Medicaid and Assisted Living in Texas: What Families Need to Know

Why Texas Families Need a Medicaid Strategy for Assisted Living

If you're an adult child in Chicago or Charlotte researching assisted living for a parent in Houston or San Antonio, the cost picture can hit hard. According to the Genworth Cost of Care Survey (2025 data, the most recent publicly available as of mid-2026), the median monthly cost of assisted living in Texas is roughly $4,500. That number swings by metro: expect closer to $3,800 in Lubbock, while Austin runs around $5,200.

Medicare does not cover assisted living. And the median Social Security benefit hovers near $1,900 per month, which leaves a gap of $2,600 or more every single month. For families on a fixed income, that math doesn't work for long.

Texas Medicaid does offer help through a waiver program called STAR+PLUS. But here's the critical detail that catches families off guard: STAR+PLUS covers only personal care and nursing services. Room, board, and utilities remain the family's responsibility, typically running $2,000 to $4,000 per month depending on the facility. That distinction matters from day one of your planning.

Families who wait until a hospital discharge or a fall to start the Medicaid process often face months of full private-pay costs that drain savings quickly. A proactive strategy, started even six months before a move, can preserve assets and avoid gaps in care.

The Texas Medicaid Waivers That Pay for Assisted Living

The main pathway for seniors who need assisted living in Texas is the STAR+PLUS program, a managed care program run by the Texas Health and Human Services Commission (HHSC). STAR+PLUS provides home and community-based services (HCBS) including personal care assistance, skilled nursing visits, medication management, and therapy.

To qualify, a resident must meet a nursing facility level of care. An HHSC assessor uses a functional assessment tool to determine whether the person needs the kind of help that would otherwise require a nursing home. If they do, STAR+PLUS can fund that care in an assisted living setting instead.

You may see references to other Texas waivers, like the Home and Community-Based Services program for individuals with intellectual and developmental disabilities. Those serve different populations. For the general aging population, STAR+PLUS is the route.

Once enrolled, the resident selects a managed care organization (MCO) such as UnitedHealthcare, Superior HealthPlan, or Molina. The MCO arranges covered services and pays the facility directly for the care portion. The family still pays room and board out of pocket.

Income and Asset Limits: Do You Qualify?

Texas Medicaid eligibility for STAR+PLUS has strict financial thresholds.

Income

The income limit is 300% of the federal Supplemental Security Income (SSI) benefit rate. In 2025, that was $2,382 per month. Because SSI rates adjust annually for cost of living, the 2026 figure may be slightly higher. Confirm the current limit with HHSC before applying.

If your parent's income exceeds that cap, they can still qualify by setting up a qualified income trust, commonly called a Miller trust. This legal instrument channels excess income into a trust account that Medicaid does not count. Without it, a person earning even $50 over the limit faces denial.

Assets

Countable resources are capped at $2,000 for a single applicant or $3,000 for a couple. Countable assets include bank accounts, stocks, bonds, and second properties. The primary home (with equity up to $688,000 as of 2025), one vehicle, personal belongings, and pre-paid burial plans are generally exempt.

Spousal Protections

If one spouse needs assisted living and the other remains at home, Texas follows federal spousal impoverishment rules. The community spouse can keep up to $154,140 in countable assets (2025 figure) and receives a minimum monthly income allowance. These protections prevent the healthy spouse from being left destitute.

Documentation Checklist

Gather these before you start the application:

Recent bank statements (all accounts, three to six months)
Social Security award letter
Pension and annuity statements
Life insurance policies (cash surrender value counts as an asset)
Deed to the home and most recent property tax statement
Vehicle registration
Proof of citizenship or immigration status

Application Timeline and Common Roadblocks

You apply through HHSC by submitting Form H1010 (Application for Assistance). You can file online, by mail, or in person at a local HHSC office. Processing typically takes 45 to 90 days, though complex cases can stretch longer.

The Level of Care Assessment

After the application is filed, HHSC schedules a level of care determination (LCOD) assessment. This may be in person or by phone. Missing this appointment is one of the top reasons applications stall. If your parent has mobility issues or cognitive decline, make sure a family member or caregiver is present to help answer questions accurately.

The Five-Year Look-Back

Texas Medicaid reviews all asset transfers made within five years of the application date. If your parent gave $20,000 to a grandchild for a wedding two years ago, that gift could trigger a penalty period during which Medicaid won't pay.

