Independent. Local. Written for Houston families.

STAR+PLUS Medicaid in Texas pays for care services delivered inside an assisted living facility — but it does not pay one dollar toward rent, meals, utilities, or laundry. For Houston families navigating this program, that distinction is not a fine-print technicality; it is the central financial reality that shapes every care decision. Understanding exactly where STAR+PLUS coverage ends and where a resident's personal obligation begins can mean the difference between a sustainable placement and an avoidable crisis. In this guide, the Houston Senior Living Guide team explores how STAR+PLUS coverage works in Houston-area assisted living, what the Optional State Supplement can and cannot do, and which practical strategies Harris County families can use to close the gap.

No — STAR+PLUS does not cover room and board in assisted living. The program covers Medicaid-funded care services only. Room and board costs remain the resident's responsibility, partially offset in some cases by the Optional State Supplement (OSS) for SSI recipients.

Key Takeaways

  • STAR+PLUS covers care, not housing — Personal attendant care, nursing visits, therapies, and medication management are covered; rent, meals, utilities, and laundry are not.
  • The Optional State Supplement (OSS) offers partial relief — SSI recipients living in qualifying Houston-area assisted living facilities may receive a fixed monthly OSS payment, but it covers only a fraction of typical room and board costs.
  • The affordability gap is substantial in Houston — With room and board running approximately $2,000–$3,500 per month at many Harris County facilities and the federal SSI rate near $943 per month for an individual, most STAR+PLUS enrollees face a significant monthly shortfall.
  • Residential care homes are an underused alternative — Smaller, licensed residential care homes in Houston often carry lower room and board costs than larger assisted living communities and can still accept STAR+PLUS care services.
  • No Texas Medicaid waiver covers ALF room and board — This is a firm policy line, not a gap that will be filled by applying to a different program. Families must plan around it, not through it.

Reviewed by the HSLG Editorial Team. Houston Senior Living Guide's editorial content is developed using verified data from the Texas Health and Human Services Commission (HHSC), CMS star ratings, Google Reviews, Bureau of Labor Statistics wage data, and Genworth Cost of Care surveys. Our directory indexes 1,500+ licensed facilities across five Houston-area counties.

Quick Answers
Q: What is the difference between Medicare and Medicaid for assisted living costs in Houston?
Medicare is a federal health insurance program that primarily covers short-term, skilled medical care, such as a limited stay in a nursing home after a hospitalization; it does not pay for long-term room and board in assisted living. Medicaid, a joint federal and state program, can cover the cost of long-term care services (but not housing) in a Houston assisted living facility for eligible low-income seniors, often through waiver programs like STAR+PLUS.
Q: What is a Medicaid 'waiver' program in Texas?
A Medicaid waiver program, such as STAR+PLUS, allows Texas to use federal Medicaid funds for long-term services and supports in community settings, like a person's home or an assisted living facility. It essentially “waives” the rule that Medicaid only pays for care in an institutional setting like a nursing home, giving seniors more choice in where they receive care.
Q: What is the Optional State Supplement (OSS) for assisted living in Texas?
The Optional State Supplement (OSS) is a state-funded cash payment that can help certain low-income seniors pay for room and board in approved living arrangements, including some Houston-area assisted living facilities. To be eligible, a person must be receiving Supplemental Security Income (SSI) and reside in a facility with a specific Medicaid contract. The OSS benefit is paid directly to the individual to help cover housing costs not paid for by Medicaid.

What STAR+PLUS Actually Covers — and What It Does Not

STAR+PLUS is a Medicaid managed care waiver program — it funds the delivery of health and long-term services, not the housing in which those services are delivered. When a Harris County resident with STAR+PLUS moves into an assisted living facility, the program pays their managed care organization (MCO) a capitated rate to coordinate and fund covered services: personal attendant care, skilled nursing visits, occupational and physical therapy, behavioral health services, medical transportation, and medication management. What STAR+PLUS explicitly does not pay for is room and board — meaning the cost of the physical space the resident occupies, the meals served in the dining room, utilities running through the building, and laundry services. Texas Medicaid draws this line because federal Medicaid law categorizes room and board as a non-medical living expense. The distinction matters because assisted living facilities in Texas are licensed as residential settings that bundle housing with services — and only the services portion qualifies for Medicaid reimbursement.

