Texas Medicaid Programs: STAR, STAR Kids, STAR+PLUS, and Eligibility

Texas Medicaid programs are organized around who you are and what kind of care you need. The state delivers most benefits through four managed care programs: STAR for families, children, and pregnant women; STAR Kids for children and young adults with disabilities; STAR+PLUS for adults with disabilities and people age 65 or older; and STAR Health for children in foster care. Separately, Texas Medicaid pays for nursing facility care and runs seven home and community-based waivers for people who need long-term services. The Texas Health and Human Services Commission (HHSC) sets eligibility, contracts with the health plans that run each program, and processes applications.

Which program applies to you depends on your age, income, household, and whether you have a disability. Each has its own rules.

STAR: Families, Children, and Pregnant Women

The State of Texas Access Reform program (STAR) is the largest of the managed care programs. You pick a health plan in your area, and that plan coordinates your doctors, specialists, and other providers. The model leans on preventive care: well-child visits, immunizations, and regular screenings.

Children on STAR get a strong benefits package through a federal requirement called Early and Periodic Screening, Diagnostic, and Treatment (EPSDT). Every child under 21 on Medicaid is entitled to comprehensive health screenings, immunizations, vision exams and eyeglasses, hearing tests and hearing aids, and full dental care including medically necessary orthodontics.¹ Lead screening is required at 12 and 24 months, and any child between 24 and 72 months without a prior test must receive one. If a screening reveals a problem, Medicaid must cover treatment even when that service isn’t normally in the adult benefit package.

Pregnant women qualify at household income up to 198 percent of the Federal Poverty Level, considerably more generous than the thresholds for other adults.² Coverage runs through prenatal, labor and delivery, and postpartum care. For children, the income cutoff depends on age: older children (ages 6 through 18) qualify at around 133 percent of the Federal Poverty Level, while infants and younger children have higher limits.

STAR Kids: Children and Young Adults With Disabilities

STAR Kids is the managed care program for Medicaid-enrolled children and young adults age 20 or younger who have disabilities. Enrollment is required if you meet at least one of these criteria:³

You receive Supplemental Security Income (SSI).
You have both Medicaid and Medicare.
You live in a community-based intermediate care facility or nursing facility.
You receive services through the Medically Dependent Children Program (MDCP) waiver, the Youth Empowerment Services (YES) waiver, or one of the intellectual and developmental disability waivers (CLASS, DBMD, HCS, or TxHmL).

The program covers prescription drugs, hospital and specialty care, preventive care, personal care services, private duty nursing, and durable medical equipment. Every STAR Kids member is assigned a service coordinator who helps families schedule appointments, obtain authorizations, and eventually move from pediatric to adult care. At age 21, most members transition into STAR+PLUS.

STAR+PLUS: Adults With Disabilities and Seniors

STAR+PLUS is the managed care program for adults age 21 and older who have disabilities and for anyone age 65 or older.⁴ Its defining feature is that medical services and long-term services and supports are bundled in a single plan. One health plan and one service coordinator handle both your doctor visits and your in-home care.

To qualify, you must be approved for Medicaid and meet an additional criterion such as receiving SSI, being age 65 or older, or having a qualifying disability. The program’s home and community-based services (HCBS) waiver is what keeps many members out of nursing facilities. Covered services include:

Personal attendant services for bathing, dressing, meals, light housework, and shopping.
Day activity and health services at licensed facilities up to five days per week, including nursing care, meals, and transportation.
Minor home modifications such as grab bars, ramps, and widened doorways.
Adaptive aids and medical equipment for daily activities or communication.

li>Emergency response systems, home-delivered meals, respite care, adult foster care, and assisted living placement.

A service coordinator conducts an assessment and builds a personalized care plan, then acts as the single point of contact across medical and in-home services.

STAR Health: Children in Foster Care

STAR Health is run in partnership with the Texas Department of Family and Protective Services (DFPS). It covers children under 18 in DFPS conservatorship, youth up to age 21 with voluntary extended foster care agreements, and former foster care youth up to age 20.⁵

Benefits include medical and dental checkups, prescription drugs, hospital care, lab tests, vision and hearing care, and mental health services. The program’s Health Passport is an internet-based electronic health record that travels with the child between placements, so new caregivers and providers can see a complete medical history.

