Texas Medicaid Home Care: STAR+PLUS Waiver Explained

If you're helping a parent or grandparent navigate senior care in Texas while managing limited financial resources, Texas Medicaid offers powerful options that many families overlook. Through the STAR+PLUS managed care program, eligible seniors can receive comprehensive home and community-based care services—from in-home assistance to adult day care to nursing services—with coverage that can significantly reduce out-of-pocket expenses.

Understanding how Texas Medicaid home care works, who qualifies, what services are covered, and how to apply are the keys to accessing these benefits. This guide walks through every step of the process, providing specific income limits, covered services, and practical advice for Texas families.

Understanding Texas Medicaid and STAR+PLUS

How Texas Medicaid Works

Texas Medicaid is a joint federal-state health insurance program for low-income individuals and families. Unlike Medicare (which is federal and based on age or disability), Medicaid is need-based. Texas Medicaid covers not just medical care but also long-term services and supports, including home care assistance, nursing facility care, and community-based services.

For seniors age 65 and older, Texas offers several Medicaid programs. Traditional Medicaid (also called fee-for-service) is one option where the state pays providers directly. However, the most common route for home care is STAR+PLUS, Texas's managed care program where the state contracts with health insurance companies (called managed care organizations or MCOs) to coordinate care and services.

What is STAR+PLUS?

STAR+PLUS stands for "State Team Access and Responsibility Plus." It's a health insurance managed care program administered by the Texas Health and Human Services Commission (HHS) that serves low-income adults, children, pregnant women, and seniors. For elderly Medicaid recipients, STAR+PLUS is often the primary option for coverage.

Under STAR+PLUS, you enroll with one of several MCOs operating in Texas—companies like Molina Healthcare, Superior HealthPlan, UnitedHealthcare, and others. Your MCO is responsible for coordinating your care, managing medical services, and arranging long-term supports like home care. The MCO works with a network of doctors, hospitals, and care providers, though you can get emergency care outside the network.

A significant advantage of STAR+PLUS is that it covers a broader range of services than traditional Medicaid fee-for-service, particularly home and community-based services. This includes personal care assistance, respite care, adult day care, and various support services that help seniors remain in their homes rather than entering nursing facilities.

Eligibility Requirements for Texas Medicaid Home Care

Age and Residency

You must be age 65 or older (or under 65 with a disability that qualifies you for Medicaid), and you must be a Texas resident. There is no citizenship requirement, but you must be a qualified immigrant status. Undocumented immigrants are not eligible for regular Texas Medicaid but may qualify for Emergency Medicaid or limited state programs.

Income Limits (2026)

This is crucial: Texas sets income limits for Medicaid eligibility. For 2026, the gross monthly income limit for a single senior is approximately $1,468 (this adjusts annually based on the federal poverty level). For a couple, it's roughly $1,968. These are gross income figures—income before deductions or taxes.

Income includes Social Security benefits, pensions, earnings, interest, and most other forms of income. Some income is excluded: the first $20 of monthly income from any source, and work-related income up to $65 monthly (plus half of earnings above that). But for most seniors living on Social Security alone, the income limit is rarely the barrier.

Asset Limits

For seniors age 65 and older, Texas sets asset limits at $2,000 for a single person and $3,000 for a couple. Assets include bank accounts, savings, money market accounts, investment accounts, vehicles over $15,000 in value, and real estate (other than your primary residence). Your primary home is not counted as an asset. One vehicle regardless of value is excluded from the limit.

These asset limits are strict, and exceeding them disqualifies you from Medicaid. If you have more than the limit, you must "spend down" assets by paying for care, making gifts (with limits), or other approved methods before reapplying.

Medical/Functional Need

Beyond income and assets, the senior must have a qualifying medical or functional need. For home care services, this generally means you need assistance with activities of daily living (bathing, dressing, toileting, eating) or have a medical condition requiring skilled nursing or therapy at home.