To understand who STAR+PLUS serves in Houston's assisted living landscape, it helps to know how Texas Health and Human Services Commission (HHSC) licenses these facilities. Type A assisted living facilities serve residents who can follow directions and self-evacuate in an emergency without staff assistance; these facilities are not required to maintain awake overnight staff. Type B assisted living facilities serve residents with higher care needs — including those who require overnight awake staff assistance — and carry more intensive staffing requirements. Both Type A and Type B facilities are present throughout Harris County, and both can enroll STAR+PLUS members who receive care services on-site. The licensing category determines staffing and operational requirements, but it does not change the room-and-board exclusion: neither type receives any Medicaid payment for housing costs under STAR+PLUS. This stands in deliberate contrast to nursing homes in Houston, where Texas Medicaid (through the traditional fee-for-service program, not STAR+PLUS) does cover the full cost of residency — including room and board — for eligible residents. That is a meaningful policy difference, and it explains why some families with very high-needs relatives ultimately find that a Medicaid-certified nursing facility is the more financially feasible path. For a deeper look at how these two care settings compare, the Houston Senior Living Guide's Assisted Living vs. Nursing Home guide walks through the tradeoffs in plain terms.

The four managed care organizations currently operating STAR+PLUS in Harris County — Community First Health Plans, Molina Healthcare, UnitedHealthcare Community Plan, and Amerigroup — administer care benefits under identical Medicaid rules regarding room and board. Families sometimes hope that choosing a different MCO will unlock housing coverage; it will not. Each plan has different care coordination processes, prior authorization timelines, and provider networks, but none of them can override the fundamental federal and state policy that excludes room and board from Medicaid-funded assisted living coverage. If you are unsure which MCO currently manages your loved one's STAR+PLUS benefits, the HHSC Provider Search portal is the authoritative starting point for verifying provider and plan relationships in Harris County. For a fuller picture of what assisted living entails before diving into funding questions, see the What Is Assisted Living? guide in the Learning Hub, and browse the full directory of assisted living communities in Houston to understand the range of facilities operating under these rules.

Quick Answers
Q: How much does room and board cost per month in Houston assisted living?
In Houston, the monthly cost for room and board alone typically ranges from $2,000 to $3,500, separate from care service fees. This price varies by neighborhood, with areas like West University or Clear Lake trending higher than communities in Spring Shadows or northeast Houston. This base rate covers your apartment, meals, and utilities, but not personal or medical care.
Q: Does the STAR+PLUS waiver cover room and board in Texas?
No, STAR+PLUS does not pay for room and board in assisted living facilities, which is a major financial gap for many families. The waiver is designed to cover the costs of personal care services, such as help with bathing, dressing, and medication management. Residents must pay for their room, meals, and utilities out-of-pocket or through other benefits like SSI.
Q: What is the income limit for STAR+PLUS, and how does that affect paying for assisted living in Houston?
To qualify for STAR+PLUS, an individual must generally meet Medicaid's low-income and asset criteria, often by qualifying for Supplemental Security Income (SSI). In 2024, the SSI benefit is around $943 per month, which falls significantly short of the typical $2,000+ monthly room and board costs in Houston. This gap is the primary financial challenge families must solve when using the waiver for assisted living.

The Optional State Supplement (OSS): Houston's Partial Bridge for Room and Board

The Optional State Supplement (OSS) is the only state-funded mechanism that directly addresses the room-and-board gap for low-income residents in Texas assisted living — but it covers only a portion of actual costs, and eligibility is narrow. OSS is a state-funded monthly payment added on top of federal Supplemental Security Income (SSI) for eligible individuals who reside in qualifying residential care settings, including licensed assisted living facilities. To receive OSS in Texas, a person must already be receiving SSI, must be living in a facility that has been approved by HHSC to participate in the OSS program, and must not be receiving full Medicaid institutional care (such as a nursing facility placement). HHSC sets OSS payment rates, and those rates are subject to adjustment during Texas legislative sessions; families should always verify the current monthly figure directly with HHSC rather than relying on any static number published online. As of current HHSC guidance, OSS supplements are in the range of several hundred dollars per month — meaningful, but well short of covering full room and board at most Houston-area facilities. Applications for OSS in Harris County are processed through the statewide HHSC benefits system; the Texas 2-1-1 referral network can also connect families with local benefits navigators who handle OSS paperwork.