Long-Term Care and Community-Based Waivers

For needs beyond what managed care and home visits can handle, Texas Medicaid pays for institutional care in nursing facilities and in intermediate care facilities for individuals with intellectual disabilities (ICF/IID). Qualifying for institutional care requires a functional assessment separate from the financial eligibility process. Assessors look at activities of daily living, memory and cognition, behavioral health, and overall medical status to decide whether you need a nursing-facility level of care.⁶ Meeting the medical threshold does not guarantee financial eligibility, and vice versa. Both must be satisfied.

For people who qualify for institutional care but want to stay home, Texas operates seven 1915(c) home and community-based services waivers:⁷

STAR+PLUS HCBS, the community-based alternative to nursing home care for adults with medical needs.
CLASS, the Community Living Assistance and Support Services waiver for people with both physical and intellectual disabilities.
HCS, Home and Community-based Services for people with intellectual and developmental disabilities.
TxHmL, Texas Home Living, a more limited set of supports for people with intellectual and developmental disabilities living with family or on their own.
MDCP, the Medically Dependent Children Program for families caring for children with high medical needs.
DBMD, Deaf-Blind with Multiple Disabilities, focused on communication and environmental interaction.
YES, Youth Empowerment Services, the only waiver focused on serious emotional disturbance in children.

Every waiver caps annual enrollment, and most have waiting lists. You may be placed on an interest list ranked by date of application, by urgency of need, or both. Some slots are reserved for people transitioning out of institutions or in crisis. Wait times run for years on certain waivers, so applying early matters even if you don’t need services yet.

Who Qualifies Financially

Texas has not expanded Medicaid under the Affordable Care Act, so adult eligibility is more restrictive than in expansion states. Parent caretakers qualify only at very low income levels, often well below the Federal Poverty Level. Pregnant women have the most generous threshold at 198 percent of FPL.² Children’s thresholds vary by age. Adults without children who are not pregnant, disabled, or age 65 or older generally do not qualify.

For seniors and people with disabilities, both income and assets are counted. The countable resource limit for a single individual is $2,000.⁸ Some assets are exempt and don’t count toward that limit:

Your primary home, as long as your equity is within the state’s home equity limit.
One vehicle.
Household goods and personal belongings, including jewelry.
A burial plot and a prepaid irrevocable burial plan.
Term life insurance policies, and whole life policies with a face value of $1,500 or less.

Everything else counts: checking and savings accounts, stocks, bonds, additional real estate, and the cash surrender value of larger life insurance policies. Going in with $2,100 in countable resources means denial even when income is low enough.

The Spend-Down Path

If your income sits slightly above the Medicaid limit, Texas offers a Medically Needy (Spend-Down) Program. HHSC calculates how much your income exceeds the limit for your household size. You then submit medical bills to the Medically Needy Clearinghouse, which totals them starting with the oldest. Once your accumulated medical expenses equal or exceed your spend-down amount, you become eligible for the rest of the eligibility period.⁹ This path works best for people with regular, predictable medical expenses.

Spousal Protections and the Five-Year Look-Back

When one spouse enters a nursing facility or starts HCBS waiver services and the other stays home, federal law protects the at-home spouse (the “community spouse”) from being financially wiped out. The Community Spouse Resource Allowance (CSRA) lets the community spouse keep a portion of the couple’s combined countable resources; for 2026, the minimum is $32,532 and the maximum is $162,660.¹⁰ The Minimum Monthly Maintenance Needs Allowance (MMMNA) lets the community spouse keep some of the institutional spouse’s income if their own falls below a floor. For 2026, the MMMNA ranges from $2,705 to $4,066.50 per month depending on shelter costs.¹¹

When you apply for Medicaid-funded long-term care, the state reviews every financial transaction from the 60 months before your application. If it finds transfers for less than fair market value, it imposes a penalty period during which Medicaid will not pay for nursing facility or waiver services.¹² The penalty length is the value of the improper transfers divided by the state’s penalty divisor. In Texas, that divisor is $242.13 per day as of September 2025.

Not every transfer triggers a penalty. Transfers to a spouse, to a blind or disabled child, or into certain trusts for a disabled beneficiary are exempt.¹³ So is transferring a home to a caregiver child who lived there for at least two years before the parent entered a facility and whose care delayed institutional placement. An undue hardship waiver is available where the penalty would deprive you of basic necessities.

