Does Medicaid Cover Assisted Living in Texas?
Texas Medicaid does not pay for assisted living the way most families expect. Standard Medicaid covers nursing homes, not assisted living communities. But Texas offers a waiver program called STAR+PLUS that can cover some services in licensed assisted living settings, with long waitlists, strict eligibility, and important limits families need to understand before counting on it.
Quick answers
- Standard Texas Medicaid does NOT cover assisted living room and board
- The STAR+PLUS Home and Community Based Services (HCBS) waiver can pay for care services in some assisted living settings, but not rent
- Wait times for STAR+PLUS are long; some families wait 1-3 years or more
- To qualify, your parent must be financially eligible for Medicaid AND meet a nursing facility level of care
- If a parent already lives in assisted living and needs Medicaid, they may have to move to a nursing home unless the facility participates in the waiver
What Texas Medicaid Actually Covers in Assisted Living
There are two very different things: the room and board at an assisted living facility (rent, meals, utilities) and the care services provided there (bathing help, medication management, health monitoring). Texas Medicaid will not pay room and board at assisted living, that cost stays with the resident regardless of Medicaid status.
What Medicaid can potentially cover, through the STAR+PLUS waiver, is the cost of care services a qualified person receives inside an assisted living community. Think personal attendant services, skilled nursing visits, and similar support. The facility itself must be enrolled in the waiver program for this to work.
This is a meaningful but limited distinction. Many families discover it too late, after their parent has already moved in.
The STAR+PLUS Waiver: How It Works
Confirm financial eligibility for Medicaid
In Texas, a single applicant for long-term care Medicaid can have no more than $2,000 in countable assets. Monthly income cannot exceed the Medicaid income limit (currently around $2,742/month for 2024). A spouse living at home may keep more assets under spousal protection rules. An elder law attorney can help structure finances to meet these thresholds legally.
Meet the level of care requirement
Texas requires that a person need nursing facility level of care to qualify for the STAR+PLUS HCBS waiver. This is assessed through a functional evaluation, activities of daily living, cognitive status, and medical needs. Not everyone who lives in assisted living will qualify; the bar is higher than many expect.
Apply and get on the waitlist
Apply through Texas Health and Human Services. After an eligibility determination, your parent is placed on the waiver interest list. As of recent reporting, waits range from several months to several years depending on where in Texas your parent lives and what waiver slot opens up. There is no way to speed this up significantly.
Find a participating facility
The assisted living community must be a Type A or Type B facility licensed by the Texas Health and Human Services Commission AND enrolled to accept STAR+PLUS participants. Not every assisted living facility does this. Ask directly: 'Do you accept STAR+PLUS Medicaid waiver residents?' before signing anything.
Coordinate the care plan
Once enrolled, a STAR+PLUS managed care organization assigns a service coordinator who works with your parent to build a care plan. Covered services are authorized on that plan. Services outside the plan are the family's responsibility.
What STAR+PLUS Does and Doesn't Cover
Covered by STAR+PLUS (potentially)
- Personal attendant services (bathing, dressing, grooming)
- Adult day care services
- Adaptive aids and medical supplies
- Emergency response systems
- Some skilled nursing visits
- Occupational, physical, and speech therapy (when medically necessary)
NOT covered, family pays out of pocket
- Monthly room and board (rent at the assisted living facility)
- Meals (included in rent, but room and board is excluded from Medicaid coverage)
- Transportation in most cases
- Personal items, clothing, entertainment
- Care services not included in the approved plan
- Any facility that isn't enrolled in STAR+PLUS
What Assisted Living Actually Costs in Texas
The Nursing Home Alternative: When Medicaid Fully Covers Care
If your parent qualifies for Medicaid and cannot get off the STAR+PLUS waitlist in time, a Texas nursing facility (also called a skilled nursing facility) accepts Medicaid directly, no waiver required. Medicaid pays the full cost of care minus the resident's monthly income contribution.
This is not the same as assisted living. Nursing homes are for people with higher care needs, often including 24-hour skilled nursing supervision. But for families who need Medicaid coverage now, it is frequently the only realistic path.
