Texas Medicaid for Seniors & Long-Term Care

STAR+PLUS is the Texas Medicaid managed care program for adults with disabilities and seniors who are enrolled in both Medicare and Medicaid (dual eligibles). It is administered by managed care organizations under contract with HHSC, including Aetna Better Health, Molina Healthcare, Superior HealthPlan, and others depending on service area.

Each STAR+PLUS enrollee is assigned a Service Coordinator through their MCO. The Service Coordinator helps the member access medical, behavioral health, and long-term services — including home health, personal attendant services, and community-based supports. For members with complex needs, the coordinator also helps manage transitions between home care, assisted living, and nursing facility placement.

Texas participates in Community First Choice (CFC), the federal Section 1915(k) option that provides attendant and habilitation services to Medicaid members with disabilities who need assistance with activities of daily living. CFC allows eligible MEPD and STAR+PLUS members to receive personal care services — bathing, dressing, mobility assistance, medication management — in their home or community rather than in a nursing facility.

CFC is a mandatory benefit once a state adopts it. Texas implemented CFC as part of STAR+PLUS. Unlike waiver programs under Section 1915(c), CFC is not subject to enrollment caps or waiting lists — every eligible Medicaid member who meets the functional criteria has a right to CFC services. CFC services are delivered through STAR+PLUS managed care plans, and a member's Service Coordinator arranges an assessment to determine the number of authorized attendant hours per week.

Texas is an income cap state for nursing facility Medicaid. An applicant whose monthly income exceeds the special income limit ($2,982/month in 2026 — 300% of the SSI Federal Benefit Rate) cannot qualify for nursing facility Medicaid through the regular MEPD rules alone. To become eligible despite exceeding the cap, the applicant must establish a Qualified Income Trust (QIT), commonly called a Miller Trust.

A Miller Trust is an irrevocable trust into which the applicant deposits excess monthly income. The trust must be set up with an attorney before the Medicaid application is submitted — HHSC cannot approve a retroactive trust. Once in place, the excess income flows through the trust and is no longer counted against the income cap.

Asset limits for nursing facility Medicaid are $2,000 for an individual. The primary home is exempt if a spouse, minor child, or qualifying dependent lives there — but it is subject to estate recovery after the Medicaid recipient's death.

When one spouse enters a nursing facility and applies for Medicaid, the spouse remaining at home (the community spouse) is protected from complete asset depletion under federal spousal impoverishment rules (42 U.S.C. § 1396r-5). The community spouse may retain up to the Community Spouse Resource Allowance (CSRA), and may also retain a Minimum Monthly Maintenance Needs Allowance (MMMNA) from the institutionalized spouse's income. Calculating exactly what can be protected requires a formal HHSC assets assessment — request one at the time of application.

Texas operates an Estate Recovery Program under HHSC. Federal law (42 U.S.C. § 1396p) requires states to seek recovery from the estates of Medicaid recipients who were 55 or older when they received Medicaid nursing facility, home- and community-based, or related services. The claim attaches after the Medicaid recipient dies and after the death of a surviving spouse — it does not remove a surviving spouse, minor child, or disabled child from the home during their lifetime. Exemptions and hardship waivers are available.

Once approved for nursing facility or HCBS-level Medicaid, Texas covers the following services for eligible seniors and adults with disabilities.