Medicaid Coverage for Assisted Living in Texas: Houston Guide

Independent. Local. Written for Houston families.

Medicaid coverage for assisted living in Texas is more nuanced than most families realize — and discovering that nuance while a parent is in crisis is the worst possible time. Texas Medicaid does not pay for room and board at an assisted living facility directly; instead, the STAR+PLUS waiver program can cover personal care and health-related services for eligible seniors who live in qualifying facilities. Houston-area families in Harris, Fort Bend, and Montgomery counties face a specific set of challenges: a sprawling, highly varied assisted living market, regional HHSC offices handling high application volumes, and waitlists that routinely stretch beyond a year. Understanding how these pieces fit together — before a care crisis forces the issue — is the most valuable thing a family can do. In this guide, the Houston Senior Living Guide team explores how Texas Medicaid works for assisted living, how to apply as a Houston-area resident, and what to do while you wait.

Key Takeaways

• STAR+PLUS covers services, not rent — The STAR+PLUS Managed Care program pays for personal care, nursing visits, therapies, and related health services at licensed Type A or Type B assisted living facilities in Texas; it does not cover room and board.
• Income and asset limits are strict — The income limit for Texas Medicaid for seniors is 300% of the Supplemental Security Income (SSI) standard (approximately $2,742/month for a single applicant as of 2026); assets must be under $2,000 for a single applicant.
• Waitlists are long — apply early and apply broadly — STAR+PLUS and Home and Community-Based Services (HCBS) waiver slots in Harris County, Fort Bend County, and Montgomery County are limited; families routinely wait 12 to 24 months or more.
• Your first concrete step is a Level of Care assessment — Houston-area families should contact their regional Texas Health and Human Services (HHSC) office and request a Level of Care (LOC) assessment in Harris County to formally establish functional need and begin the eligibility process.

How STAR+PLUS Works for Houston Seniors in Assisted Living

Texas Medicaid's STAR+PLUS Managed Care program is the primary — and in most cases, the only — Medicaid pathway available to seniors living in an assisted living facility in Texas. The program is administered through managed care organizations (MCOs) contracted with HHSC, and it covers a meaningful range of personal care and health-related services. What it does not cover is equally important to understand: STAR+PLUS will not pay your parent's rent, meals, or utility share at an assisted living community. Those costs remain the responsibility of the resident, typically funded through Social Security income, a pension, personal savings, long-term care insurance, or a combination. Families near the Texas Medical Center corridor — covering the Medical Center, Greenway Plaza, and Midtown areas — often find access to STAR+PLUS-enrolled facilities with higher clinical staffing ratios, which matters significantly for seniors with complex or medically fragile care needs.

A second structural reality families must grasp is that only Texas-licensed Type A and Type B assisted living facilities — as defined and regulated by HHSC — are eligible to enroll as STAR+PLUS providers and bill for covered services. Type C facilities (dedicated memory care) and unlicensed board-and-care or personal care homes generally cannot participate in STAR+PLUS billing. This distinction is missing from most national Medicaid guides and creates real confusion for Houston families who assume any assisted living facility will accept Medicaid. Before touring a community, verify its license type using the HHSC Provider Search portal, and confirm separately that the facility is enrolled as an active STAR+PLUS provider. For a plain-English explanation of facility types and care levels, see our What Is Assisted Living? guide.

What STAR+PLUS Covers in an Assisted Living Setting

• Personal care services — bathing, dressing, grooming, and mobility assistance
• Nursing supervision and skilled nursing visits — medication management, wound care, health monitoring
• Physical, occupational, and speech therapies — when medically necessary
• Durable medical equipment and medical supplies — wheelchairs, incontinence supplies, and similar items
• Transportation to medical appointments — non-emergency medical transport coordinated through the MCO
• Behavioral health services — counseling and psychiatric support for eligible enrollees

"The single most common mistake Houston families make is assuming that because a facility accepts Medicaid residents, it is actively enrolled in STAR+PLUS — those are two different things. Always verify enrollment status in the HHSC TULIP portal before signing a contract." — HSLG Editorial Team

Applying for Texas Medicaid in Harris County: A Step-by-Step Overview

Navigating the Texas Medicaid application process requires moving through several sequential steps, each managed by different parts of the HHSC system. The process is not fast — families who start the application the day a parent moves into assisted living are already behind. Understanding the pipeline helps Houston-area families plan months, not weeks, in advance. For context on what Houston-area assisted living actually costs and how Medicaid fits into the overall budget, see our Assisted Living Cost in Houston guide; for how Medicare interacts with this process, see Does Medicare Cover Assisted Living?

The Five-Step Application Process

1. Confirm financial eligibility. A single applicant must have monthly income at or below 300% of the federal SSI standard (approximately $2,742/month as of 2026) and countable assets below $2,000. Married applicants have additional protections: the Community Spouse Resource Allowance (CSRA) lets the at-home spouse retain a portion of the couple's assets, and the Minimum Monthly Maintenance Needs Allowance (MMMNA) protects a portion of income for the community spouse. For seniors whose income exceeds the cap, a Qualified Income Trust (Miller Trust) — a Texas-specific legal instrument — can redirect excess income to establish eligibility. Because these rules are complex and state-specific, consult a Houston-area elder law attorney before attempting spend-down planning. This guide provides information, not legal advice.
2. Submit a Medicaid application. Applications can be submitted online through YourTexasBenefits.com or in person at a Harris County HHSC benefits office. Fort Bend and Montgomery County residents submit through their respective regional HHSC offices. The application establishes the household's financial eligibility for Medicaid broadly; STAR+PLUS enrollment is a separate step that follows.
3. Request a Level of Care (LOC) assessment. Once a Medicaid application is active, request an LOC assessment through HHSC. An assessor visits the senior to evaluate functional limitations and care needs. The LOC score determines eligibility for the STAR+PLUS waiver or HCBS waiver services in an assisted living setting — and it is required before a waiver slot can be assigned.
4. Get placed on the interest list. After LOC assessment, HHSC places eligible individuals on the STAR+PLUS or HCBS waiver interest list. In Harris County and neighboring Fort Bend and Montgomery counties, these lists are not short. Families should request interest list placement immediately and confirm the placement in writing.
5. Identify enrolled facilities while waiting. Use the HHSC Provider Search portal to locate Type A and Type B assisted living facilities in the Houston area that are actively enrolled STAR+PLUS providers. Tour those facilities, understand their private-pay rates for room and board, and communicate openly about your Medicaid timeline.

