Lauren Henderson spent three weekends researching assisted living communities in the Plano–Allen corridor. She had a spreadsheet. She had toured four places. She knew which ones had good food, which ones smelled like bleach, and which ones had memory care wings her mother probably didn't need yet but might in three years. The monthly cost ranged from $4,500 to $6,800 — not including medication management or physical therapy — and Lauren's mother Carol, a 76-year-old retired Plano ISD math teacher, earned $2,170 a month in Social Security and pension income combined.
The arithmetic did not work. Lauren knew it. Carol knew it. And so Lauren had started calling her sister in Oklahoma to talk about what they were going to do when Carol's $85,000 in savings ran out.
Then a colleague at Lauren's Frisco tech firm mentioned, almost in passing, that her own mother had "Medicaid coming to the house." Lauren assumed she'd misheard. Medicaid — the government health program? The one with the $2,000 asset limit? Coming to the house, to help someone get dressed in the morning?
She made an appointment with a Texas elder law attorney the following week.
The Program Most Texas Families Never Find Until It's Too Late
Here is what the attorney explained: Texas operates a Medicaid managed care program called STAR+PLUS that does something most families never realize Medicaid can do. It pays for care at home — personal attendant services, adult day programs, home health visits, even emergency response devices and home modifications — for elderly Texans and adults with physical disabilities who would otherwise need nursing home placement.
For tens of thousands of Texans who cannot afford assisted living and do not want to go to a nursing home, STAR+PLUS is the program that makes staying at home financially possible.
The catch — and it is a significant one — is that accessing the most valuable services under STAR+PLUS requires getting on a waiting list. In the Dallas–Fort Worth service area, that wait currently runs eighteen months to three years. Families who call the day a parent's health collapses and they can no longer manage alone often discover they are years away from receiving help, rather than days or weeks.
Lauren Henderson was exactly the kind of family this article is for. She had done everything right in the present — the research, the tours, the financial planning — without knowing that the most important planning action for her mother's situation had needed to happen two years earlier.
What STAR+PLUS Actually Covers
STAR+PLUS is Texas's Medicaid managed care program for adults who are age 65 or older, or who have a physical disability, and who require a nursing facility level of care. It is operated through a network of managed care organizations (MCOs) — including Superior HealthPlan, UnitedHealthcare Community Plan, Molina Healthcare, and Amerigroup — contracted by the Texas Health and Human Services Commission (HHSC).
The program has two tiers of services that are often confused.
State plan services — things like physician visits, prescription drugs, laboratory tests, and hospital care — are available to anyone who qualifies for Medicaid, regardless of the STAR+PLUS interest list. These are the basic Medicaid benefits most people think of when they think of "Medicaid."
Home and community-based services (HCBS) — the tier that most elder law clients are actually asking about — include the following, subject to individual need and MCO service plans:
- Personal Attendant Services (PAS): Hands-on help with activities of daily living — bathing, dressing, grooming, toileting, meal preparation, light housekeeping, and transfers. This is the most commonly used and most valuable STAR+PLUS service. A personal attendant typically works 10 to 40 hours per week depending on the client's assessed needs.
- Day Activity and Health Services (DAHS): Adult day programs providing structured activities, nursing oversight, meals, and social engagement during daytime hours. DAHS lets a family caregiver work during the day while knowing their parent is supervised and engaged.
- Home Health Services: Skilled nursing visits, wound care, medication management, and therapy services delivered at home rather than in a clinical setting.
- Emergency Response Services: Medical alert devices that allow a STAR+PLUS participant to summon help quickly — a relatively inexpensive benefit that prevents hospitalizations and reduces fall-related injuries.
- Home Modifications: Ramp installations, grab bar additions, and other modifications that make the home safer and reduce the likelihood of falls or injury. These are subject to program caps.
- Supportive Counseling: Mental health services for participants managing chronic illness, disability, or cognitive decline.
The HCBS services — especially PAS — are the ones that make the difference between a family that can sustain a parent at home and one that cannot. A senior who needs help bathing and dressing every morning but is otherwise independent may need only two to three hours of personal attendant care daily. At the program's reimbursement rate, that is coverage worth $800 to $1,500 per month that the family would otherwise be paying out of pocket or providing themselves.
Who Qualifies — and the Asset Rule Most People Misunderstand
STAR+PLUS HCBS eligibility requires meeting both a financial test and a clinical test. Most families stumble on the financial requirements before they even get to the clinical assessment.