Texas uses standardized assessments to determine this. When you apply for STAR+PLUS, a care coordinator evaluates your functional status and medical conditions to determine what level of care you need and what services you qualify for. Having a diagnosis like dementia, Parkinson's disease, diabetes requiring management, mobility limitations, or incontinence strengthens your qualification.

Services Covered Under Texas Medicaid STAR+PLUS Home Care

In-Home Personal Care Assistance

This is the primary home care service covered—assistance with activities of daily living including bathing, dressing, grooming, oral hygiene, toileting, incontinence care, transferring, and eating. In-home care also includes household tasks necessary for health and safety: meal preparation, light housekeeping, laundry, and medication reminders.

The frequency and duration of in-home care depend on your assessed needs. A senior with dementia might receive 8 hours daily, while someone with mild mobility limitations might get 5 hours weekly. Your MCO's care coordinator develops a care plan specifying the hours and type of assistance you receive.

Skilled Nursing Services

If you have a medical condition requiring skilled nursing—such as wound care, medication injection, catheter management, or monitoring of complex conditions—Texas Medicaid covers skilled home health nursing. These services are typically provided by licensed nurses employed by home health agencies contracted with your MCO.

Therapy Services

Physical therapy, occupational therapy, and speech therapy at home are covered when medically necessary. For example, physical therapy after a hip fracture or stroke, or occupational therapy to regain functional independence in self-care tasks.

Adult Day Care

Adult day care centers provide supervision, activities, socialization, meals, and sometimes therapeutic services during daytime hours. STAR+PLUS covers adult day care typically for 2-5 days weekly, depending on your assessed need. This service is valuable for seniors with some cognitive decline or social isolation needs while allowing family caregivers to work or rest.

Respite Care

Respite care provides temporary relief for family caregivers. STAR+PLUS offers a limited number of respite hours annually—typically 10-14 days per year—to give family caregivers a break. Respite can be in-home or in a facility depending on your plan and needs.

Medical Transportation

Medicaid covers non-emergency medical transportation to doctor appointments and other covered medical services when you have no other transportation. This is typically arranged through your MCO's transportation provider, though you may need to call ahead to schedule.

Durable Medical Equipment and Supplies

Wheelchairs, walkers, incontinence supplies, diabetic testing supplies, oxygen equipment, and other medically necessary equipment and supplies are covered when prescribed by your physician.

Limitations and Exclusions

Texas Medicaid does not cover room and board in an assisted living facility or nursing home through STAR+PLUS (though it covers the care portion if you're admitted). It doesn't cover cosmetic services, experimental treatments, or services provided by family members who aren't paid caregivers. Some services have approval requirements—your doctor must certify medical necessity before your MCO approves coverage.

The Application Process for Texas Medicaid

Where to Apply

You apply for Texas Medicaid through the Health and Human Services Commission (HHSC). You can apply online at YourTexasBenefits.com, by mail, by phone (1-800-696-4674), or in person at your local HHSC office. The online application is fastest and most convenient for most people.

Required Documentation

When applying, you'll need proof of age (birth certificate, passport, or ID), proof of Texas residency (utility bill, lease, or government correspondence), income verification (recent pay stubs, Social Security statement, or tax returns), and bank statements showing assets. If you have medical needs, bring documentation of conditions and current medications.

Timeline

Initial Medicaid decisions typically come within 30 days of application, though complex cases may take longer. If you apply online, you may receive approval faster. Once approved for Medicaid, you then choose a STAR+PLUS MCO plan (if multiple plans serve your area), and your benefits typically begin the first day of the following month.

The Care Coordination Process

After approval, you're assigned a care coordinator with your chosen MCO. This coordinator contacts you to assess your health and functional needs through standardized questions and possibly a home visit. They develop your care plan specifying what services you'll receive, how often, and which providers will deliver them. You have input into your care plan and can request changes if your needs evolve.

