Does Medicaid Pay for Assisted Living in Texas? — 2025 STAR+PLUS Waiver Guide for Houston Families

--- ## The Core Misconception — Why Families Lose Weeks Families call us regularly saying some version of: "My mom qualifies for Medicaid — does that mean her assisted living is covered?" The honest answer is: probably not, and definitely not in the way you think. Here is the distinction that matters: Texas Medicaid does NOT pay room and board in assisted living. A typical Houston ALF bill of $5,000/month breaks down as roughly $3,000–$4,000 for room and board (what you pay for the apartment, meals, housekeeping, and building) — and $1,000–$2,000 for personal care services (what staff do for your loved one directly). Medicaid pays $0 toward the first category. The STAR+PLUS Waiver may cover the second category — but only if the facility accepts the waiver's reimbursement rate, which most private Houston assisted living communities do not. The state reimbursement rate for STAR+PLUS is substantially below market rate, so most ALFs simply don't participate. This distinction matters enormously for financial planning. A family counting on Medicaid to cover a $5,000/month community may find themselves responsible for $3,500–$4,000/month even after benefits kick in — if they can find a participating facility at all. Families who understand this early make better decisions. Those who don't often end up moving a loved one twice. --- ## STAR+PLUS Waiver — What It Actually Covers STAR+PLUS is Texas Medicaid's managed care program for seniors and people with disabilities who need long-term services and supports. In the Houston area, STAR+PLUS is administered through two managed care organizations (MCOs): Superior HealthPlan and Community First Health Plans. STAR+PLUS covers:

• Personal attendant care (help with bathing, dressing, toileting, meal prep)
• Nursing oversight and medication management
• Adult day care and adult foster care
• Respite services (temporary care to give family caregivers a break)
• Emergency response systems
• Home-delivered meals
• Minor home modifications for safety (grab bars, ramps)

STAR+PLUS does NOT cover:

• Room and board (rent, meals, housekeeping) — the largest expense in any ALF
• Private room premiums
• Activity programs or social amenities
• Transportation beyond specific medical purposes

Enrollment limits matter. STAR+PLUS is not an entitlement program — Texas has approximately 24,000 statewide enrollment slots. This means waitlists are possible, and not every qualifying applicant is enrolled immediately. --- ## 2025 Texas Medicaid Eligibility — Income, Assets, and the Miller Trust Texas Medicaid eligibility for long-term care (nursing home and STAR+PLUS Waiver) has three financial gates: income, assets, and level of care. ### Income Limit — 2025

Category	2025 Limit	2026 Limit
Individual income cap	$2,829/mo	$2,982/mo
Personal Needs Allowance (kept by resident)	$85/mo	$85/mo
Asset limit (individual)	$2,000	$2,000
Asset limit (couple)	$3,000	$3,000
Community spouse resource allowance	up to $155,931	adjusted annually

### The Qualified Income Trust (QIT / Miller Trust) If income exceeds the $2,829/month cap, a Qualified Income Trust — commonly called a Miller Trust — allows the applicant to redirect gross income into a trust account, making them eligible for Medicaid despite exceeding the income limit. Critical rules about Miller Trusts:

• ALL gross income for the eligibility month must be deposited into the trust — not just the excess amount
• The trust is irrevocable — it cannot be undone once established
• Texas uses the "name on the check" rule: income is attributed to whoever's name appears on the payment source
• The trust must be properly drafted — work with an elder law attorney, not just a bank

### Spousal Impoverishment Protections When one spouse enters a nursing facility or STAR+PLUS program and the other remains in the community, federal law protects the community spouse from total impoverishment:

• Community Spouse Resource Allowance (CSRA): Up to $155,931 in assets is sheltered for the community spouse — protected from Medicaid spend-down
• Minimum Monthly Maintenance Needs Allowance (MMMNA): The community spouse keeps up to $3,948/month in income (requires housing/utility costs above $793.13/month to qualify for the higher allowance)
• The community spouse's income is NOT counted in the institutionalized spouse's eligibility determination

--- ## Which Houston Assisted Living Communities Accept STAR+PLUS? This is the most practical question — and the most honest answer is: not many. Most private Houston assisted living communities do not accept STAR+PLUS Waiver because the state reimbursement rate is significantly below market rate. A community charging $5,000/month has limited incentive to accept state payment rates of $1,200–$1,800/month for care services when private-pay residents fill beds at full rate. The communities that do participate typically have:

• Lower base rates closer to the state reimbursement range
• A mission-driven or nonprofit ownership structure
• Explicit STAR+PLUS certification from the Texas HHSC

Rather than listing specific community names (STAR+PLUS participation changes frequently as facilities gain and lose certification), the most reliable approach is to:

