How to Apply for STAR+PLUS Medicaid in Houston, TX

Independent. Local. Written for Houston families.

Navigating STAR+PLUS Medicaid in Houston requires understanding one key fact upfront: Texas operates this program through managed care, meaning Harris County residents who qualify do not receive services directly from the state — they enroll with a private Managed Care Organization that coordinates everything from nursing home placement to home health visits. For Greater Houston families managing a parent's transition to long-term care, or for seniors approaching the $2,000 asset threshold themselves, the application process involves two parallel tracks, a waitlist for home-based services, and document gathering that can delay approval by weeks if done out of order. The stakes are real — a single missed bank statement or an undocumented asset transfer within the five-year look-back period can freeze an application at the worst possible time. In this guide, the Houston Senior Living Guide team explores every step of the STAR+PLUS application process, from initial eligibility through MCO selection, with specific resources for Harris County residents.

STAR+PLUS Medicaid is available to Harris County residents who are age 65 or older, or adults 21 and older with a qualifying disability, who meet Texas Medicaid's income and asset limits and need long-term services and supports. The program covers nursing facility care, home health, personal attendant services, adult day care, and certain home modifications — delivered entirely through a contracted MCO, not directly by the state.

Key Takeaways

• STAR+PLUS is Texas Medicaid's managed long-term care program — it serves adults 65 and older and adults with disabilities in Harris County who need nursing facility or home and community-based long-term services and supports, and it is entirely distinct from STAR Medicaid, which covers children and pregnant women.
• Confirm your Harris County zip code falls within the STAR+PLUS service area — before calling the Texas Health and Human Services Commission (HHSC), Houston applicants should verify their address is within the designated Houston STAR+PLUS service region using the HHSC managed care enrollment tool.
• Two program tracks exist — HCBS and Nursing Facility — and the track determines your application path — the Home and Community-Based Services (HCBS) waiver track has a waitlist in Texas; the Nursing Facility track does not, and eligible applicants can enroll directly.
• Financial eligibility requires income at or below 300% of the SSI Federal Benefit Rate (approximately $2,829/month for a single individual as of 2026) and countable assets under $2,000 — key Texas exemptions include the primary home, one vehicle, and up to $1,500 in designated burial funds, none of which count toward the asset cap.

Who Qualifies and What STAR+PLUS Actually Covers in Houston

STAR+PLUS is Texas Medicaid's integrated managed care program for adults who need long-term services and supports — and it is not the same program as regular STAR Medicaid. STAR serves children and pregnant women; STAR+PLUS is the separate program for adults age 65 and older and for adults age 21 and older who have a qualifying physical or intellectual disability. A common question among Houston families is whether a parent over 65 who has not been formally diagnosed with a disability can still apply. The answer is yes — age 65 alone is a standalone qualifying criterion in Texas, provided the applicant meets income and asset thresholds and can demonstrate a functional need for long-term services and supports through HHSC's assessment process. Residents in Harris County, Fort Bend County, and the surrounding Greater Houston metro should be aware that STAR+PLUS enrollment is geographically structured, and verifying that your specific zip code falls within the Houston STAR+PLUS service area is the correct first step before initiating any application.

What STAR+PLUS actually pays for is broader than many Houston families expect. The program covers nursing facility care — meaning it does pay for placement in a licensed nursing home in Houston when a resident meets the nursing level of care criteria. It also covers home health services, personal attendant services (help with bathing, dressing, and meals), adult day care, and certain home modifications that allow seniors to age safely in place. For families exploring whether an assisted living community might be an intermediate step, our guide to What Is Assisted Living? explains how that care type differs from nursing facility placement and when STAR+PLUS may apply to each setting. Crucially, STAR+PLUS does not pay the state directly for these services — coverage is delivered entirely through a contracted Managed Care Organization. The MCO assigns a care coordinator, authorizes services, and manages the network of providers a member can use in the Houston area. This structure means the MCO you choose has direct, practical consequences for which doctors, facilities, and attendants you can access.