A Note on Dual-Eligible Seniors

Seniors who qualify for both Medicare and Medicaid are called dual eligibles, and their benefits coordination under STAR+PLUS managed care is meaningfully different from Medicaid-only enrollment. Medicare pays first for any Medicare-covered service; the STAR+PLUS managed care plan then coordinates to cover remaining costs and fill gaps — including services Medicare does not cover, such as personal care assistance. Medicare Savings Programs can also help pay Medicare Part B premiums and cost-sharing, reducing out-of-pocket expenses further. If your parent holds both Medicare and Medicaid, contact HHSC or a local State Health Insurance Assistance Program (SHIP/Texas HICAP) counselor for a personalized benefits review before selecting a managed care plan.

Houston Waitlist Realities and Finding Medicaid-Accepting Facilities

There is no sugarcoating the waitlist situation in Greater Houston: STAR+PLUS and HCBS waiver slots are rationed by the Texas Legislature, and HHSC does not publish a real-time waitlist count for Harris County or its neighboring counties. What families and elder law attorneys in the Houston area consistently report is that waits of 12 to 24 months or longer are the norm, not the exception. Fort Bend County and Montgomery County families face similar timelines and must apply through their own regional HHSC offices rather than Harris County. The practical implication is stark: a family that begins the process only after a parent has moved into assisted living may be paying entirely out-of-pocket for well over a year before a waiver slot activates. Getting on the interest list the moment a senior appears to be approaching Medicaid eligibility thresholds — even before a specific facility is selected — is the single most impactful timing decision a family can make.

Houston's senior population brings additional local variables that affect facility selection beyond Medicaid enrollment status. Texas heat safety is a genuine quality-of-care issue: summer temperatures in Houston regularly exceed 100°F with high humidity, and a facility's cooling infrastructure, outdoor safety protocols, and heat emergency procedures should factor into any evaluation. Hurricane preparedness is equally non-negotiable. Under HHSC licensing rules, Type A and Type B facilities have different evacuation requirements: Type A facilities serve residents who can evacuate without assistance, while Type B facilities must maintain more robust evacuation plans for residents who need help. Understanding which license a facility holds tells families something real about its emergency readiness. For a deeper look at what to ask during facility tours, see our Hurricane Preparedness for Senior Families guide.

Three Strategies to Run Simultaneously

• Get on the STAR+PLUS interest list now — Do not wait until a facility is chosen or a move-in date is set. Contact your regional HHSC office, complete the LOC assessment, and request interest list placement. The clock does not start until you do.
• Use the HHSC TULIP portal to identify enrolled providers — The HHSC Provider Search portal lets families filter by county, license type, and STAR+PLUS enrollment status. Houston's 29 suburbs each have varying concentrations of enrolled Type A and Type B facilities — areas like Katy, Sugar Land, and The Woodlands have grown their senior living markets considerably in recent years. Browse assisted living communities in Houston, senior living in Katy, senior living in Sugar Land, and senior living in The Woodlands to get a geographic lay of the land.
• Consider residential care homes as a bridge option — While waiting for a STAR+PLUS waiver slot, some families use smaller residential care homes in Houston as a lower-cost interim setting. While most residential care homes cannot bill STAR+PLUS directly, monthly costs are often significantly lower than large assisted living communities, which can preserve assets during a long waiver wait.

Start Your Search on Houston Senior Living Guide

You found this article through a search — and that is exactly how Houston Senior Living Guide is designed to work. We are the largest free, independent senior care directory in Greater Houston, with more than 1,500 licensed facilities indexed across Harris, Fort Bend, Montgomery, Galveston, and Brazoria counties. Unlike national listing sites that scrape outdated data and sell your contact information, every facility in our directory is verified against Texas HHSC licensing records and updated weekly.

Here is how families use the Guide:

• Browse by area — We cover 29 suburbs and 8 Inner Loop neighborhoods, each with facility counts, care types, and local context. Start with assisted living in Houston or jump straight to a specific area like Katy or Sugar Land.
• Compare care types — Not sure whether your family needs assisted living, memory care, or a residential care home? Our Learning Hub breaks down the differences in plain English.
• Talk to our AI Senior Care Guide — Houston Senior Living Guide is the only local directory with a built-in AI Senior Care Guide trained on Houston-area facility data, Texas HHSC licensing records, and neighborhood-level detail. Describe your family's situation in a few sentences and get a personalized assessment — not a generic chatbot response.

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Why Houston Senior Living Guide

Houston Senior Living Guide is the largest free, independent senior care directory serving Greater Houston, with more than 1,500 licensed facilities indexed across Harris, Fort Bend, Montgomery, Galveston, and Brazoria counties. Our data is sourced directly from HHSC licensing records and updated weekly — so the facility information families rely on reflects current operational and enrollment status, not stale national aggregator data. With dedicated pages for 29 suburbs, 8 Inner Loop neighborhoods, and a Learning Hub built around Texas-specific regulations, we provide the county-level and neighborhood-level detail that national platforms simply cannot replicate.

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.