1. Use the Texas HHSC HCSSA provider lookup to find STAR+PLUS certified agencies in your ZIP code
2. Call communities directly and ask: "Do you accept STAR+PLUS Waiver through [Superior HealthPlan / Community First Health Plans]?"
3. Contact a CareBridge advisor — we maintain a current list and know which facilities in each Houston submarket actively participate

Talk to a CareBridge advisor about STAR+PLUS options in your area →

--- ## Nursing Facility Medicaid vs. ALF Medicaid — When Each Applies The term "Medicaid nursing home" is familiar; the STAR+PLUS waiver path through assisted living is less understood. Here is how they differ:

Setting	What Medicaid Pays	Eligibility Level
Nursing facility (SNF)	Everything — room, board, care, nursing, therapy	Nursing facility level of care (NF LOC) — requires PASRR screening
STAR+PLUS in ALF	Care services only (attendant, nursing oversight) — NOT room/board	NF LOC assessment required; facility must be STAR+PLUS certified
Home STAR+PLUS	Care services in own home — NOT housing costs	NF LOC assessment required; preference over institutional care under law

Texas law includes an "institutional preference" provision — before someone can enter a nursing facility on Medicaid, the state assesses whether they could be served in a community setting instead. Families who would prefer assisted living over nursing home care should make that preference clear during the HHSC assessment. --- ## PACE Program for Houston — It's Not Here (Yet) PACE — the Program of All-Inclusive Care for the Elderly — is a comprehensive model that fully integrates medical care, personal care, and social services for nursing-home-eligible seniors who live in the community. It is often described as the most comprehensive Medicaid-funded option for frail seniors. The critical fact: Houston does not have a PACE site as of mid-2025. Texas has three PACE sites: El Paso, Amarillo, and Lubbock. Harris County appears in state planning documents as a future PACE service area, but no provider has opened a site in the Houston metro as of this writing. Much of the content appearing in national senior living directories incorrectly implies PACE is available in Houston — it is not. If and when a PACE site opens in Harris County, it would serve seniors who:

• Are age 55 or older and nursing-home-eligible
• Live in the PACE service area
• Can safely live in the community with PACE support (rather than in a facility)
• Consent to receive all their healthcare through the PACE organization

The Texas HHSC maintains a PACE development page with current status — check there for updates on Houston-area sites. --- ## 5-Year Lookback and Medicaid Planning Medicaid has a 60-month lookback period from the application date. The state reviews all asset transfers made below fair market value during those five years — and penalizes the applicant accordingly. How the penalty works: If the applicant gifted $30,000 to grandchildren three years before applying, Medicaid divides that amount by the state's average daily nursing home cost (~$242/day in Texas). That $30,000 creates a roughly 124-day penalty period during which Medicaid won't pay. What is NOT exempt under the lookback:

• Annual gifts to family members — the IRS annual gift exclusion ($19,000 in 2025) has NO relevance to Medicaid lookback. These are completely separate legal frameworks.
• Transfers to most trusts
• Below-market property sales

What IS exempt:

• Transfers to a spouse (always exempt)
• Transfers to a disabled child of any age
• Transfers to a trust for a disabled person under 65
• Transfers of the home to a caregiver child who lived there for 2+ years and enabled the applicant to delay nursing home care

The hard truth: Medicaid planning needs to happen 5+ years before a care crisis — not during one. If your family is in crisis now, the lookback window has likely already started. Focus on what can still be done: correctly documenting exempt assets, establishing the Miller Trust if needed, and understanding the MERP exposure on the home. An elder law attorney (not a general estate planning attorney — an elder law specialist) is the right resource here. --- ## How to Apply for Texas Medicaid The application process involves several moving parts. Expect 45–90 days for a standard application; complex cases can run 4–6 months. Step 1: Apply at YourTexasBenefits.com or in person Online: YourTexasBenefits.com Phone: 1-877-541-7905 In person: Multiple Harris County HHSC benefits office locations. Appointments recommended. Alternative form: H1200 (Application for Assistance — Your Texas Benefits) Step 2: Gather documents — before you apply

• 60 months of bank and investment account statements (yes, 5 full years)
• Vehicle titles
• Property deeds and any property appraisals
• Social Security cards and Medicare card
• Award letters for all income sources (Social Security, pension, annuity)
• Life insurance policies (to confirm face value and cash surrender value)
• Any trust documents