Financial Eligibility and the Documents Houston Applicants Must Gather First

The income limit for STAR+PLUS Medicaid in Texas is 300% of the SSI Federal Benefit Rate — approximately $2,829 per month for a single individual as of 2026, though applicants should always confirm the current figure directly with HHSC, as SSA adjusts the SSI FBR annually. A question that comes up frequently in Houston is what happens to income and assets when a married couple is involved. Texas Medicaid applies spousal impoverishment protections under federal Medicaid law, which means the community spouse — the partner who remains at home — is entitled to retain a Minimum Monthly Maintenance Needs Allowance (MMMNA) from the institutionalized spouse's income. The rules governing exactly how that allowance is calculated involve income and expense details specific to each household, and the numbers can shift depending on whether the community spouse has independent income. Married Houston couples navigating this calculation should work with a qualified benefits counselor or an elder law attorney familiar with Texas Medicaid rules before submitting an application, rather than estimating based on general guidance. The countable asset limit for the applicant is $2,000 — but not all assets are counted. Texas exempts the primary home (as long as the applicant or community spouse lives there or the applicant intends to return), one vehicle regardless of value, and up to $1,500 in designated burial funds. These exemptions matter enormously for Houston families with modest home equity and a paid-off vehicle.

Gathering the right documents before contacting HHSC is the single most controllable factor in preventing application delays for Houston applicants. Harris County HHSC offices do offer walk-in assistance, but arriving prepared shortens every subsequent step. The following checklist covers what Houston applicants should have in hand before initiating the process:

• Proof of age and identity — government-issued photo ID, birth certificate, or passport
• Social Security card — or documentation of Social Security number
• Proof of Texas residency — a utility bill, lease agreement, or bank statement showing a current Harris County address
• Income documentation — Social Security Administration award letters, pension benefit statements, annuity documentation, and any other income sources; bring the most recent documents available
• Bank statements for the last three months — for all checking, savings, and money market accounts; missing even one account is among the most common reasons Houston applications stall
• Documentation of exempt assets — property deed for the primary residence, vehicle title, and any pre-paid burial contract or designated burial account documentation showing the $1,500 or less in burial funds
• Documentation of any asset transfers in the past five years — HHSC applies a five-year look-back period; undocumented transfers of assets that appear to have been made to qualify for Medicaid can trigger a penalty period

Houston is one of the most linguistically diverse cities in the United States, and HHSC provides interpreter services for Spanish, Vietnamese, Arabic, Chinese, and other languages at no cost to applicants. This is a meaningful access point for Houston's large Spanish-speaking and Vietnamese-speaking senior populations — both groups are well-represented in Harris County's elderly population and should know that language is not a barrier to applying. HHSC Harris County offices are located throughout the metro, and staff can assist with in-person document review for applicants who are uncertain whether their paperwork is complete before a formal submission.

"The five-year look-back period catches Houston families off guard more than any other STAR+PLUS rule — a well-meaning gift of cash or a property transfer to an adult child can create a Medicaid penalty period that delays nursing facility coverage precisely when it is most urgently needed." — HSLG Editorial Team

The Houston Application Process: HCBS Track, Nursing Facility Track, and the Waitlist

STAR+PLUS in Texas operates on two distinct tracks, and which track applies to a Houston applicant determines the entire application path — including whether a waitlist is involved. The Home and Community-Based Services (HCBS) waiver track serves people who want to remain at home, in an assisted living setting, or in another community-based environment while receiving Medicaid-funded support — personal attendant services, home health, adult day care, and home modifications. This track has a limited number of available slots statewide, and Harris County applicants should expect to encounter a waitlist. Actual wait times in Harris County vary based on available waiver slots and can range from several months to well over a year. The single most important action for a Houston family pursuing this track is to get on the STAR+PLUS HCBS interest list immediately — not after completing financial eligibility paperwork, not after a hospitalization resolves, but now, because position on the interest list is time-stamped and does not advance while you wait to get organized. The Nursing Facility track, by contrast, has no waitlist. If a Houston applicant meets both financial eligibility and functional level-of-care criteria for nursing facility placement, HHSC processes the enrollment directly and the applicant can move to MCO selection without a holding period. For families weighing whether assisted living might be an appropriate intermediate step before or during a STAR+PLUS application, our comparison guide on Assisted Living vs. Nursing Home lays out how the two care settings differ clinically, financially, and in terms of Medicaid coverage.