Income limit: For STAR+PLUS HCBS, the income threshold is 300 percent of the SSI Federal Benefit Rate — which in 2026 works out to $2,982 per month for a single applicant. Social Security income, pension payments, IRA distributions, and annuity payments all count toward this limit. A senior whose income exceeds $2,982 per month is not automatically disqualified. Like nursing facility Medicaid, excess income can be channeled through a Qualified Income Trust (Miller Trust) to bring the applicant into compliance. The existence of the income cap is not the end of the conversation — it is the beginning of a planning question.
Asset limit: The countable asset limit for STAR+PLUS is $2,000 for a single applicant — the same threshold that applies to nursing facility Medicaid. This is where most families stop: "My mother has $85,000 in savings. She doesn't qualify."
That reaction is understandable and partly correct. A senior with $85,000 in countable assets does not qualify today. But the asset limit is a snapshot, not a permanent bar. Assets can be reduced legitimately through a combination of allowed spend-downs (prepaid funeral and burial expenses up to the plan limit; outstanding debts; home modifications; medical equipment), and the STAR+PLUS interest list is long enough that a family who begins planning now may have a senior who is financially eligible by the time services actually become available.
Exempt assets are also often overlooked. The primary residence is exempt during the applicant's lifetime (subject to estate recovery after death). One vehicle is exempt. Personal property, household goods, and a prepaid burial arrangement within program limits are generally exempt. A senior with $85,000 in a CD who also owns a home may have significantly less in countable assets than a quick reading of her bank statement suggests.
Clinical eligibility: The senior must require a nursing facility level of care — meaning they need the kind of hands-on assistance with activities of daily living, cognitive support, or medical services typically associated with institutional placement. HHSC determines this through a functional assessment, not a physician opinion alone. An applicant who lives independently and manages all daily tasks without assistance will not meet the clinical threshold, even if their finances qualify. The assessment is designed to identify people who would be placed in a nursing home without HCBS support.
The Interest List: Texas's Quiet Crisis in Elder Care Access
Here is the fact most families never learn until it is too late to matter: STAR+PLUS HCBS services are not available on demand. They are accessed through an HHSC Interest List — effectively a waiting list — that reflects the limited capacity of the program at any given time.
In the Dallas–Fort Worth service area, families placing a parent on the interest list in 2026 are receiving information that suggests waits of eighteen months to three years for HCBS services to begin. In some areas of the state the waits are shorter; in others they are longer. The wait is driven by available provider capacity, program funding, and the number of people already in the queue.
There is no penalty for going on the interest list before financial or clinical eligibility is formally established. HHSC allows individuals to be placed on the list while planning is still underway. The practical advice from Texas elder law attorneys is uniform: get your parent on the interest list now, regardless of whether they currently meet the financial test. You can establish eligibility by the time services are offered. You cannot jump the queue once a crisis arrives.
The process begins with a single call to Texas 2-1-1 — dial 2-1-1 from any phone or visit 211texas.org. The 2-1-1 referral connects families to their local HHSC eligibility office, which handles both the interest list request and the eventual financial and clinical determination. There is no cost to be placed on the list.
Questions about elder law? A WG Law attorney can walk you through your options.
How the STAR+PLUS Application Actually Works
Once a person reaches the front of the interest list and services are available, the formal enrollment process begins. HHSC conducts both a financial eligibility review (income, assets, exempt property) and a clinical assessment (functional needs, medical conditions, care requirements). If both tests are met, the applicant chooses or is assigned to an MCO in their service area.
The MCO then develops a service plan — an individualized assessment of the participant's needs translated into specific services and hours. A participant whose primary need is morning personal care might receive fifteen to twenty hours per week of PAS. One with more complex needs — medication management, wound care, adult day attendance four days per week — might receive a substantially larger package of services.
Services are delivered by STAR+PLUS providers contracted with the MCO. The participant does not pay for the covered services; the MCO pays the provider. The participant continues paying for any non-STAR+PLUS expenses in their life — rent, food, transportation, non-covered medical expenses — from their own income and resources.
For seniors who qualify as both Medicare and Medicaid eligible (called "dual eligibles"), STAR+PLUS coordinates both programs. Medicare remains the primary payer for Medicare-covered services (Part A hospital coverage, Part B physician visits). STAR+PLUS Medicaid fills gaps and provides the HCBS services Medicare does not cover. This coordination is managed by the MCO and, in most cases, is handled transparently for the participant.