The real-world math for a Houston STAR+PLUS enrollee receiving OSS is sobering. Room and board costs at licensed assisted living facilities in Harris County typically run between $2,000 and $3,500 per month depending on facility type, neighborhood, and amenities — see the Assisted Living Cost in Houston guide for a detailed breakdown. The federal SSI benefit for an individual sits near $943 per month under current federal rates. When a STAR+PLUS enrollee applies their SSI income toward room and board, the facility is generally entitled to retain all but a small personal needs allowance (currently set at $60 per month under Texas rules for ALF residents receiving OSS). Add in an OSS supplement and the total available for room and board may reach approximately $1,000–$1,200 per month in the best-case scenario — still leaving a monthly gap of $800 to $2,500 at most Houston facilities. That gap is not an administrative error. It reflects a deliberate structural reality: Texas Medicaid was designed to fund care services, and the expectation is that residents will use personal income, family contributions, or other assistance to cover housing. Understanding this arithmetic before a placement decision is made — not after the first billing cycle — is one of the most valuable things a Houston family can do.

"The room-and-board gap in Houston's STAR+PLUS system is one of the most misunderstood financial realities in local elder care — families often discover it after a placement is made, not before. Planning around this gap from the start is the only way to make a STAR+PLUS assisted living arrangement financially sustainable." — HSLG Editorial Team

Closing the Gap: What Houston Families Can Do When STAR+PLUS Falls Short

When STAR+PLUS care coverage and OSS together do not cover full room and board — which is the typical outcome for most Harris County enrollees — families have four realistic options, none of which is perfect, but each of which has helped Houston-area seniors maintain stable placements. The foundation of any gap-closing strategy starts with correctly applying all available income. Under Texas Medicaid rules for ALF residents receiving OSS, the facility retains the resident's SSI income (minus the $60 personal needs allowance) toward room and board, and the OSS supplement adds to that amount. Families sometimes assume SSI income is protected for personal use — it is not, beyond that small allowance. Getting this income flow correctly established with the facility's billing department is step one. Beyond that baseline, the practical strategies available to Houston families include the following:

  • Apply for OSS if not already enrolled. Many eligible STAR+PLUS enrollees are not receiving OSS simply because no one initiated the application. If your loved one receives SSI and lives in a Harris County ALF that participates in OSS, contact HHSC or call 2-1-1 Texas to begin the enrollment process. It will not close the full gap, but every dollar of OSS is a dollar that does not need to come from family contributions.
  • Contact the Harris County Area Agency on Aging. The Area Agency on Aging serves Harris County residents and can connect families with local housing assistance programs, benefits counselors, and transitional resources. They are not able to pay room and board directly, but a benefits counselor can identify local programs that may provide wrap-around support — particularly for seniors transitioning out of a hospital or experiencing a housing crisis.
  • Consider a residential care home as a lower-cost alternative. Licensed residential care homes in Houston — smaller, home-based settings that serve six or fewer residents — often carry significantly lower room and board costs than larger corporate or campus-style assisted living communities. Many residential care homes in Harris County accept STAR+PLUS enrollees for the care services component while charging less for the housing component. This is an underutilized option that deserves serious consideration before a family exhausts other resources.
  • Pursue a family contribution agreement. Many Houston-area ALFs will work with families to establish a formal arrangement where adult children or other family members contribute a defined monthly amount toward room and board. This is not charity — it is a structured financial plan. Facilities generally prefer this to vacancy or frequent turnover, and a frank conversation with the admissions or billing director about sustainability is always worth having.
  • Explore Supplemental Needs Trust eligibility. For STAR+PLUS enrollees who have received a personal injury settlement, inheritance, or other lump-sum payment, a properly structured Supplemental Needs Trust (also called a Special Needs Trust) may allow those funds to supplement room and board without disqualifying the individual from Medicaid eligibility. This requires a Texas elder law attorney and is not appropriate for every situation, but it is a legitimate tool that Houston families sometimes overlook.
  • Evaluate whether a nursing facility placement is more financially viable. For residents with very high care needs, the calculus sometimes shifts. In a Medicaid-certified nursing home in Houston, Texas Medicaid covers the full cost of residency — including room and board — for eligible individuals. If STAR+PLUS care needs have escalated to a level that nursing facility care would meet, and the room-and-board gap in assisted living is creating an unsustainable financial burden, a nursing facility evaluation may be the most pragmatic path forward.

