, extendable to 180.8Texas Health and Human Services. Medicaid for the Elderly and People with Disabilities Handbook – R-3100 Establish Processing Deadlines Applications that cannot be certified within those windows, even with extensions, must be denied. Once approved, you’ll receive a notice with your effective date and MCO assignment, and your MCO will send a member card and start coordinating care.

Directing Your Own Care

If you want more control, the Consumer Directed Services (CDS) option lets you hire, train, supervise, and fire your own attendants instead of taking whoever the MCO sends. You become the legal employer.9Texas Health and Human Services. STAR+PLUS Handbook – Consumer Directed Services

As a CDS employer, you set wages within your service budget, handle scheduling, and submit timesheets to a financial management services agency (FMSA) that runs payroll. You have to comply with state and federal employment laws, including overtime, and you’ll need an employer identification number and Texas Workforce Commission registration. The FMSA pays payroll taxes, but if it fails to, the tax liability falls on you. You are also legally liable for negligent acts by workers you employ. CDS suits people who already have a trusted potential caregiver in mind. For others, the paperwork and liability outweigh the flexibility.

If You’re Denied or Services Are Cut

If HHSC denies your application, reduces your services, or ends your eligibility, you have 90 days from the date of the action to request a fair hearing.10Texas Health and Human Services. Texas Works Handbook – B-1020 Time Period for Requesting Fair Hearing The deadline that actually matters is much shorter. To keep your services running while you appeal, you must request the hearing before the effective date on the notice. That can be as little as 10 days after the notice is dated, so don’t set the letter aside.11Texas Health and Human Services. Community Care Services Eligibility Handbook – Appeals and Fair Hearings

File before the effective date and the state must continue community-based services, including HCBS waiver services, at the current level until the hearing officer decides.11Texas Health and Human Services. Community Care Services Eligibility Handbook – Appeals and Fair Hearings One exception: if your underlying Medicaid eligibility itself has been terminated, services do not continue during the appeal unless that eligibility is reinstated. Federal rules generally require a hearing decision within 90 days of the request.12Medicaid.gov. Understanding Medicaid Fair Hearings

Two Planning Traps Before You Apply

The 60-Month Look-Back

Texas reviews the previous 60 months of your finances when you apply for long-term care Medicaid. If you gave assets away or sold them below fair market value during that window, the state imposes a penalty period during which Medicaid will not pay for nursing facility care.13Texas Health and Human Services. Medicaid for the Elderly and People with Disabilities Handbook – I-2100 Look-Back Policy The penalty clock starts on your medical effective date, not on the date you made the transfer.

Some transfers are exempt. Transferring your home to a spouse, to a child under 21, or to a blind or disabled child of any age does not trigger a penalty.14Centers for Medicare and Medicaid Services. Deficit Reduction Act of 2005 – Transfer of Assets Texas must also consider an undue hardship waiver if a penalty would genuinely threaten your health, safety, or access to food and shelter. Moving assets around to qualify is the most scrutinized area of Medicaid planning, and doing it without professional guidance is risky.

Estate Recovery After Death

After a STAR+PLUS participant dies, Texas may seek to recover the cost of certain long-term care services paid on their behalf. The Medicaid Estate Recovery Program (MERP) applies only to services received after age 55 and only reaches assets that pass through the probate estate, such as real property, vehicles, and cash.15Texas Health and Human Services. Medicaid Estate Recovery Program FAQs

Assets that bypass probate are generally not subject to recovery, including life insurance proceeds, retirement accounts, pensions, payable-on-death bank accounts, and joint accounts with right of survivorship.15Texas Health and Human Services. Medicaid Estate Recovery Program FAQs Recovery is also barred when the deceased is survived by a spouse, a child under 21, or a blind or disabled child of any age.16Medicaid.gov. Estate Recovery

MERP places no liens before or after death and cannot collect more than the value of the probate estate. Heirs are not required to pay out of their own pockets. Texas does not offer payment plans, so families dealing with a MERP claim usually resolve it through probate.15Texas Health and Human Services. Medicaid Estate Recovery Program FAQs Estate planning that moves assets out of probate before death can reduce exposure, but the look-back rules limit how and when it can be done.