Estate Recovery After Death

Federal law requires every state to seek repayment from the estates of Medicaid recipients who were age 55 or older when they received certain benefits.¹² The Texas Medicaid Estate Recovery Program (MERP) can recover costs paid for nursing facility care, ICF/IID care, HCBS waiver services, and related hospital and prescription drug costs. The state never claims more than it paid.¹⁴

Recovery is blocked while any of these people survive the recipient:

A surviving spouse.
A child under age 21.
A child of any age who is blind or permanently disabled.
An unmarried adult child who lived full-time in the recipient’s home for at least one year before the recipient’s death.

Texas also waives recovery when the estate is worth $10,000 or less, when total Medicaid costs were $3,000 or less, or when selling the property would cost more than the property is worth. An undue hardship exemption is available for heirs whose family income falls below a specified threshold. Life insurance with a named beneficiary and bank accounts with a payable-on-death designation pass outside the estate and are not subject to MERP claims.

How to Apply

Which form you use depends on who is applying. Families and children use Form H1010, the Texas Works Application, which covers children’s Medicaid, Medicaid for pregnant women, Medicaid for parent caretakers, and former foster care youth.¹⁵ Seniors and people with disabilities use Form H1200 for Medicaid for the Elderly and People with Disabilities and Medicare Savings Programs.¹⁶

Have these ready:

Identity and citizenship documents: birth certificate, passport, or naturalization papers.
Income verification: pay stubs from the past 60 days, an employer statement, self-employment records, or your most recent tax return.¹⁷
Resource documentation: bank statements, life insurance policies, records of property you own.
Household details: Social Security numbers for each household member, monthly expenses like rent and utilities, and employer contact information.

You can submit through the Your Texas Benefits online portal, mail your application to HHSC at P.O. Box 149024, Austin, TX 78714-9024, or fax it to 1-877-447-2839.¹⁸

Timelines and Appeals

Applications from people age 65 or older, or from anyone with a disability already established through Social Security records, must be decided within 45 days. If your disability still needs to be determined by HHSC’s Disability Determination Unit, the deadline extends to 90 days.¹⁹

If the state needs more documents, you’ll receive a Request for Information. On redeterminations, you have 10 days to respond. Missing that deadline is one of the most common reasons cases stall or get denied. You can check status through the Your Texas Benefits website, the mobile app, or by calling 2-1-1.

If your application is denied or your benefits are reduced, you have 90 days from the effective date of the action to request a fair hearing.²⁰ A fair hearing lets you present evidence and argue your case before an independent hearing officer. Errors in income calculation, missing documents that can be supplied later, and misclassified disability status are all correctable on appeal.

1
Medicaid.gov. Early and Periodic Screening, Diagnostic, and Treatment
2
Texas Health and Human Services. Texas Works Handbook – D-110, General Policy
3
Texas Health and Human Services. STAR Kids
4
Texas Health and Human Services. STAR+PLUS
5
Texas Health and Human Services. STAR Health
6
Medicaid.gov. Functional Assessments and Quality Improvement
7
Medicaid.gov. Home and Community-Based Services 1915(c)
8
Texas Health and Human Services. Appendix XI, Income and Resource Limits
9
Texas Health and Human Services. Medically Needy Program
10
Medicaid.gov. 2026 SSI, Spousal Impoverishment, and Medicare Savings Program Resource Standards
11
Medicaid.gov. 2026 SSI and Spousal Impoverishment Standards
12
Office of the Law Revision Counsel. 42 USC 1396p – Liens, Adjustments and Recoveries, and Transfers of Assets
13
Centers for Medicare and Medicaid Services. Deficit Reduction Act of 2005 – Transfer of Assets
14
Texas Health and Human Services. Your Guide to the Medicaid Estate Recovery Program
15
Texas Health and Human Services. Form H1010, Texas Works Application for Assistance – Your Texas Benefits
16
Texas Health and Human Services. Form H1200, Application for Assistance – Your Texas Benefits
17
Texas Health and Human Services. Texas Works Handbook – A-1370 Verification Requirements
18
Texas Health and Human Services. Texas Health and Human Services – Form H1200
19
Texas Health and Human Services. Medicaid for the Elderly and People with Disabilities Handbook – B-6400, Processing Deadlines
20
Texas Health and Human Services. Texas Works Handbook – B-1020, Time Period for Requesting Fair Hearing