Medicaid Estate Recovery and the Home
One of the most persistent fears Texas families have about Medicaid — for nursing home care or HCBS — is that the state will take the house. The fear is legitimate but more manageable than most families assume.
Texas participates in the federal Medicaid Estate Recovery Program (MERP) under Texas Human Resources Code § 32.0663, implementing 42 U.S.C. § 1396p(b). After a Medicaid recipient's death, HHSC may file a claim against the estate to recover costs paid. The key word is "estate" — defined in Texas as the probate estate, meaning assets that pass through the court-supervised probate process.
A home that passes to heirs outside of probate is generally not subject to MERP recovery. A Lady Bird deed — which transfers the home automatically at death without probate — keeps the property outside the probate estate and therefore outside the reach of MERP. For many Texas families receiving STAR+PLUS HCBS, recording a properly structured Lady Bird deed is one of the most important protective steps their elder law attorney will recommend.
For married participants, the home is also protected during the community spouse's lifetime. MERP cannot pursue recovery against the home while the surviving spouse remains living there. That protection ends at the surviving spouse's death, which is why planning while both spouses are living — before one requires nursing home placement or extended HCBS — is valuable.
Carol Henderson's Updated Plan
Here is what changed after Lauren Henderson's meeting with the attorney.
Carol's income — $2,170 per month — was under the $2,982 STAR+PLUS income cap. No Miller Trust needed on the income side. Her $85,000 in savings was above the $2,000 asset limit, but the attorney identified several legitimate uses: prepaying her funeral plan (up to $15,000, exempt), installing grab bars and a walk-in shower conversion recommended by her physical therapist (home modifications exempt), paying off her outstanding car note, and making one month's advance payment on her apartment to reduce the bank balance going forward.
After those steps, Carol's countable assets were projected to drop substantially — not to $2,000 immediately, but close enough that the remaining balance could be managed carefully as the interest list wait played out. The attorney also placed Carol on the STAR+PLUS interest list the same week — not waiting until she was financially eligible, because the wait time, not the financial analysis, was the binding constraint.
Lauren's spreadsheet of assisted living communities remained in her files. But the arithmetic had changed. Instead of choosing between $4,500 per month and an impossible savings account, the family was now managing a two-year planning window before Carol's name reached the front of the list — and when it did, twenty to thirty hours per week of personal attendant care, coordinated through a managed care organization, would allow Carol to stay in the apartment she'd lived in for eleven years.
When to Have This Conversation
The families who navigate STAR+PLUS most successfully share one characteristic: they started the conversation early. Not when the fall happened, not when the dementia diagnosis arrived, not when the checking account fell below $10,000 — but when a parent began needing regular help with daily tasks and it was still possible to plan deliberately.
The questions worth asking now, even if nursing home placement or assisted living seems years away:
- Does my parent require assistance with bathing, dressing, grooming, or meal preparation? If so, the clinical threshold for STAR+PLUS HCBS may already be met.
- What are my parent's countable assets, and what legitimate steps could reduce them within Medicaid's rules before an application is filed?
- Is the home protected from MERP? Is a Lady Bird deed or Transfer on Death Deed in place?
- Is my parent already on the STAR+PLUS interest list? If not, why not?
- Does my parent's income exceed $2,982 per month? If so, is a Qualified Income Trust appropriate?
The cost of a consultation with a Texas elder law attorney to answer these questions is measured in hundreds of dollars. The cost of waiting until the crisis arrives — and discovering that the interest list has a two-year queue — is measured in something harder to calculate.
Taylor Willingham and the WG Law Elder Law Team
Attorney Taylor Willingham is WG Law's founding attorney and has guided more than 10,000 Texas families through estate planning and elder law matters, including Medicaid planning, STAR+PLUS navigation, long-term care strategy, guardianship, and Qualified Income Trusts. He is the author of five books on estate planning and elder law and practices out of WG Law's McKinney and Southlake offices, serving families across Collin County, Tarrant County, and the greater DFW metroplex.
This article is for general informational purposes only and does not constitute legal advice. Medicaid eligibility rules, program structures, and interest list wait times change. Contact a licensed Texas elder law attorney to discuss your parent's specific situation.
Call 214-250-4407 or request a consultation with WG Law's elder law team. For related reading, see our guides on the Texas Medicaid five-year look-back rule, Qualified Income Trusts for seniors over the Medicaid income cap, Medicaid estate recovery in Texas, protecting your home from Medicaid, and Medicaid crisis planning when a parent needs a nursing home now. You can also learn more about our Texas elder law practice and our Medicaid planning services.