One firm reality to communicate clearly to families: there is no separate Texas Medicaid waiver that covers room and board in assisted living facilities. STAR+PLUS is itself a Medicaid waiver program — it operates under a federal waiver granted to Texas under Section 1915(c) of the Social Security Act — and it does not include a room-and-board benefit for ALF residents. Families sometimes hear about other Medicaid waiver programs (such as the Community First Choice option or the Medically Dependent Children's Program) and wonder whether a different waiver would cover their situation. None of the Texas Medicaid waiver programs currently cover room and board in an assisted living setting. This is a documented policy gap that Texas advocates have raised during multiple legislative sessions, not a temporary oversight. Families navigating STAR+PLUS applications in Harris County can begin or review their applications through the HHSC benefits portal; the HHSC Provider Search tool can also help identify which licensed ALFs in Harris County are currently enrolled to receive STAR+PLUS care services. For additional context on what Medicare (as distinct from Medicaid) does and does not cover in assisted living — a common source of confusion — see the Learning Hub's Does Medicare Cover Assisted Living? guide.

Quick Answers
Q: What are our options if a Houston-area assisted living facility's room and board is too expensive, even with STAR+PLUS?
If a facility's room and board costs create a gap, first apply the resident's SSI income, as facilities will accept this toward the cost. You can also explore licensed residential care homes in more affordable Houston suburbs, which often have lower room and board fees but still accept STAR+PLUS for care services. For additional local support, contact the Harris County Area Agency on Aging to ask about other financial assistance programs.
Q: How do I choose between a Type A and Type B assisted living facility in Texas for a STAR+PLUS recipient?
The choice depends entirely on the resident's care needs. Type A facilities are for residents who can evacuate independently in an emergency, while Type B facilities are licensed for residents who need more hands-on assistance and require overnight staff availability. Both types in Houston can contract with STAR+PLUS to cover care services, but the resident must first meet the facility's specific admission criteria for their level of care.

Houston Neighborhood Context: How Location Affects the Room-and-Board Gap

The size of the room-and-board gap a STAR+PLUS enrollee faces in Houston depends significantly on which neighborhood or suburb the facility is located in — and families who understand this geography can make placement decisions that meaningfully reduce monthly shortfalls. Houston's assisted living market is not uniform. Facilities in higher-cost neighborhoods — particularly those in West University Place, Bellaire, and parts of Clear Lake near the NASA corridor — tend to charge at the upper end of the $2,000–$3,500 room-and-board range or beyond. These facilities often have newer construction, more amenity-rich campuses, and higher staff-to-resident ratios, all of which are reflected in their pricing. For a STAR+PLUS enrollee whose total available resources for room and board max out near $1,200 per month after SSI and OSS, placing a loved one in a West University facility is likely not financially sustainable without substantial family contributions. Senior living in Clear Lake offers excellent care quality but tends to price accordingly given the area's demographics and cost of living.

Neighborhoods in northeast Houston, parts of Spring Shadows, and areas along the corridors served by northwest Houston senior living facilities tend to offer a broader range of price points, including assisted living communities and residential care homes with lower base room-and-board rates. This does not mean lower quality of care — many HHSC-licensed facilities in these areas have solid inspection records and serve STAR+PLUS enrollees effectively. It does mean that a family working with a constrained budget should not limit their search to the closest facility or the one with the most polished website. The Houston Senior Living Guide directory covers facilities across Harris County with enough geographic breadth to identify options that align with both care needs and financial reality. When comparing facilities, always ask the admissions coordinator to separate the room-and-board cost from the care services cost in their quoted monthly rate — some facilities bundle these together in a single all-inclusive figure, which can obscure the true room-and-board obligation relevant to a STAR+PLUS placement. For a complete picture of Houston-area assisted living pricing across neighborhoods and facility types, the Assisted Living Cost in Houston guide is the most detailed local resource available.

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Why Houston Senior Living Guide

Houston Senior Living Guide is the largest free, independent senior care directory serving the Greater Houston metro, with more than 1,500 licensed facilities indexed across Harris, Fort Bend, Montgomery, Galveston, and Brazoria counties. Every facility listing is verified against Texas HHSC licensing records and updated weekly — not scraped once and forgotten. Our editorial team specializes in the regulatory and financial nuances of Texas Medicaid programs, including STAR+PLUS, so the guidance in this article reflects how these programs actually operate in Harris County, not how national summaries describe them.

About This Guide

Houston Senior Living Guide is a free, independent resource helping families navigate senior care options across the Greater Houston metro area. Our directory includes more than 1,500 licensed facilities across Harris, Fort Bend, Montgomery, Galveston, and Brazoria counties, with data sourced directly from the Texas Health and Human Services Commission (HHSC). We exist to make the search for quality senior care less overwhelming and more informed.

Why This Guide Exists — This guide was built by a Houston-area family after navigating assisted living, memory care, and home health firsthand when our mother was diagnosed with a memory care condition. Our content is reviewed by a licensed registered nurse in Texas. We built what we wished existed when we needed it.