STAR+PLUS Managed Care Organizations in Texas

Which MCOs serve your area depends on where you live. Major MCOs operating STAR+PLUS programs across Texas include Molina Healthcare, Superior HealthPlan, UnitedHealthcare, Aetna Better Health, Centene's regional plans, and others. Your area may have 2-4 choices.

Each MCO has different care coordinators, networks of home care providers, and sometimes slightly different service availability. When you're approved for Medicaid, you'll receive information about which MCOs serve your county and can choose based on which has better home care providers in your area, convenient locations, or other factors.

Contact your MCO's Member Services to ask how many home health agencies they contract with, what adult day care options exist in your area, and what their typical approval timeline is for home care services.

Cost-Sharing Under STAR+PLUS

A major advantage of STAR+PLUS for seniors is minimal cost-sharing. Unlike traditional Medicaid which sometimes requires small copayments, STAR+PLUS generally has no copayments for home care, nursing services, or other long-term services and supports. You pay nothing for covered services.

You are responsible for any costs exceeding covered services. For example, if your care plan covers 20 hours of in-home care weekly but you need 30 hours, you'd pay out-of-pocket for the additional 10 hours. Supplemental services beyond your MCO's scope are your responsibility.

Common Issues and Solutions

Approved for Medicaid but Denied Home Care Services

Being approved for Medicaid doesn't automatically mean home care is covered. Your MCO's care coordinator might assess that you don't meet the functional need threshold. If you disagree, you have appeal rights. Request an appeal with the MCO and provide additional medical documentation supporting your need. Consider asking your doctor to write a letter detailing why home care is medically necessary.

Services Approved but Provider Issues

Your MCO approves services, but the home care agencies they contract with have long wait lists or gaps in availability. Contact your care coordinator immediately. They can escalate to find alternative providers, increase hours from existing providers, or temporarily adjust your care plan. Don't just accept gaps in care—your MCO has responsibility to provide approved services.

Family Member as Caregiver

Many MCOs allow adult children, spouses, or other relatives to be employed as paid caregivers under STAR+PLUS. However, there are strict rules: the family member must not be your legal guardian, must be properly trained and certified if needed, and their wage must be reasonable for market rates. The arrangement requires MCO approval and goes through proper employment channels.

Moving to Another State

If your eligible senior moves out of Texas, Medicaid coverage ends. Texas Medicaid does not cover services in other states. However, they may be eligible for Medicaid in the new state (each state has its own program). Contact the new state's Medicaid agency immediately when you move.

Income Limits, Spend-Down, and Medicaid Planning

What if Income Exceeds the Limit?

If gross monthly income exceeds $1,468 (or $1,968 for couples), traditional Medicaid is unavailable. However, Texas offers alternatives. The Medicaid Buy-In for Elderly and Disabled allows certain higher-income individuals to purchase Medicaid by paying a premium. Additionally, if your senior has significant medical expenses, those can reduce countable income, potentially bringing you below the limit.

Spend-Down Strategies

If assets exceed limits, you can "spend down" by paying for medical expenses, long-term care, or home modifications. Some seniors strategically make gifts (subject to lookback periods), pay off debts, or purchase prepaid funeral plans to reduce countable assets. Work with an elder law attorney familiar with Medicaid rules, as improper spend-down can result in penalties or disqualification.

Supplementing Medicaid with Other Resources

While STAR+PLUS covers many services, it may not cover everything your senior needs. Consider supplementing with: VA benefits if your senior is a veteran (Aid & Attendance can add $3,500+ monthly), state programs like the Elderly and Disabled with Serious Functional Disabilities program, long-term care insurance if they have a policy, and private-pay care for services beyond Medicaid coverage.

Renewal and Ongoing Management

Medicaid requires annual renewal. Texas will contact you before your renewal date requesting updated income, asset, and residency information. Failure to renew results in loss of coverage. Your MCO's care coordinator may contact you periodically to reassess your functional needs and adjust your care plan accordingly. Schedule regular meetings with your care coordinator to ensure your care plan remains appropriate as needs change.