Does Medicaid Pay for Assisted Living in Texas?

Texas Medicaid does not cover the cost of room and board in an assisted living community, but it can pay for the care services a resident receives there, through a specific program called the STAR+PLUS Home and Community-Based Services (HCBS) waiver.

If you're reading this, there's a good chance you're in the middle of a hard decision: maybe a parent's health has changed, maybe the cost of care is starting to feel unmanageable, and maybe you're not sure where to even start. That's a heavy place to be, and you're not alone in it. Thousands of Texas families ask this exact question every year, and the answer is more hopeful than most people expect once you understand how the pieces fit together.

This guide walks through exactly what Texas Medicaid does and doesn't cover, who qualifies, how to apply, and what it typically costs even with help. If you're comparing communities as you plan, our Texas assisted living directory can help you find options in your area that work with Medicaid waivers.

What Medicaid Covers (and Doesn't Cover) in Texas Assisted Living

Here's where the confusion usually starts. Regular Texas Medicaid, the standard health coverage program, does not pay for assisted living at all. It wasn't built for it. Traditional Medicaid nursing home coverage is broader and includes room and board, which is one reason people assume assisted living works the same way. It doesn't.

Assisted living coverage runs through a different door: the STAR+PLUS HCBS waiver. This program can pay for the personal care and support services a resident receives, things like help with bathing, dressing, medication reminders, and 24-hour supervision. What it will not pay for is the "hotel" side of the arrangement: the private living unit, meals, and housekeeping. Texas Health and Human Services requires every STAR+PLUS HCBS member in assisted living to pay room and board directly to the facility, no exceptions.

So if someone asks if Medicaid pays for assisted living in Texas, the honest answer really has two parts. Yes, for the care. No, for the roof. For the food. I know that making this split early avoids a lot of heartache later, especially when you’re comparing what a facility really costs versus what the waiver really covers.

The STAR+PLUS HCBS Waiver, Explained

STAR+PLUS is the umbrella name for Texas Medicaid's managed care program for adults 65 and older or living with disabilities. Within STAR+PLUS sits the HCBS waiver, sometimes just called the STAR+PLUS Waiver, which funds long-term services and supports for people who would otherwise need a nursing facility but want to stay in a community setting instead, including assisted living, adult foster care, or their own home.

Once someone is approved, a Managed Care Organization (MCO), a private health plan contracted by the state, takes over coordinating their services. The MCO assigns a service coordinator, helps the member choose a participating assisted living facility, and authorizes the specific services in an individualized service plan. Not every assisted living facility accepts STAR+PLUS, so this is a practical detail to confirm early: the facility has to be contracted with the member's MCO before Medicaid dollars can flow to it.

It's worth repeating the core distinction one more time here, because it's the detail families most often miss: this waiver is what determines whether Medicaid pays for assisted living in Texas, but it only ever pays for the service side of the bill.

Who Qualifies for Texas Medicaid Assisted Living Coverage

Qualifying for the STAR+PLUS HCBS waiver means clearing two separate bars: one medical, one financial.

Functional eligibility. The applicant generally must be a Texas resident who is 65 or older, or 21 and older with a qualifying disability. They must also be assessed as needing a nursing facility level of care, meaning their physical or cognitive needs are serious enough that, without support, a nursing home would otherwise be the next step.

Financial eligibility (2026 figures). For a single applicant, Texas Medicaid waivers require:

For married couples where only one spouse is applying, the same $2,982 income limit typically applies to the applicant alone, while the non-applicant spouse's income is usually protected and disregarded. Certain assets don't count toward the limit either, a primary home (with some conditions), one vehicle, and personal belongings are generally exempt.

If your loved one's income is slightly over the limit, that's not necessarily the end of the road. Texas allows a legal tool called a Qualified Income Trust, often called a Miller Trust, which lets excess income be redirected into an irrevocable trust so it no longer counts against the Medicaid limit. This is a common and accepted strategy, though it's worth setting up correctly, which usually means working with a Medicaid planner or elder law attorney.

How to Apply for Texas Medicaid Assisted Living Coverage

Applying for STAR+PLUS HCBS is a separate step from applying for regular Medicaid health coverage, and it helps to know that going in.

