How to Get Medicaid-Funded Home Care in Texas: The STAR+PLUS Guide

If your aging parent or disabled family member needs home care but cannot afford private rates, Texas Medicaid's STAR+PLUS program may be the answer. STAR+PLUS is a managed care program that covers personal care services, attendant care, and support services for eligible low-income Texans — keeping people out of nursing facilities by funding care at home.

The process isn't simple, and the timeline is long. But for families who qualify, STAR+PLUS can provide ongoing home care support at little or no cost. This guide explains who qualifies, how to apply, what's covered, and what to do while you wait for approval.

What Is Texas STAR+PLUS?

STAR+PLUS is Texas's Medicaid managed care program for adults who are elderly (age 65+) or who have disabilities. It combines medical care (similar to a Medicaid HMO) with long-term services and supports — including home and community-based services (HCBS) for people who need significant assistance with daily activities.

The key program within STAR+PLUS for home care is the HCBS Waiver (also called the Community Based Alternatives waiver). It is designed specifically for individuals who would otherwise qualify for nursing facility admission but choose to remain at home. The state funds this program because keeping people at home is typically less expensive than institutional care.

Who Qualifies for STAR+PLUS HCBS in Texas?

Eligibility requires meeting all of the following criteria:

• Age: 21 years or older. (Children and adolescents have separate Medicaid programs.)
• Texas Medicaid enrollment: Must be currently enrolled in or eligible for Texas Medicaid.
• Income limit: Gross monthly income below approximately $2,742 (300% of the federal SSI benefit rate). This limit applies to the individual, not the household.
• Asset limit: Countable assets below $2,000 for a single individual. Countable assets generally include bank accounts, investments, and second vehicles. The primary home, one vehicle, household furnishings, and personal effects are typically excluded.
• Nursing-facility level of care: A functional assessment conducted by HHSC must determine that the individual requires the level of care provided in a nursing facility — typically meaning significant deficiencies in multiple ADLs.

What STAR+PLUS HCBS Covers

Approved STAR+PLUS HCBS enrollees in Houston can receive the following services through their managed care organization:

• Personal Attendant Services (PAS): Assistance with bathing, dressing, grooming, meal preparation, mobility, and toileting.
• Respite care: Temporary relief for family caregivers, both in-home and short-term residential.
• Adult day programs: Daytime supervision and activities at a group facility.
• Emergency response system: A personal alert device for individuals living alone.
• Home modifications: Minor accessibility modifications such as grab bars, ramps, or widened doorways to support safe home living.
• Consumer Directed Services (CDS): An option allowing enrollees to hire, train, and direct their own personal attendants rather than using an agency-employed caregiver.

Houston MCOs: Who Manages STAR+PLUS in Harris County?

In Houston (Harris County and surrounding counties), STAR+PLUS is administered through three managed care organizations:

• Molina Healthcare of Texas
• Amerigroup Texas
• UnitedHealthcare Community Plan

HHSC assigns enrollees to an MCO at enrollment. Members may request a change to a different MCO during an annual open enrollment period or for good cause. Your MCO is responsible for authorizing services and assigning a service coordinator to manage your care plan.

How to Apply: A 5-Step Process

• Step 1: Apply for Medicaid. Submit a Medicaid application online at YourTexasBenefits.com, by calling 211 in Texas, or in person at your local HHSC benefits office. You'll need proof of identity, Social Security number, income documentation (pay stubs, Social Security award letters), and bank/asset statements.
• Step 2: Financial eligibility determination. HHSC reviews your application and determines whether you meet the income and asset criteria for Medicaid. This typically takes 30–45 days.
• Step 3: Functional assessment. Once financially approved, HHSC schedules an in-home functional assessment to determine whether you meet nursing-facility level of care. A trained assessor evaluates your ADL deficiencies and overall care needs.
• Step 4: MCO enrollment and care plan development. If approved for HCBS, you are enrolled in an MCO and assigned a service coordinator. Together you develop a care plan specifying the services, hours, and providers that will support you at home.
• Step 5: Services begin. Your MCO authorizes the services outlined in your care plan, and you begin receiving care through your selected provider.

What to Do While You Wait (60–120 Days)

The STAR+PLUS HCBS timeline is long — typically 60 to 120 days from application to services starting. Many Houston families cannot wait that long for care to begin. Options for bridging the gap include private pay (out-of-pocket), assistance from the HGAC Area Agency on Aging, community resources through faith-based organizations, and family caregiving support. If your loved one has a long-term care insurance policy, activating that coverage immediately is typically the best bridge strategy.

Working With an MCO Service Coordinator

Once enrolled in STAR+PLUS HCBS, your primary point of contact is your MCO service coordinator. This individual is responsible for developing your care plan, authorizing service hours, and connecting you with approved providers. The service coordinator's role is significant — they are the person who translates your functional needs into authorized hours of care.

Good service coordinators are proactive, knowledgeable about available community resources, and responsive to changes in care needs. If you feel your service coordinator is not adequately reflecting your loved one's care needs in the authorized hours, you have the right to request a care plan review. Documenting changes in functional status — with physician notes — between annual reviews can support requests for increased authorization. You also have the right to file a grievance with your MCO if you believe services were improperly denied or reduced.

Frequently Asked Questions

Can a married person qualify for STAR+PLUS HCBS in Texas?

Yes, with specific rules. For married couples, the asset limit is higher — typically $2,000 for the applicant plus an allowance for the community (non-applying) spouse. The community spouse's income is generally not counted in the applicant's income calculation. These rules are complex; consult an elder law attorney.

What if there's a waitlist for STAR+PLUS HCBS in my area?

Unlike some Medicaid waiver programs in Texas, STAR+PLUS HCBS does not technically have a waitlist — it is an entitlement program, meaning anyone who qualifies is entitled to services. However, the approval process itself takes time, which is functionally similar to a wait. Incomplete applications or missing documentation are the most common causes of extended delays.

Can I choose Consumer Directed Services under STAR+PLUS?

Yes. CDS allows you to hire, supervise, and — in some cases — have a family member provide your personal attendant services under STAR+PLUS. The CDS model works through a Financial Management Services Agency (FMSA) that handles payroll and compliance. Not all MCOs process CDS in exactly the same way; ask your service coordinator about the CDS option specifically.