Texas STAR+PLUS and STAR+PLUS HCBS: Texas 2026 Guide

STAR+PLUS is Texas Medicaid’s managed care program for adults 65 and older and adults with disabilities. Within it, the STAR+PLUS Home and Community Based Services (HCBS) program pays for long-term care at home and in assisted living for members who meet a nursing facility level of care. It is overseen by Texas Health and Human Services (HHSC).

Below we cover the 2026 eligibility rules for STAR+PLUS, the services it can pay for, the steps to apply, how waiting lists work, and how the program sits alongside nursing home Medicaid in Texas. For the full statewide rules on income, assets, spouses and the look-back, see our Texas Medicaid guide.

Figures change periodically. Double-check current amounts before relying on them.

What STAR+PLUS is

STAR+PLUS members choose a managed care organization, which assigns a service coordinator. All members can get basic attendant care through the plan if they qualify. The STAR+PLUS HCBS program adds a fuller package of services for people who meet nursing facility medical necessity. Members can use Consumer Directed Services (CDS) to hire their own attendants, including family members other than a spouse, with a financial management agency handling payroll.

STAR+PLUS is a managed care program: instead of paying each provider directly, Texas pays health plans to organize care. Members choose a plan where more than one is offered, and the plan’s care coordinator manages the plan of care. Eligibility rules remain the state’s, and members keep fair hearing rights if a plan cuts or denies care.

Who qualifies in 2026

Texas looks at both how much help a person needs and what they own and earn. In general, to qualify for STAR+PLUS an applicant must:

be 65 or older, or 21 or older with a disability;
live in Texas;
meet nursing facility medical necessity, assessed through the plan;
meet Texas long-term care financial rules; and
have an HCBS cost plan within program limits.

Financial rules. For STAR+PLUS, Texas Health and Human Services applies the long-term care Medicaid rules for income and assets, generally the same ones used for nursing home care. Savings, investments and real estate other than the home count; the home, a car, belongings and some burial funds usually do not. Gifts and below-value sales in the last 60 months are reviewed, and a transfer penalty can push back the start of services.

Texas has an income cap for long-term care: in 2026, gross income must be $2,982 a month or less, with a Qualified Income Trust above that. The single-person asset limit is $2,000. People who already receive SSI or full Medicaid can request STAR+PLUS HCBS through their plan without the interest list.

Texas’s 2026 long-term care Medicaid numbers, from our state guide:

Item	2026 figure
Income limit (applicant)	$2,982 a month (special income limit). Above this, a Qualified Income Trust is needed
Asset limit (single applicant)	$2,000
Asset limit (couple, both applying)	$3,000
Home equity limit	$752,000
Spouse at home: resource allowance (CSRA)	Minimum $32,532 / maximum $162,660
Spouse at home: monthly income allowance	$4,066.50 (Texas uses the federal maximum)
Personal needs allowance (nursing home)	$75 a month
Look-back period	60 months (5 years)

Married applicants. When one spouse applies and the other stays at home, spousal impoverishment protections generally apply, so the spouse at home can keep a share of the couple’s assets and may receive part of the applicant’s income. The spousal allowance pages explain how these amounts are figured.

Services STAR+PLUS can cover

The plan covers long-term care services listed in the member’s plan of care, along with Medicaid medical benefits. Depending on assessed need, STAR+PLUS can include:

service coordination
personal attendant services
adult foster care
assisted living services
emergency response services
home-delivered meals
minor home modifications and adaptive aids
respite care
nursing and therapies
transition assistance services
dental services
consumer directed services

Room and board is not included. Medicaid rules bar STAR+PLUS from paying rent and food, so anyone using it in a residential setting pays those costs from income. The plan of care often assumes some help from relatives where it is available. Medical care continues through Medicaid and Medicare in the usual way.

How to apply for STAR+PLUS

The steps below describe the usual path. Many people apply for Medicaid and request the waiver at the same time, so that the money and care tests run side by side.

If already on Medicaid or SSI, call the STAR+PLUS plan and ask for an HCBS assessment.
If not on Medicaid, ask HHSC to be added to the STAR+PLUS HCBS interest list.
When released from the interest list, complete the Medicaid financial application.
The plan’s nurse assesses medical necessity and builds an individual service plan.
Services start once approved.

Staying organized. Copy every form before you send it and keep a simple call log. Assessors only see one visit, so describe what a difficult day looks like and have a regular helper in the room. Memory problems, falls and the need for supervision all count, even when the person can still do some tasks alone. If the answer is no, the written notice explains how to request a fair hearing and the deadline.

Waiting lists and timing

Texas uses an interest list for people who would qualify for Medicaid only through the HCBS program. KFF’s 2026 survey reported more than 15,000 older adults and people with physical disabilities on it. SSI recipients and current Medicaid members are not placed on the list.

Because openings can be limited, it usually makes sense to get on any list early, even before needs are urgent. Stopgaps can include state plan home care, adult day centers, PACE where it operates and local aging services. The waiver waiting lists page explains common rules.

How it relates to nursing home Medicaid

STAR+PLUS also covers members in nursing facilities, so a member moving to a nursing home stays in the program.

A move from home to a nursing facility, or back, generally happens within STAR+PLUS rather than requiring a new program. The same financial rules apply in both settings, but in a nursing facility most of the member’s income is paid toward care.

Tips for families

Network matters: check whether each plan includes the providers you already rely on. Keep the care plan on file, and treat any reduction notice as time-sensitive, since appeal windows are short. Five years of financial records are usually needed, and the look-back applies as with any long-term care Medicaid.

Working with a Certified Medicaid Planner is often the fastest way through STAR+PLUS. A planner who handles Texas cases regularly can spot eligibility problems before Texas Health and Human Services does, organize the records and help plan around any wait. Costs range widely, from about $150 to $600 an hour, about $500 to $6,000 for application help, and about $2,500 to $15,000 or more for full planning.

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.