1. Start the conversation. Call 2-1-1 or visit YourTexasBenefits.com to begin the application and get placed on the STAR+PLUS HCBS interest list.

2. Complete the Medicaid application. This establishes financial eligibility and may involve submitting income and asset documentation.

3. Undergo a needs assessment. A nurse or assessor evaluates whether the applicant meets the nursing facility level of care requirement.

4. Wait for waiver enrollment. Because STAR+PLUS HCBS has a capped number of participants statewide, there's often a genuine wait after the interest list contact before services actually start.

5. Choose a health plan and facility. Once approved, the applicant selects an MCO, and the MCO helps identify an assisted living facility that's contracted to accept STAR+PLUS HCBS members.

That interest list step is one of the most important things to plan around. It is not unusual for families to be told there's a wait, so the earlier you start the process, the more breathing room you'll have.

What It Actually Costs, Even With the Waiver

STAR+PLUS HCBS pays for the care piece, but families should budget to pay for room and board on their own. In Texas, this charge is based upon the federal SSI benefit rate minus a small personal needs allowance. This is a standard monthly amount and does not reflect the full private pay rate of the facility. It’s a whole lot cheaper than market rate, but it’s still a real bill.

For instance, Texas assisted living communities usually cost between $4,500 and $4,900 a month for private-pay residents in 2026, though there’s a lot of variability by city and level of care. Most families budget for that room-and-board contribution even with the waiver covering services, or anything not included in the individual service plan.

Other Ways to Help Pay for Assisted Living in Texas

Because Medicaid's assisted living coverage in Texas is partial, many families layer it with other resources:

• VA Aid & Attendance: An added monthly benefit for eligible veterans and surviving spouses that can help offset assisted living costs.

• Long-term care insurance: If a policy exists, it may cover room and board directly, filling the exact gap Medicaid leaves open.

• Private pay and spend-down: Some families cover costs from savings initially while working through the Medicaid application and interest list timeline.

• Community First Choice (CFC): A related but separate Medicaid program that can provide personal care support, mainly for those living at home rather than in a facility.

None of these need to be figured out alone. A Medicaid planner, elder law attorney, or your local Area Agency on Aging can help map out which combination makes sense for your family's specific finances.

Frequently Asked Questions

Does regular Texas Medicaid cover assisted living? No. Regular Medicaid in Texas covers medical care and, for some people, some in-home supports, but it does not cover assisted living facility costs. Assisted living services are covered under the STAR+PLUS HCBS waiver only.

What's the difference between STAR+PLUS and STAR+PLUS HCBS? STAR+PLUS is the overall Medicaid managed care program for older adults and people with disabilities in Texas. STAR+PLUS HCBS has a waiver component that provides funding for long-term services and supports in community settings, including assisted living.

How long is the waitlist for the STAR+PLUS waiver in Texas? As the waiver is limited in the number of slots statewide, the wait times vary and are not published as a fixed number. It’s important to get your name in early, as you can expect to wait a while between signing up for the interest list and starting services.

Under the waiver, can a family member be hired as a caregiver? Some related programs in Texas Medicaid, such as Community First Choice, allow participants to direct their own care and hire some caregivers, including some family members. Rules vary by program, so it is a good idea to check with your MCO or caseworker directly.

What if my income is slightly over the limit? A Qualified Income Trust (also known as a Miller Trust) is a legal way of diverting excess income so it is not counted toward the Medicaid limit. This is a standard, long-standing option in Texas for otherwise eligible applicants who exceed the income limit.

Medicaid for Assisted Living in Texas

So, does Medicaid pay for assisted living in Texas? Yes — through the STAR+PLUS HCBS waiver, it can cover the care services that make daily life safer and more manageable. What it won't cover is the room and board itself, which stays the resident's responsibility, calculated using a standardized, more affordable rate. Knowing that distinction from the start makes the whole process easier to plan for, whether you're just starting to research or already filling out the application.

Understanding the financial assistance is only half the picture, the right fit matters just as much as the right price. Seniors Living Communities lets you search and compare communities near you by city, budget, and care type. Take a quiz using our free Matching Tool to find communities that match your budget, and bring our Tour Companion along when you tour to help you compare value, not just cost.

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