If your parent currently lives in assisted living and runs out of money, the facility may ask them to leave unless it participates in STAR+PLUS. That's a crisis most families don't see coming until it's already happening.
One Important Warning for Families
Texas has a 5-year Medicaid lookback period. If your parent transferred assets, gave money to family members, sold property below market value, or moved assets to trusts, within the past 60 months, Medicaid can impose a penalty period during which they are ineligible for coverage. Plan early, before a health crisis forces the conversation. An elder law attorney in Texas can help you avoid costly mistakes.
Strategies for Families Planning Ahead
You don't have to be in crisis to apply. Getting on the waitlist early, even if your parent doesn't need waiver services yet, can save years of waiting later.
Before signing an assisted living contract, confirm whether the facility participates in STAR+PLUS. Ask for it in writing. This protects you if your parent outlives their savings.
Asset planning for Medicaid eligibility is legitimate, but it must be done correctly and far enough in advance. The lookback period catches families who act too late.
Texas participates in the Medicaid Estate Recovery Program. After your parent dies, the state can make a claim against their estate to recoup benefits paid. A home that avoided probate via a living trust is generally protected; a home that goes through probate may not be.
Even if your parent qualifies for STAR+PLUS, the family will still pay room and board. Know this number before choosing a facility, and make sure your parent's income (Social Security, pension) will cover it long-term.
How to Actually Apply for STAR+PLUS in Texas
Contact Texas Health and Human Services at 2-1-1 or visit hhs.texas.gov to start the application. You can also call 1-800-252-9240, which is the Texas Long-Term Care Information line. Tell them your parent needs to be assessed for the STAR+PLUS Home and Community Based Services waiver.
You'll need documentation of income, assets, medical conditions, and level of care needs. A caseworker conducts the functional assessment, usually in person. After eligibility is confirmed, your parent goes on the interest list.
For help understanding options, Texas Area Agencies on Aging (AAA) offer free counseling. Find your local AAA at eldercare.acl.gov or by calling 1-800-677-1116.
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Frequently Asked Questions
Can my parent apply for Medicaid while already living in assisted living in Texas?
Yes, but it depends on the facility. The assisted living community must be enrolled in the STAR+PLUS waiver program. If it isn't, your parent would need to either transfer to a participating facility or transition to a nursing home where standard Medicaid applies. Call the facility's billing department and ask directly about STAR+PLUS participation.
What happens to my parent's Social Security income if they go on Medicaid in a nursing home?
In a Texas nursing home, your parent contributes almost all of their monthly income toward the cost of care. They keep a small personal needs allowance, currently $60/month in Texas, for personal expenses. Medicaid covers the rest of the nursing home bill. This is different from assisted living, where your parent would pay room and board from their income and Medicaid covers care services separately.
Is there a faster alternative to the STAR+PLUS waitlist?
Not really, but there are a few things to know. If your parent is currently in a nursing home and wants to transition back to assisted living with Medicaid, they may be prioritized through a 'nursing facility transition' pathway. Also, some counties have shorter waits than others. An elder law attorney or certified benefits counselor can help identify the fastest realistic path for your parent's specific situation.
Does a spouse's income or assets affect Medicaid eligibility in Texas?
Yes, but there are spousal protection rules that apply. The community spouse (the one not applying for Medicaid) can keep a minimum monthly maintenance needs allowance from the applying spouse's income, and can protect a portion of shared assets called the Community Spouse Resource Allowance. Texas follows federal minimums for these protections. An elder law attorney can help you maximize what the community spouse keeps.
What is a Senior Move Manager? A Senior Move Manager is a trained specialist who helps older adults and their families navigate moves, downsizing, and care transitions. They handle the logistics so you don't have to.
If you're trying to find an assisted living community in Texas that accepts Medicaid or participates in STAR+PLUS, a local senior care professional can make the search much faster. Use the SeniorMoveGuide directory to find experienced senior move managers and care advisors in Texas who know which facilities in your area work with Medicaid, and which ones will leave your family scrambling later.
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