How to Join the STAR+PLUS HCBS Interest List in Harris County

The entry point for Harris County residents who want to be added to the STAR+PLUS HCBS interest list is the 2-1-1 Texas helpline — a free, 24-hour service that serves as the statewide intake mechanism for the HCBS waitlist. Here is the process, step by step:

1. Call 2-1-1 from any phone in Texas (the call is free and available around the clock).
2. Tell the specialist that you want to be added to the STAR+PLUS Home and Community-Based Services interest list for Harris County.
3. Provide the following information: full legal name, date of birth, Harris County home address, and a reliable contact phone number.
4. Request and record the confirmation number you are given — this is your proof of interest list placement and its associated date-stamp.
5. Understand that placement on the interest list does not guarantee services. When a slot opens, HHSC will contact you to conduct both the financial eligibility review and a functional needs assessment. At that point, you must still qualify under both criteria.

Because the HCBS interest list can be long, Houston families in situations where nursing-level care may become necessary before a waiver slot opens should consider simultaneously initiating the Nursing Facility track application. The two tracks are not mutually exclusive in the planning phase — speaking with an HHSC caseworker or a nonprofit benefits counselor about running both processes in parallel is a reasonable approach for Houston seniors with rapidly progressing care needs. Organizations such as the Houston Area Agency on Aging can help families understand which track best fits the current clinical situation.

Choosing a STAR+PLUS MCO in Harris County: What Houston Families Need to Know

Once HHSC determines financial and functional eligibility, Houston applicants in Harris County select a Managed Care Organization — and this choice has direct, practical consequences for which doctors, facilities, and home care providers a member can access. The MCOs currently operating in the Houston STAR+PLUS service area include Molina Healthcare of Texas, Superior HealthPlan, and Wellpoint (formerly Anthem). Each MCO contracts with a different set of providers, and a member who chooses an MCO without verifying network details may find that their existing geriatrician, specialist, or preferred nursing home is out-of-network. Houston Senior Living Guide presents these MCOs for informational purposes only and does not recommend one over another — the right choice depends entirely on an individual family's provider relationships, geographic location within Harris County, and care coordination preferences.

Three Questions Every Houston Family Should Ask Each MCO Before Enrolling

Comparing MCOs requires asking the right questions, not just reading plan brochures. Before selecting a STAR+PLUS MCO in Harris County, families should contact each plan directly and get clear answers to the following:

• Does my current primary care physician or geriatrician participate in your network? — For Inner Loop Houston seniors in the 77000 zip code cluster, this question is especially significant given the density of Texas Medical Center-affiliated physicians in that area. A geriatrician affiliated with a major TMC health system may not participate in every MCO network.
• Which nursing homes and assisted living facilities near my Houston zip code are in-network? — If nursing facility placement or assisted living support is on the horizon, knowing which specific licensed facilities near the applicant's home participate in the MCO network is essential. The HHSC Long-Term Care Provider Search tool lets families verify whether a specific Houston-area facility holds current licensure, but MCO network participation requires a separate check directly with the plan.
• What is your care coordination model? — STAR+PLUS requires each MCO to provide a dedicated care coordinator. Ask whether coordinators are assigned by geographic area within Harris County, whether they specialize in geriatric care or LTSS, and what the typical caseload is per coordinator. A care coordinator managing a lighter caseload in a Houston suburb may be more responsive than one handling a large Inner Loop caseload — this is worth asking explicitly.

Members enrolled in STAR+PLUS are permitted to switch MCOs once per year outside of an open enrollment period if their needs change or if they are dissatisfied with their current plan. Houston families should document their reasons for any MCO switch and work through the HHSC enrollment process to ensure continuity of services during the transition. The STAR+PLUS program overview on Texas HHS includes current information on enrollment periods and the formal process for requesting an MCO change.

