If you're trying to figure out whether a parent or spouse can get help paying for home care through Texas Medicaid, the short answer is: it depends on income, assets, and a medical assessment — and all three have to line up. The relevant program is called STAR+PLUS, and within it, the part that pays for care at home is the Home and Community-Based Services (HCBS) waiver.
Below is a breakdown of exactly what's required, using the current 2026 figures from the Texas Health and Human Services Commission (HHSC), followed by the steps to actually apply.
What STAR+PLUS actually covers at home
STAR+PLUS is Texas's Medicaid managed care program for adults age 65 and older and adults with disabilities. The HCBS waiver specifically funds services delivered in a person's own home instead of a nursing facility, including:
- Personal attendant services (bathing, dressing, mobility assistance)
- Skilled nursing and therapy services
- Adult day care and respite care for family caregivers
- Home modifications like grab bars and wheelchair ramps
- Adaptive aids and medical equipment
The goal of the waiver is explicitly to help people avoid nursing home placement, so the eligibility rules are built around proving that a nursing home is the realistic alternative without this support.
The three eligibility tests
Texas evaluates every STAR+PLUS HCBS application against three separate criteria. Failing any one of them disqualifies the application, so it's worth understanding each on its own.
1. Income limit
For 2026, the income limit is $2,982 per month for a single applicant. That figure is set at 300% of the federal SSI benefit rate and adjusts each January. If both spouses in a household are applying, each spouse's income is evaluated separately against that same limit — one spouse's income does not get added to the other's for this test.
If only one spouse is applying, the non-applicant spouse's income is not counted against the applicant. In fact, income can sometimes be transferred from the applicant spouse to the non-applicant spouse through a Monthly Maintenance Needs Allowance, up to roughly $4,066 per month, to prevent the at-home spouse from being left without enough income to live on.
What if income is too high?
Exceeding the income limit doesn't automatically disqualify someone. Texas allows applicants to establish a Qualified Income Trust — often called a Miller Trust — where excess income is deposited each month. Because that income legally belongs to the trust rather than the applicant, it isn't counted toward the Medicaid limit. This requires setting up the trust correctly, so many families work with an elder law attorney for this step specifically.
2. Asset limit
The asset limit is $2,000 for a single applicant and $3,000 if both spouses are applying. Countable assets include things like bank accounts, stocks, and additional property. A primary home and one vehicle are generally exempt and don't count toward this limit.
For married couples where only one spouse is applying, Texas still considers the couple's combined assets when determining eligibility, but a portion is protected for the non-applicant spouse through the Community Spouse Resource Allowance — for 2026, up to half of the couple's combined countable assets, capped at $162,660.
| Eligibility factor | 2026 limit |
|---|---|
| Monthly income (single applicant) | $2,982 |
| Countable assets (single applicant) | $2,000 |
| Countable assets (both spouses applying) | $3,000 |
| Community Spouse Resource Allowance (max) | $162,660 |
| Home and one vehicle | Exempt |
3. Medical and functional need
Beyond the financial tests, an applicant must also demonstrate a medical need for a Nursing Facility Level of Care (NFLOC) — meaning a state assessor determines that without this support, the person would require nursing home placement. This is evaluated through an in-home functional assessment that looks at the applicant's ability to manage daily activities like bathing, dressing, mobility, and medication management, along with any cognitive or medical conditions.
This step matters as much as the financial tests. A family can meet every income and asset requirement and still be denied if the assessment doesn't support a nursing-facility level of need.
Texas residency and citizenship rules
Applicants must be Texas residents who intend to remain in the state, and either U.S. citizens or qualified immigrants. Lawful permanent residents generally face a five-year waiting period, though refugees and asylees are typically exempt from that wait.
How to apply, step by step
- Apply for Texas Medicaid. This is done through YourTexasBenefits.com, by phone, by mail to HHSC, or in person at a local HHSC office. You'll need documentation of income, assets, residency, and citizenship status.
- Request the STAR+PLUS HCBS functional assessment. Call HHSC directly to start this process — it's a separate step from the general Medicaid application and determines the medical eligibility piece.
- Complete the in-home assessment. A state assessor visits the home to evaluate functional and medical need against the Nursing Facility Level of Care standard.
- Get placed with a managed care organization (MCO). Once approved, you'll select from the MCOs operating in your area — options in the Houston region typically include UnitedHealthcare, Molina, and Superior HealthPlan.
- Meet with your assigned service coordinator. The MCO assigns a coordinator who builds a personalized care plan and approves specific hours and services.
- Choose how care is delivered. Families can choose agency-directed care, where a licensed home care agency manages caregivers, or Consumer Directed Services (CDS), where the family hires and manages caregivers directly.
Expect a waitlist
Because STAR+PLUS HCBS has limited enrollment in many regions, some areas maintain an interest list before a Medicaid slot opens up. Wait times vary significantly by region and change year to year. Getting on the interest list as early as possible — even before you think you'll need services — is one of the most important steps a family can take.
Common reasons applications get delayed or denied
- Uncounted transfers or gifts. Texas applies a 5-year look-back period on asset transfers. Gifting money or property below fair market value in that window can trigger a penalty period of ineligibility.
- Missing documentation. Incomplete proof of income, assets, or residency is one of the most common reasons applications stall during the verification interview.
- Underestimating the functional assessment. Families sometimes assume financial eligibility is the hard part and are caught off guard when the medical assessment doesn't support nursing-facility-level need.
- Not reporting changes. Income or household changes must be reported to HHSC within 10 days; failing to do so can create overpayments that need to be repaid later.
Getting help with the process
Medicaid planning for home care sits at the intersection of financial rules, medical assessments, and paperwork deadlines — and mistakes at any stage can cost months of delay. Many families in the Pasadena and Southeast Houston area choose to consult an elder law attorney for the financial planning piece, particularly if a Miller Trust or asset planning is involved.
On the care side, New Dimensions Caregivers works with families throughout this process — helping coordinate the functional assessment, explaining what a service coordinator's care plan should include, and providing care in the interim while an application is pending. If you're not sure where to start, a free conversation with our team costs nothing.
Need help navigating this process?
Our care coordinators help Pasadena-area families understand their options before and during the Medicaid application process.