There are legal strategies families use to address excess assets before applying. Pre-paying funeral and burial expenses is one common approach, since those become exempt. Purchasing an exempt vehicle to replace an older one, paying down a mortgage, or funding a pooled special needs trust through a nonprofit are other options families explore with an elder law attorney. The key is that every dollar must go toward something of fair market value or an exempt category. Simply giving money away will create problems.

Common Pitfalls

Forgetting to list all income sources (pensions, rental income, even small annuities)
Not setting up a Miller trust before the eligibility determination
Missing the LCOD appointment
Failing to provide proof of citizenship or legal residency

When you call HHSC to check on an application, try something like: "I'm calling about a STAR+PLUS application for my mother. Can you confirm the status of her level of care assessment and let me know if any documents are still needed?" Be specific. Have the case number ready.

What STAR+PLUS Covers (and What It Doesn't)

Covered Services

Personal care assistance: bathing, dressing, toileting, grooming
Medication management
Skilled nursing visits
Physical and occupational therapy
Medical supplies, including incontinence products

Not Covered

Room and board: rent, utilities, and meals. This is the single largest out-of-pocket cost, and it falls entirely on the resident's income (Social Security, pension, etc.).
Non-medical services like housekeeping, laundry, or recreational transportation. Some MCOs offer limited extras, but don't count on it.

The facility and the MCO negotiate a daily rate for waiver-covered services. That rate is separate from the room-and-board charge. When touring, ask the business office: "What is your private-pay rate, and does it differ from your Medicaid rate for room and board?" Some facilities charge different amounts, and the gap can affect your monthly budget.

Alternatives if You Don't Qualify for Medicaid

Not everyone meets the strict asset and income limits. Several other options exist.

VA Aid and Attendance. If your parent or their late spouse served during wartime, the VA Aid and Attendance pension may help. In 2025, the maximum monthly benefit was roughly $2,400 for a married veteran and $1,320 for a surviving spouse. Apply through VA Form 21-2680.

Long-term care insurance. If your parent purchased a policy years ago, check whether it covers assisted living. Many policies pay a daily benefit that can bridge the gap between Social Security income and the facility's room-and-board charge.

Federal tax deductions. Texas has no state income tax, but on federal returns, medical expenses exceeding 7.5% of adjusted gross income are deductible. Assisted living costs qualify if the resident is chronically ill as defined by IRS Publication 502.

Medicaid Buy-In for working adults with disabilities. If the senior is under 65 and has a qualifying disability, the Texas Medicaid Buy-In program may offer coverage with higher income limits than traditional Medicaid. This is a lesser-known option worth exploring.

Bridge financing. Reverse mortgages or short-term bridge loans can provide cash flow for families waiting on a STAR+PLUS slot, though these carry their own costs and risks.

Finding a Facility That Accepts STAR+PLUS in Texas

Not every assisted living community in Texas takes STAR+PLUS. Many operate as private-pay only. Start with the HHSC provider search to find facilities contracted with STAR+PLUS MCOs in your area.

Call the facility's business office directly and ask: "Do you have a contract with any STAR+PLUS managed care organization? How many waiver beds do you currently have available? What is your monthly room-and-board charge for Medicaid residents?"

Waiting lists are a reality, especially in the Dallas-Fort Worth metroplex and greater Houston, where demand outpaces supply. Wait times of three to twelve months are common. If your parent is being discharged from a hospital, ask the facility about priority placement for urgent cases.

The Texas Long-Term Care Ombudsman can provide complaint history and help you evaluate a facility's track record before you commit.

Key Questions to Ask When Touring a Facility

Bring this list with you, on paper or on your phone:

"Do you accept STAR+PLUS? Which MCOs are you contracted with?"
"What is the monthly room-and-board charge I must pay out of pocket? Does that include utilities and three meals a day?"
"How do you handle the transition from private-pay to Medicaid if my family member is on a waiting list?"
"Are there extra fees for medication management or incontinence supplies that STAR+PLUS won't cover?"
"Can you describe the experience of current residents on STAR+PLUS? Are they receiving the same level of care as private-pay residents?"
"If Medicaid beds aren't filled, do you convert them to private-pay? Could my parent lose their spot?"

These questions signal to the facility that you understand the system. That alone can change the quality of the answers you get.

Consider a daughter in Minneapolis coordinating a move for her father in El Paso. She can't tour every facility in person. A phone call with these questions, followed by a request for the facility's most recent state inspection report, gives her a solid foundation before she books a flight for a final walkthrough.

This article provides general information about Texas Medicaid programs and assisted living costs. It is not legal or financial advice. Consult an elder law attorney or Medicaid planning specialist for guidance specific to your family's situation.