Medicaid HCBS Waivers in Texas 2026: The Complete Guide
Last reviewed: · Senova editorial team
What you'll learn
If you're caring for a loved one in Texas — a parent recovering from a stroke, a spouse with dementia, an adult child with a developmental disability — the question that haunts most families is the same: how do we afford care without putting Mom in a nursing home?
That's exactly the gap Texas Medicaid's HCBS waivers fill. "HCBS" stands for Home and Community-Based Services. The federal government waives certain Medicaid rules so the state can pay for care delivered in your home — not just in a nursing facility. In Texas, the largest of these waivers is STAR+PLUS, and as of 2026 it serves more than 750,000 adults statewide.
This guide walks you through the program in plain English: who qualifies, what's covered, how to apply, and what to do while you wait. We'll cite the official Texas Health and Human Services (HHSC) source on every contested point so you can verify it yourself.
1. What HCBS waivers are — and why Texas calls them STAR+PLUS
Medicaid covers nursing-home care by default in every state. HCBS waivers exist because nursing-home care is expensive (Medicaid spends an average of $87,000/year per nursing-home resident in Texas in 2026), and most people would rather stay home. The waiver lets Medicaid pay for the same level of care, just delivered at the patient's home or in an assisted living facility, often at half the cost.
Texas runs HCBS through several programs: STAR+PLUS (the biggest, for adults 21+), Community First Choice, and category-specific waivers like HCS (intellectual/developmental disabilities) and MDCP (medically dependent children). For most older adults and adults with physical disabilities, STAR+PLUS is the right door to knock on.
STAR+PLUS isn't a separate program from Texas Medicaid — it's the delivery model Texas Medicaid uses for long-term services and supports. Once you qualify for Medicaid, your benefits flow through a STAR+PLUS managed care organization (MCO).
2. 2026 eligibility
Three tests, all required:
Financial — income
For 2026, the income cap for STAR+PLUS HCBS is 300% of SSI, which works out to about $2,901 per month for an individual (gross). Couples have separate spousal-protection rules — spouse income generally doesn't count against the applicant.
Financial — assets
Countable assets must be at or below $2,000 for an individual in 2026. Your primary home, one vehicle, and retirement accounts in payout status generally don't count. Cash, brokerage accounts, second homes, and additional vehicles do.
Level of care
You must be assessed as needing nursing-facility-level care — meaning, without home support, you'd need to live in a nursing home. The assessment is done by a Texas HHSC nurse using a tool called the Texas Medical Necessity and Level of Care (MN/LOC) form. It evaluates your ability to perform activities of daily living (bathing, dressing, eating, transferring, toileting), cognitive status, and medical complexity.
3. Services covered
STAR+PLUS HCBS pays for the kinds of services families usually pay out of pocket:
- Personal care — help with bathing, dressing, meal prep, medication reminders. Up to 50 hours/week typical, with higher hours authorized for high-need cases (some recipients qualify for 24/7 in-home care).
- Skilled nursing visits — wound care, IV therapy, catheter changes, medication administration.
- Physical, occupational, and speech therapy at home.
- Respite care — short-term replacement caregivers so family caregivers can rest. Up to 30 days per year typical.
- Adult day health — supervised daytime care at a community center, including meals and activities.
- Home modifications — ramps, grab bars, walk-in showers (lifetime cap typically $7,500).
- Durable medical equipment — wheelchairs, hospital beds, oxygen.
- Emergency response systems — wearable medical alert buttons.
- Transportation to medical appointments.
4. How to apply — step by step
- Apply for Medicaid. Go to YourTexasBenefits.com or call 2-1-1 (Texas's HHS information line). You'll fill out the universal benefits application — same form covers SNAP, Medicaid, and CHIP. Have ready: pay stubs (last 30 days), tax returns (last year), bank statements, Social Security benefit letters, photo ID, proof of citizenship.
- Wait for a decision. Standard Medicaid is approved or denied in 30–45 days for most applicants. If you're denied for income reasons, ask about the Medically Needy "spend-down" program.
- Once on Medicaid, request long-term services & supports (LTSS). Call your STAR+PLUS Medicaid health plan or your local HHSC office and tell them you need a level-of-care assessment for HCBS.
- Take the level-of-care assessment. An HHSC nurse comes to your home (or schedules a phone interview) and completes the MN/LOC form.
- Choose a STAR+PLUS plan. If you weren't already in a STAR+PLUS plan, you'll pick one (Amerigroup, Cigna-HealthSpring, Molina, Superior, UnitedHealthcare, or BCBS depending on region).
- Choose a provider. Once approved, you can pick any agency that contracts with your STAR+PLUS plan. Browse Senova's list of Texas home health providers →
Ready to compare Texas providers?
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See Texas home health providers →5. Waitlists by region
STAR+PLUS itself doesn't have a statewide waitlist — once you're financially and clinically eligible, services should start within 30 days. However, certain category-specific waivers (HCS, CLASS, DBMD) do have multi-year waitlists, and Texas's "interest list" is over 200,000 names long for some programs.
Urban regions (Houston, Dallas, San Antonio, Austin) typically have shorter wait times and more provider options. Rural West Texas and the Panhandle can have longer authorization timelines simply because there are fewer participating agencies.
6. Choosing a Texas-approved provider
Once you're authorized for STAR+PLUS HCBS, the choice of provider is yours. Look for:
- Medicare and Texas state license. All listings on Senova are Medicare-certified through CMS Care Compare; your STAR+PLUS plan adds the Medicaid contract layer.
- Acceptance of your specific MCO. Confirm the agency contracts with your STAR+PLUS plan (e.g., UnitedHealthcare, Molina, Superior).
- Response time. A good agency starts care within 7–14 days of authorization. Ask for the average start time before signing.
- Written care plan. Reputable agencies provide a written plan of care signed by a registered nurse before services begin.
- Recent CMS survey deficiencies. Search the agency's name on Medicare's Care Compare to see any recent inspection issues.
- References. Reputable providers will share two or three current-patient references on request.
7. Frequently asked questions
Can I keep my own home and still qualify for STAR+PLUS HCBS?
Yes. Your primary residence is exempt from the asset test as long as you live in it (or intend to return after a hospital/nursing-home stay). The home stays yours; STAR+PLUS pays for care delivered in the home.
What if my income is just above the $2,901 cap?
Texas allows a Qualified Income Trust (QIT) — also called a Miller Trust — that lets you redirect "excess" income into a trust, bringing your countable income below the cap. You'll need an attorney to set it up; many elder-law attorneys do this for $300–$800.
Will accepting STAR+PLUS HCBS put a Medicaid lien on my home?
Not while you're alive and using the home. Texas does have a Medicaid Estate Recovery Program (MERP) that may seek reimbursement from your estate after death, but there are exemptions (surviving spouse, dependent child, undue hardship). Talk to an elder-law attorney before transferring any assets.
Can my spouse keep their own income and assets?
Yes. Texas follows federal "spousal impoverishment" rules. The community spouse can keep up to about $154,000 in countable assets and up to $3,853/month in income (2026 figures) without affecting the applicant's eligibility.
How long does it take from application to first home visit?
Realistic timeline: 60–120 days. Medicaid approval (30–45 days) + LTSS request and assessment (30–45 days) + provider selection and care-plan setup (7–30 days). Urban metros tend to be faster.
What if my parent is in a hospital or rehab now?
Apply immediately. Hospitals can refer you to a Medicaid-eligibility specialist. Apply while still in the facility — services can start the day they discharge home if you've been pre-authorized.