Step 3: Level-of-care assessment HHSC will conduct a functional assessment to determine if the applicant meets nursing facility level of care (NF LOC). This is required for both nursing facility Medicaid and STAR+PLUS enrollment. The assessment covers ADLs, cognitive function, and medical complexity. Step 4: PASRR screening (if applicable) Applicants with a primary diagnosis of mental illness or intellectual disability require a Pre-Admission Screening and Resident Review (PASRR) before placement in a nursing facility. This adds time to the process. Step 5: Choose a STAR+PLUS MCO (for non-nursing facility applicants) Applicants who qualify for home and community-based STAR+PLUS will choose between Superior HealthPlan and Community First Health Plans as their MCO. Each MCO has its own provider network. --- ## Common Gotchas — What Surprises Families 1. "Medicaid-certified" vs. "Medicaid-friendly." These terms are used interchangeably by salespeople but mean completely different things. Medicaid-certified means the facility has completed the state certification process and actively bills Medicaid. Medicaid-friendly means nothing specific — it is marketing language. Always ask for the STAR+PLUS certification number. 2. Spousal impoverishment confusion. Many families try to protect assets by transferring everything to the community spouse before applying. This works — but only up to the $155,931 CSRA limit. Amounts above that limit are counted against the applicant, and transfers above the CSRA within the lookback period can create penalties. 3. Medicaid Estate Recovery (MERP). Texas MERP has recovered over $102 million since 2006. The state places a claim against the probate estate of a Medicaid recipient for long-term care costs paid after age 55. This can affect the home — but only after the surviving spouse has died, and only through probate. A Lady Bird Deed (Texas enhanced life estate deed) can pass the home to heirs outside of probate, avoiding MERP entirely while preserving Medicaid eligibility. Consult a Texas elder law attorney before making this decision. 4. Assuming denial means no options. Medicaid applications are frequently denied for documentation issues rather than actual ineligibility. Common denial reasons: incomplete bank statement history, missed asset disclosures, income slightly over the cap (but Miller Trust not established). Appeals are available — and often successful with proper documentation. 5. The "cost limit" trap in assisted living. Even if a STAR+PLUS-certified ALF is found, the state has a cost-of-care limit that caps what it will pay. If the facility's rate exceeds the state's approved cost, the family must cover the gap — sometimes called a "room and board supplement." Make sure you understand the full cost structure before assuming Medicaid covers the gap. 6. Not considering nursing facility Medicaid. For seniors with higher care needs and limited resources, nursing facility Medicaid — which covers the full cost — may actually be a better financial fit than trying to cobble together STAR+PLUS in an ALF. The quality of Houston-area nursing facilities varies widely, and some are genuinely good. Don't rule them out on perception alone. --- ## Related Guides Before making financial decisions, these posts are worth reading:

• Cost of Assisted Living in Houston in 2025 — real price ranges by neighborhood, what's included, and common billing surprises
• Memory Care in Houston 2025 — costs, communities, dementia stages, and payment options
• VA Aid & Attendance for Houston Veterans — if your family includes a veteran, this benefit can significantly change the financial picture
• How CareBridge Gets Paid — full transparency on our compensation structure before you work with us

--- ## Frequently Asked Questions Does Medicaid pay for assisted living in Texas? Not in the way most families expect. Medicaid does NOT pay room and board in assisted living. The STAR+PLUS Waiver may cover care services in a limited number of STAR+PLUS-certified ALFs — but most private Houston assisted living communities do not accept the waiver due to low state reimbursement rates. What is the STAR+PLUS Waiver? STAR+PLUS is Texas Medicaid's managed care program for seniors and people with disabilities needing long-term services and supports. In Houston, it is administered by Superior HealthPlan and Community First Health Plans. It covers attendant care, nursing oversight, adult day care, respite, and home-delivered meals. It does not cover room and board. Is PACE available in Houston? No — as of mid-2025, Houston does not have an operational PACE site. Texas has three PACE sites: El Paso, Amarillo, and Lubbock. Harris County is in state planning documents as a future area, but no provider has opened here yet. What is MERP and will it take my parent's house? MERP (Medicaid Estate Recovery Program) is a federally required program under which Texas seeks reimbursement from the estates of Medicaid recipients for long-term care costs. The state can place a claim against the probate estate — including the home — after the recipient and surviving spouse both die. A Lady Bird Deed can protect the home from MERP by transferring it outside of probate. Consult a Texas elder law attorney. How long is the Texas Medicaid waiver waitlist? STAR+PLUS has limited enrollment slots rather than a traditional waitlist. The application itself takes 45–90 days for standard cases; 4–6 months for complex ones. Starting before funds are exhausted is critical. What is the income limit for Texas Medicaid in 2025? $2,829/month for an individual. If income exceeds this, a Qualified Income Trust (Miller Trust) can establish eligibility. The asset limit is $2,000 for an individual, $3,000 for a couple. What is the 5-year lookback? Medicaid reviews asset transfers for 60 months before the application date. Gifts or below-market transfers during this period can create penalty periods. The IRS annual gift tax exclusion does not protect gifts from the Medicaid lookback — they are separate legal frameworks. ---