Key Takeaways
If you’re worried about how to pay for long-term care for an aging parent or family member with disabilities, you’re not alone. The cost of care is one of the biggest sources of anxiety for Central Texas families, and most people have no idea where to start with Texas Medicaid programs.
STAR+PLUS is the Texas Medicaid managed care program that combines medical care and long-term services and supports for adults 65 and older and adults with disabilities. The star plus HCBS waiver (Home and Community-Based Services) can help your loved one access in-home and community-based services instead of moving to a nursing home.
In this guide, you’ll learn who qualifies in Texas in 2024–2026, what waiver services are covered, how to apply through Your Texas Benefits and 2-1-1, and how long it typically takes. Next of Kin Homecare in Central Texas can help families understand options and coordinate private-pay support around Star Plus and other funding sources.
What Is STAR+PLUS and the STAR+PLUS HCBS Waiver?
The costs of long-term care services are a major source of stress for families. Many Central Texas families don’t know where to start with Texas Medicaid—and that’s completely understandable. The system wasn’t designed to be intuitive.
The Star Plus program is a Texas Medicaid managed care program run by the Texas Health and Human Services Commission. It combines regular healthcare services (doctor visits, hospital care, prescription medications) with long-term services and supports for eligible adults. This includes adults aged 65 and older and adults with intellectual and developmental disabilities who qualify for Medicaid.
The star plus HCBS waiver is the home and community-based part that allows people to receive support in home or community settings instead of a nursing facility. STAR+PLUS HCBS provides services that help individuals who would otherwise require nursing home care live at home, including personal assistance services and respite care. This community-based services program replaced the older community-based alternatives program in 2014.
When you enroll in Star Plus, you join a health plan through one of the managed care organizations operating in your area. This health plan provides service coordination and helps arrange both medical and home support services.
Who Can Qualify for STAR+PLUS in Texas?
Eligibility has three main parts: age or disability status, financial qualification, and functional need assessment.
Age and Disability Requirements: To be eligible for STAR+PLUS Medicaid, applicants must be Texas residents aged 65 or older or aged 21 or older with a disability and require a nursing facility level of care. Some adults in specialized Medicaid categories, such as the cervical cancer program, may also qualify.
Residency and Citizenship: Your loved one must live in Texas and be a U.S. citizen or qualified legal resident. Short-term absences won’t disqualify someone, but moving out of state ends eligibility.
Functional Need (Nursing Facility Level of Care): The star plus waiver requires that your loved one needs help with activities of daily living—bathing, dressing, toileting, transferring, eating—or medical oversight similar to what’s provided in a nursing facility. Applicants must undergo a Medical Necessity and Level of Care assessment to determine whether they meet the nursing facility level-of-care requirement. In everyday terms, this might include someone with advanced dementia who can’t be left alone, has frequent falls, or has complex medical needs requiring ongoing supervision.
People already on nursing home Medicaid may have a smoother path to the waiver when transitioning back to the community through transition assistance services.
STAR+PLUS Medicaid Financial Eligibility (Income and Assets)
Financial rules change periodically, so the numbers here (2024–2026) are examples—always verify with HHSC or the Area Agency on Aging.
Income Limits: The income limit for a single applicant to qualify for STAR+PLUS Medicaid in 2024 is $2,829 per month, which translates to an annual income of $33,948. Income includes Social Security benefits, pensions, and other regular monthly income sources—though some Social Security exclusion programs may apply.
For married couples, the rules differ depending on whether only one spouse or both spouses apply. If only one spouse is applying for Medicaid, the non-applicant spouse can keep 50% of the couple’s assets, up to $148,620 as of 2024.
Asset Limits: Single applicants are allowed countable assets valued up to $2,000 in 2024, but many assets are exempt from this limit, including the primary home (if equity is less than $713,000), one vehicle used for transportation, household goods, and personal belongings.
Look-Back Period Warning: Texas Medicaid applies a 60-month look-back period for gifting or transferring assets below fair market value. Transfers during this period can trigger a penalty that delays eligibility. If you’re considering transferring assets, speak with an elder law attorney first.
Over the Limits? How Miller Trusts and Planning Strategies Work in Texas
Many Central Texas families discover their loved one’s monthly income is “a little over” the monthly income limit and assume automatic denial. That’s not necessarily true.
A Qualified Income Trust, known in Texas as a Miller Trust, is a special bank account into which part or all of your parent’s income is deposited. For Medicaid counting purposes, monthly income equal to or exceeding the limit can be redirected into this trust so the person’s countable income falls within program rules.
A Miller Trust must be drafted with specific legal language, typically with help from an elder law or Medicaid planning attorney. Funds in the trust can only be used for permitted expenses, such as medical care costs and the personal needs allowance.
Miller Trusts solve income problems, not excess assets. For assets, other tools—such as spend-down on care services, allowable home repairs, or certain irrevocable trusts—may apply. Improper transfers during the look-back period can cause delays, so seek professional guidance.
What Services Does the STAR+PLUS HCBS Waiver Cover In-Home?
