STAR+PLUS waiver eligibility in Texas rests on three tests: you must be 65 or older or meet the Social Security Administration’s definition of disability, your care needs must reach nursing-facility level, and your finances must fit within the program’s income and resource limits ($2,982 in monthly income and $2,000 in countable resources for an individual in 2026). The waiver is Texas Health and Human Services Commission’s (HHSC) home and community-based services program under Section 1915(c) of the Social Security Act, which lets Medicaid pay for care at home instead of in a nursing facility.1Social Security Administration. Social Security Act 1915 Meeting the rules gets you approved; it does not always get you enrolled right away, because most applicants land on an interest list first.
The Medical Test
The core medical question is whether you need the same level of care a nursing facility would provide. HHSC answers it with a standardized tool, the Medical Necessity and Level of Care Assessment, administered by a licensed professional.2Texas Health and Human Services. Medical Necessity and Level of Care Assessment 3.0 The assessment covers your ability to bathe, dress, eat, and move around your home, along with cognitive patterns, mood, behavior, skin conditions, medications, and active diagnoses.
There is no fixed federal count of activities of daily living you must fail. Texas evaluators weigh the whole picture. Advanced dementia, frequent falls, difficulty managing medications, or needing hands-on help with several daily tasks all point toward meeting the threshold.3Texas Health and Human Services. Appendix XII, Nursing Facility and Home and Community-Based Services Waiver Information If you’re under 65, you also need to meet Social Security’s disability definition.
The Income Limit
Texas uses a Special Income Limit set at 300% of the federal SSI benefit rate, which comes to $2,982 per month for an individual in 2026.4Legal Information Institute. 1 Texas Admin Code 358.433 – Special Income Limit5Social Security Administration. SSI Federal Payment Amounts6Texas Health and Human Services. Appendix XXXVI, QITs and MEPD Information All recurring income counts: Social Security, pensions, veteran’s benefits, annuity payments.
Being a few hundred dollars over the limit does not disqualify you. A Qualified Income Trust, commonly called a Miller Trust, brings you back under. You establish an irrevocable trust, open a dedicated bank account using your Social Security number, and deposit income into it each month. Because the income is diverted into the trust before it reaches you, it stops counting for eligibility.6Texas Health and Human Services. Appendix XXXVI, QITs and MEPD Information
The trust has to follow specific rules. It must be written and irrevocable. Only income goes in; you cannot deposit savings or other assets. All income from a chosen source must be deposited in the month received, and the trustee must distribute funds by the last day of the following month. Missing that distribution deadline counts as a transfer of assets and can trigger a penalty. The document must also include a reversion clause stating that when you die, any remaining trust funds go to Texas to reimburse Medicaid, up to the total value of benefits you received.
Each month the trustee pays your personal needs allowance, any court-ordered guardianship fees, and, if you’re married, an amount to bring your spouse’s income up to the maintenance allowance. Trust administration costs come last. HHSC recommends you not serve as your own trustee; most families use a spouse, adult child, or attorney.
The Resource Limit
Countable resources cannot exceed $2,000 for an individual or $3,000 for a couple.7Medicaid.gov. January 2026 SSI and Spousal CIB Countable means bank accounts, investments, and cash. Several assets are excluded:
- Your primary home, as long as you intend to return or a spouse still lives there
- One vehicle
- Personal belongings and household furnishings
Life insurance policies with cash value and any real estate beyond your primary home do count. If you’re over the limit, you generally have to spend down before qualifying, but the spend-down has to be done carefully because of the look-back rule described below.
If You’re Married and Only One Spouse Applies
When one spouse applies and the other stays in the community, federal spousal impoverishment rules protect the non-applicant. In 2026, the spouse at home can keep income up to $4,066.50 per month under Texas’s Monthly Maintenance Needs Allowance.8Texas Health and Human Services. MEPD and TW Bulletin 25-24
The community spouse also keeps a portion of the couple’s combined countable resources through the Community Spouse Resource Allowance. The federal maximum for 2026 is $162,660. The exact allowance depends on the couple’s total assets at the initial eligibility determination. Assets above that must be spent down before the applying spouse qualifies, though options like purchasing an annuity or prepaying burial expenses can help with this legally.