Assisted Living, Type A and Type B Licensing, and STAR+PLUS in Houston

Not every assisted living facility in Houston accepts STAR+PLUS members, and those that do must hold appropriate HHSC licensure. Texas licenses assisted living facilities as either Type A (for residents who do not require 24-hour supervision and could self-evacuate in an emergency) or Type B (for residents who need higher levels of support, including those who may be non-ambulatory or cognitively impaired). A STAR+PLUS member receiving HCBS waiver services can live in a licensed assisted living facility, but the facility must hold current HHSC licensure and must participate in the member's MCO network for waiver services to apply. Houston families researching this option can use the HHSC Long-Term Care Provider Search to verify a facility's licensure type and current standing. For a broader view of assisted living communities in Houston across Harris County and the surrounding suburbs, Houston Senior Living Guide's directory indexes licensed facilities by location, care type, and service profile. Families who are uncertain whether assisted living or a nursing home is the right setting for their loved one's level of need should also review our guide on Does Medicare Cover Assisted Living? — a parallel question that affects whether Medicare or Medicaid is the appropriate funding source at any given stage of care.

After Enrollment: What to Expect Once You Are in STAR+PLUS

Enrollment in STAR+PLUS is not the end of the process — it is the beginning of an ongoing managed care relationship that Houston families should actively engage rather than passively accept. Once a member is enrolled with an MCO, the MCO assigns a care coordinator who is responsible for developing a person-centered service plan. This plan documents the member's specific needs, authorizes the services the MCO will pay for, and identifies the providers who will deliver those services. For HCBS members living at home in Houston, the care coordinator typically conducts an in-home assessment to document functional limitations, safety risks, and the types of support needed — this is where home modification authorizations, personal attendant hours, and adult day care enrollment originate. Families should understand that the care coordinator works for the MCO, not for the member — and while many coordinators are skilled, experienced advocates, members and their family representatives have the right to request changes to the service plan if the initial assessment does not capture the full scope of the member's needs.

Houston families should treat the annual service plan review as an active advocacy opportunity, not a routine administrative step. A member's functional needs can change significantly over 12 months — particularly for Houston seniors managing progressive conditions such as dementia, Parkinson's disease, or post-stroke recovery. If a member's care needs increase between annual reviews, families can request an out-of-cycle reassessment by contacting the MCO care coordinator directly. Documenting changes in writing — through emails or letters to the care coordinator — creates a record that can support appeals if service authorizations are reduced or denied. Members have the right under Texas Medicaid rules to appeal MCO coverage decisions, and the Texas Health and Human Services Commission maintains a formal appeals and grievance process. The Texas Health and Human Services Commission (HHSC) website provides current information on member rights and the appeals process for STAR+PLUS enrollees in Harris County and across the state.

For Houston families with a loved one transitioning out of a hospital or rehabilitation stay, timing the STAR+PLUS enrollment process with the discharge plan is one of the most overlooked coordination challenges in Harris County. Hospital discharge planners and social workers at Houston-area medical centers — including those affiliated with the Texas Medical Center — are generally familiar with STAR+PLUS, but the family's role in accelerating the financial eligibility documentation process cannot be delegated entirely to a hospital staff member. If a STAR+PLUS application has not already been initiated before a hospitalization, the family should contact HHSC and 2-1-1 Texas simultaneously during the hospital stay to begin both the Nursing Facility track application and the HCBS interest list enrollment, depending on the likely discharge destination. Waiting until after discharge to begin the paperwork adds weeks to a process that is already measured in weeks under the best circumstances.

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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 — all verified against Texas HHSC licensing records and updated weekly. Our editorial team brings neighborhood-level expertise across 29 Houston suburbs and 8 Inner Loop communities, so families get guidance that reflects how care actually works in their corner of Harris County, not generic national advice. We exist to give Houston families the same quality of information that used to require hiring a private placement consultant.

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.