The plus home and community-based waiver is designed to keep your loved one safe at home while avoiding or delaying nursing home placement. STAR+PLUS provides access to a range of long-term services and supports, including personal care, adult day care, and home modifications, enabling seniors and adults with disabilities to live in their own homes or in assisted living residences.
Major Home and Community-Based Services Include:
- Personal attendant services (help with bathing, dressing, grooming, toileting, mobility, meal preparation) delivered in the home
- Day activity and health services (adult day health) with socialization, supervision, and some health services
- Nursing services, respite care—both in-home and out-of-home—to give family members temporary relief
- Adaptive aids and medical equipment like walkers, grab bars, shower chairs, medical supplies, and personal emergency response systems
- Minor home modifications (ramps, widened doorways, bathroom modifications) that improve safety
- Home-delivered meals for nutrition support
- Emergency response services and nursing services when medically necessary
- Dental services, physical therapy, occupational therapy, and speech-language therapy are based on medical necessity
- Cognitive rehabilitation for those recovering from stroke or brain injury
- Adult foster care and assisted living options within the program
Services covered under the STAR+PLUS HCBS Waiver include home-delivered meals, personal emergency response systems, in-home nursing services, and adaptive aids. Exact services and hours are based on an individualized service plan created with your service coordinator.
Service Coordination: The Heart of the STAR+PLUS Program
The STAR+PLUS program includes service coordination, where a service coordinator helps members develop a personalized service plan based on their individual needs and goals. Every star plus member is assigned a service coordinator through their managed care health plan.
What Service Coordinators Do:
- Meet with your family (often in the home) to understand needs
- Create and update the care services plan
- Arrange personal attendant hours, day activity, and health services
- Order adaptive aids and coordinate minor home modifications
- Help with authorizations and support consultation when conditions change
- Connect you to other services like lab tests, prescription drugs, and medicare doctor visits
Participants in the STAR+PLUS program can receive services through managed care organizations, which coordinate both medicare services and long-term care services, ensuring a comprehensive approach to care.
Participants can also receive consumer-directed services through financial management services, allowing them to hire their own caregivers, excluding spouses. This Consumer Directed Services option sometimes lets families select and supervise certain attendants, including some relatives, with the health plan providing payroll and training support.
Contact your service coordinator whenever needs change—after hospitalization, new diagnosis, or caregiver burnout—to adjust the plan.
STAR+PLUS vs. Medicare Home Health and Other Programs
Families often confuse Star Plus Medicaid with Medicare home health. Here’s the difference:
Medicare Home Health: Short-term, medically-focused services like nursing or therapy after illness or hospitalization. Usually, a few hours per week, not designed for ongoing daily personal care.
STAR+PLUS HCBS: Ongoing home and community-based services like personal care, respite care, and day programs for chronic needs.
Many Central Texas seniors have both Medicare and Medicaid (dual eligible). Medicare remains primary for hospital care and regular healthcare services, while Star Plus covers additional long-term services and supports through the medicaid waiver.
Other Funding Sources:
- VA Aid and Attendance for qualifying veterans and surviving spouses
- Private long-term care insurance policies
- Out-of-pocket private-pay home care
Non-medical home care agencies like Next of Kin Homecare can supplement what Star Plus covers—extra hours, companionship, transportation, or coverage while you’re on a waiting list for medicaid benefits, and families may want to explore non-medical home care options in Central Texas to understand what types of support are available.
How to Apply for STAR+PLUS and STAR+PLUS HCBS in Central Texas
Don’t wait until a crisis—applying early gives time to resolve income and asset levels and documentation issues.
Application Options:
- Your Texas Benefits website (yourtexasbenefits.hhsc.texas.gov): Create an account, submit a Medicaid application, and upload documents
- Call 2-1-1 (option 2): Speak with someone who can start an application or mail forms
- In-person: Visit a local HHSC benefits office
Documents to Gather:
- ID and Social Security numbers
- Proof of income (Social Security award letters, pensions, supplemental security income statements)
- Bank statements showing income and asset levels
- Insurance information
- Any existing medical assessments
Clearly state that your loved one needs help to avoid or leave a nursing facility and ask for an assessment for the community-based services HCBS waiver. Some areas maintain interest lists, so get on the list early if advised.
Timelines: How Long Does It Take from Application to Services?
Timelines vary, but here’s a realistic expectation:
- Medicaid financial eligibility determination: 30–45 days (longer if documentation is missing)
- Star Plus enrollment: Health plan assigned shortly after approval
- Service coordinator contact: Usually within 30 days of enrollment
- NFLOC assessment and service planning: Additional weeks before in-home services begin
Overall range: 1–3 months from complete application to services starting, sometimes longer if there’s a waiver wait list or financial complications.
Keep copies of all paperwork, respond quickly to requests, and work with local resources to avoid delays; a helpful step is learning more about navigating in-home senior care in Central Texas, so you know which services to line up while Medicaid is pending.
Local Help in Central Texas: Area Agency on Aging and Regional Resources
Nobody should navigate Star Plus alone. Central Texas has strong support organizations.