The Five-Year Look-Back
HHSC reviews the 60 months of financial transfers immediately before your application. Gifts, sales below market value, and transfers to family members during that window can trigger a penalty period during which you’re ineligible for waiver services.9Texas Health and Human Services. I-2100, Look-Back Policy The penalty length is the value of the transfers divided by the average monthly cost of nursing facility care in Texas.
Even ordinary generosity gets caught here. Large checks to grandchildren, helping an adult child with a down payment, gifting a car — any of it can create a problem. If you think you’ll apply within the next five years, talk to an elder law attorney before moving significant money or property.
The Interest List
Meeting the eligibility rules does not mean immediate services. Demand for STAR+PLUS HCBS consistently exceeds funding from the Texas Legislature, so most applicants are placed on an interest list.10Texas Health and Human Services. Interest List Reduction When a slot opens, HHSC contacts the next person in line. Waits range from months to several years depending on appropriations and turnover.
Keep your address and phone number current with HHSC the entire time you’re waiting. If they cannot reach you when your name comes up, you can lose your place. When your turn arrives, an assessor meets with you in person to verify the medical criteria and confirm that home care is appropriate.
How to Apply
You apply on Texas Form H1200, “Application for Assistance,” downloadable at YourTexasBenefits.com or available at any local HHSC office.11Texas Health and Human Services. Form H1200, Application for Assistance – Your Texas Benefits Before you start, pull together:
- Social Security numbers for everyone in the household
- Contact information for your doctors, plus recent hospital discharge summaries or diagnostic records supporting your need for nursing-level care
- Income verification: Social Security award letters, pension statements, VA benefit letters, and anything else recurring
- Bank statements for all checking, savings, and investment accounts, plus life insurance policies with cash value and deeds for any real estate beyond your primary home
- Names and relationships of everyone living in your home
The form asks for a line-by-line accounting of your finances. Precision matters. Missing documents and inconsistent numbers are the most common reason applications stall. You can submit the completed packet through the Your Texas Benefits online portal, mail it to the HHSC document processing center, or drop it off at a local office.
If You’re Denied
You can request a fair hearing on any denial, reduction, or other adverse action. The deadline is 90 days from the effective date of the decision, and you can request the hearing orally or in writing.12Texas Health and Human Services. B-1020, Time Period for Requesting Fair Hearing HHSC staff are not allowed to discourage you from filing. Even after 90 days, a hearings officer may accept a late appeal for good cause.
Come prepared. For a medical denial, an updated letter from your physician explaining why you need nursing-level care can be persuasive. For a financial denial, verify that every document was submitted and that excluded assets, especially your home, were categorized correctly. Legal aid organizations and elder law attorneys often help at this stage.
What Happens to Your Estate After You Die
One piece of the waiver worth knowing before you apply: Texas can seek reimbursement from your estate after you die for services you received at age 55 or older. This is the Medicaid Estate Recovery Program (MERP).13Texas Health and Human Services. Your Guide to the Medicaid Estate Recovery Program
Texas will not pursue a MERP claim if:
- A spouse is still living
- A surviving child is under 21
- A surviving child of any age is blind or permanently and totally disabled
- The estate is worth $10,000 or less, or total Medicaid costs were $3,000 or less
- An unmarried adult child lived full-time in the deceased person’s home for at least one year before death
- Selling the estate property would cost more than the property is worth
Heirs can also request a hardship waiver in writing. The state may waive recovery if the property was a family farm or business that served as the heirs’ primary income for at least 12 months before death, or if recovery would push the heirs onto public assistance. Where the homestead is worth less than $100,000 and heirs’ family income falls below certain thresholds (for 2025, $46,950 for one person or $63,450 for a family of two), the state may not pursue the home.13Texas Health and Human Services. Your Guide to the Medicaid Estate Recovery Program Hardship waivers are not automatic; heirs have to ask and provide documentation.
Planning matters. The Miller Trust’s reversion clause routes any leftover trust funds to the state first. Beyond that, the family home is usually the largest asset exposed to a claim. An elder law attorney can walk through options such as a life estate deed or the caregiver child exemption before you apply, while those options are still available.