Greater Houston Senior Living Guide
STAR+PLUS Nursing Facility Diversion Waiver — Houston Guide
The STAR+PLUS Home and Community-Based Services (HCBS) waiver provides additional services beyond standard STAR+PLUS to help people who qualify for nursing home care remain in their homes and communities. It is sometimes called the Nursing Facility Diversion waiver.
How the Waiver Works
The HCBS waiver is an additional layer on top of standard STAR+PLUS benefits. It provides services specifically designed to keep people out of nursing facilities — things like adult foster care, home-delivered meals, minor home modifications, and respite care for family caregivers. Your MCO administers the waiver services.
There are a limited number of waiver slots. If all slots are filled, you may be placed on an interest list. Your MCO can tell you the current availability in your region.
Who Qualifies for Nursing Facility Diversion?
- Must be enrolled in STAR+PLUS
- Must meet nursing facility level of care
- Must be able to live safely in the community with waiver supports
- Must choose to receive services in the community rather than a nursing facility
- A waiver slot must be available (limited capacity)
What Home Health Services Are Covered?
- Adult foster care
- Assisted living as a waiver service (Room & Board not included)
- Home-delivered meals
- Minor home modifications (ramps, grab bars, widened doorways)
- Nursing services beyond standard home health visits
- Respite care (temporary relief for family caregivers)
- Adaptive aids and medical supplies
- Transition assistance services
What Is NOT Covered?
- Room and board (rent, mortgage, food costs)
- Services available through standard STAR+PLUS (not duplicated)
- Major home construction or renovation
- Services in a nursing facility (defeats the waiver purpose)
How to Enroll
- Be enrolled in STAR+PLUS and meet nursing facility level of care.
- Contact your MCO and ask about HCBS waiver availability.
- Your MCO conducts a comprehensive assessment to determine need.
- If approved and a slot is available, your MCO develops a person-centered service plan.
- Waiver services begin according to the service plan — often coordinated alongside existing home health.
For eligibility questions, call the HHSC Benefits Helpline at 2-1-1 or visit hhs.texas.gov.
Find an Agency That Accepts Nursing Facility Diversion
Browse HHSC-licensed home health agencies in the Houston area that accept Nursing Facility Diversion.
Find Nursing Facility Diversion Agencies →FAQ
Nursing Facility Diversion — Frequently Asked Questions
Is there a waiting list for the STAR+PLUS waiver?
There can be. The HCBS waiver has a limited number of slots per region. If no slot is available, you are placed on an interest list. Standard STAR+PLUS services (PAS, CFC, skilled nursing) continue while you wait.
Can I get home-delivered meals through the waiver?
Yes. Home-delivered meals are a waiver service for people who cannot prepare meals due to physical limitations. The number of meals per week is based on your individual service plan.
Does the waiver pay for assisted living?
The waiver can pay for assisted living services (care and supervision), but it does not cover room and board. The resident or their family must pay the room and board portion.
What is respite care under the waiver?
Respite care provides temporary relief for unpaid family caregivers. A trained caregiver comes to the home (or the member goes to a facility temporarily) so the family caregiver can rest, run errands, or take a break.
Can I receive waiver services and home health at the same time?
Yes. The waiver supplements standard STAR+PLUS benefits. You continue to receive skilled nursing, therapy, PAS, and other services alongside the additional waiver services.
Related Medicaid Programs
This guide is for informational purposes only. Houston Senior Living Guide is not affiliated with HHSC, CMS, or any MCO.