The Capital Area Council of Governments (CAPCOG) Area Agency on Aging serves Travis, Williamson, Hays, Bastrop, Burnet, Blanco, Caldwell, Fayette, Lee, and Llano counties. They offer a starting point for understanding benefits, but many families also review comprehensive Austin home care solutions for seniors to compare community-based supports alongside STAR+PLUS.
- Free benefits counseling
- Help understanding medicaid healthcare and Medicare options
- Assistance with Star Plus and HCBS applications
- Caregiver support and referrals to community-based services
Call them for one-on-one guidance if you’re unsure where to start. Reach out early—not just in crisis.
How Next of Kin Homecare Works Alongside STAR+PLUS
Even when your loved one qualifies for Star Plus, approved HCBS hours may not cover every need. The waiver might not include enough evening coverage, weekend help, or companionship hours.
Next of Kin Homecare provides personalized non-medical in-home care services, including:
- Personal care (bathing, dressing, grooming)
- Meal preparation and light housekeeping
- Transportation options, appointment assistance, and medication reminders are coordinated with broader senior transportation resources in Central Texas
- Companionship services tailored to your family’s schedule
We coordinate with your Star Plus service coordinator to build a blended plan using waiver services efficiently while filling gaps with private-pay support. Examples include caregiver presence while you work, 24/7 home care solutions for a parent with complex needs, overnight supervision and nightly assistance for a parent with dementia in a home setting, or extra respite care services so family caregivers can rest.
We offer 24/7 availability, customized care plans, and a free in-home consultation to review coverage and find services that meet program rules for your situation.
Step-by-Step Roadmap: Your Next Moves If You Think You Qualify
- Confirm likely eligibility: Check age/disability status, Texas residency, approximate monthly income limit and assets, and whether long-term or even 24/7 home care support might be needed
- Gather documents: Social Security statements, bank records, insurance info
- Apply: Create an account at Your Texas Benefits or call 2-1-1 (option 2)
- Request HCBS assessment: Ask specifically about the star plus home and community-based services waiver
- Contact CAPCOG Area Agency on Aging: Get free counseling for Travis, Williamson, Hays, Bastrop, Burnet, Blanco, Caldwell, Fayette, Lee, or Llano counties, and ask about caregiver stress management and local respite resources or respite care benefits for Central Texas families
- Call Next of Kin Homecare: Schedule a free in-home consultation to discuss immediate needs while Medicaid is pending, and review the best in-home care options in Austin, our family-centered approach, and caregiving team, and how we focus on achieving senior home care independence
While the system is complex, families who take these steps usually feel more in control and better prepared for their loved one’s future.
Frequently Asked Questions about the STAR+PLUS Waiver in Central Texas
Can my parent keep living at home and still qualify for STAR+PLUS HCBS?
Yes. Star Plus HCBS is specifically designed so that adults who meet nursing facility level of care requirements can receive services in the home or another community setting. HHSC and the health plan must determine that your loved one’s needs can be safely met at home with a combination of waiver services, informal support, and other community resources.
Can a family member be paid as a caregiver under STAR+PLUS?
For many families, arranging paid help is only part of the picture; understanding local respite care options for caregivers can make it easier to take breaks without disrupting your loved one’s routine.
In many cases, Star Plus allows certain relatives (often excluding spouses and legal guardians) to be paid attendants through Consumer Directed Services, depending on program rules and health plan policies. Ask your service coordinator about CDS options, eligibility rules, and required training.
What happens if my parents’ health gets worse after enrolling in STAR+PLUS?
If needs eventually go beyond what can be safely managed at home, families sometimes explore top nursing homes and senior care communities in Austin, alongside STAR+PLUS and Medicaid options.
Service plans aren’t permanent. Families can request a reassessment from the service coordinator if conditions change—such as new falls, hospitalizations, or increased confusion. The coordinator may increase attendant hours, add respite care, or explore adult foster care or assisted living within the program.
Does STAR+PLUS pay for rent or mortgage payments?
Star Plus and the HCBS waiver do not pay for room and board in a private home setting and generally don’t cover rent or mortgage costs. Some assisted living residences under Star Plus may have partial coverage for care services but require separate room-and-board contributions.
How does private-pay home care work with STAR+PLUS if we’re on a wait list?
While waiting for Star Plus HCBS approval or for a slot to open, families often hire private-pay agencies like Next of Kin Homecare for immediate in-home support, including errand assistance for seniors. To better understand how to combine these supports with waiver services, you can also review educational senior care and caregiving videos that walk through common scenarios.
While waiting for Star Plus HCBS approval or a slot to open, families often hire private-pay agencies like Next of Kin Homecare for immediate in-home support. Once waiver services begin, you can reduce private-pay hours, keeping them where they add the most value—such as evenings, weekends, companionship, or specialized dementia care.
Ready to explore your options? Schedule a free in-home consultation with Next of Kin Homecare to discuss how to combine STAR+PLUS, VA benefits, long-term care insurance, and private-pay care for your loved one’s unique needs.
