How STAR+PLUS Medicaid Covers Assisted Living in Houston, TX

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Navigating how STAR+PLUS Medicaid covers assisted living in Houston, TX, can feel like a complex puzzle for families trying to secure quality care for a loved one. Many Houston-area seniors and their adult children are unsure what this critical Texas Medicaid program actually pays for in an assisted living community versus a traditional nursing facility. The distinction is crucial: STAR+PLUS is a managed care program designed to fund home and community-based services (HCBS), which are the supportive care services a resident receives. It does not, however, cover the cost of room and board. Understanding this difference is the most important step for Houston families making long-term care decisions. In this guide, the Houston Senior Living Guide team explores how STAR+PLUS Medicaid covers assisted living in Houston, which Harris County managed care organizations administer the benefit, and what families can expect to pay out of pocket.

The STAR+PLUS program covers essential personal care, skilled nursing visits, therapies, and other supportive services delivered inside a licensed assisted living facility. However, it does not pay for the monthly cost of room and board. With average assisted living costs in the Houston metro area ranging from $3,500 to $5,500 per month according to the Genworth 2024 Cost of Care Survey, most STAR+PLUS beneficiaries must bridge a significant out-of-pocket gap. Families typically cover this gap using the resident's Social Security or SSI income, personal savings, or veteran's benefits like Aid and Attendance.

Key Takeaways

STAR+PLUS funds services, not rent. The program covers Home and Community-Based Services (HCBS) like personal care and medication management within a facility but explicitly excludes room-and-board costs.
Enrollment is through a Managed Care Organization (MCO). Harris County residents must enroll in a STAR+PLUS MCO to receive benefits. The current MCOs serving Houston are Molina Healthcare, Superior HealthPlan, Community Health Choice, and UnitedHealthcare Community Plan.
A significant cost gap exists. With median assisted living in Houston costs creating a monthly gap of $2,000 to $4,500, families must plan for substantial out-of-pocket expenses.
Only licensed ALFs can participate. Only Type A and Type B assisted living facilities licensed by the Texas Health and Human Services Commission (HHSC) are eligible to contract with STAR+PLUS MCOs to provide services.

Q: Does STAR+PLUS cover room and board at assisted living facilities in Houston?

No, STAR+PLUS does not pay for room and board at any Texas assisted living facility. Federal Medicaid rules prohibit using funds for these costs, so the program only covers personal care services. Houston families must pay for room and board out-of-pocket, which is why the significant cost gap exists.

Q: What is the difference between a Type A and Type B assisted living facility?

The distinction is based on a resident's ability to safely evacuate during an emergency. Type A facilities are for residents who are physically and mentally capable of evacuating on their own. Type B facilities are licensed to care for residents who may require staff assistance to get out safely, representing a higher level of care.

What STAR+PLUS Actually Covers — and What It Doesn't

STAR+PLUS is a Texas Medicaid managed care program that combines acute medical care (like doctor visits and hospital stays) with long-term services and supports (LTSS) for adults who are aged, blind, or have a disability. The LTSS component is delivered through an HCBS waiver, which allows Medicaid to pay for care in community settings like an assisted living facility, preventing or delaying placement in a more costly nursing home. This is a critical distinction, as federal Medicaid law prohibits the use of funds for room and board in assisted living, a rule that does not apply to nursing facilities.

The services STAR+PLUS covers are focused on daily living and health maintenance. While the exact service plan is tailored to the individual's assessed needs, covered HCBS supports typically include:

Personal Attendant Services (PAS): Hands-on help with activities of daily living (ADLs) such as bathing, dressing, grooming, and mobility.
Skilled Nursing Visits: Intermittent nursing care provided by a registered nurse (RN) or licensed vocational nurse (LVN), such as wound care or medication administration.
Therapy Services: Physical, occupational, and speech therapy to help residents maintain or regain function.
Medication Management: Assistance with ordering, storing, and taking medications as prescribed.
Emergency Response Services: A personal emergency response system (PERS) that allows residents to call for help 24/7.
Care Coordination: A service coordinator from the MCO who helps manage the resident's care plan and connect them with necessary resources.

For a Houston-area facility to receive payments for these services on behalf of a resident, it must be licensed by the Texas Health and Human Services Commission (HHSC) as either a Type A or Type B facility. Families can verify a community’s license status and review inspection reports through the official HHSC Provider Search (TULIP) portal.

Harris County MCOs: Which Plans Serve Houston ZIP Codes

To access STAR+PLUS benefits in Houston, an eligible senior must enroll with one of the Managed Care Organizations contracted with the state to serve Harris County. The choice of MCO is important because it determines which assisted living facilities are in-network, the specific processes for care authorization, and the quality of the care coordination team assigned to your loved one. As of 2025, the four STAR+PLUS MCOs serving Harris County are:

Molina Healthcare of Texas
Superior HealthPlan
Community Health Choice
UnitedHealthcare Community Plan

Families can compare these plans and find member services contact information on the state's managed care enrollment portal. When selecting a plan, it's wise to ask which assisted living communities in your desired Houston neighborhood are already contracted with that MCO. Proximity to the Texas Medical Center means that some MCOs have robust care coordination networks specifically for medically complex seniors who require frequent specialist appointments. It is crucial to actively compare plans during the STAR+PLUS enrollment period rather than defaulting to the plan that is auto-assigned by the state.

It's also important to note that the available plan mix can vary by county. While these four MCOs serve Harris County, a senior living in Fort Bend County or Montgomery County may have a slightly different set of options. Always verify the MCOs serving your specific ZIP code during the enrollment process outlined by the Texas HHS STAR+PLUS program.

Q: Does STAR+PLUS cover the full cost of assisted living in Houston?

No, STAR+PLUS does not cover the cost of room and board in a Houston assisted living facility. The program pays for the *care services* a resident receives, such as help with daily activities, but the resident is responsible for paying the facility's monthly rent. This is a crucial distinction for families to understand when budgeting for care.

Q: How long does it take to get approved for STAR+PLUS in the Houston area?

The approval process for STAR+PLUS in the Houston area typically takes between 45 and 90 days from the date you submit a complete application. This timeline can be affected by the complexity of your financial situation and the speed of documentation submission. It is highly recommended to begin the application process well in advance of an anticipated move.

Q: What is the income limit for STAR+PLUS assisted living benefits in Texas?

The income limit for STAR+PLUS institutional care, which includes assisted living services, is tied to federal guidelines and changes annually. For 2024, the individual income limit is $2,829 per month, but you should always verify the current income and asset limits with Texas Health and Human Services when applying, as specific circumstances can affect eligibility.

Step-by-Step: How Houston Residents Enroll in STAR+PLUS for Assisted Living

The enrollment process for STAR+PLUS in the Houston area involves several distinct steps coordinated between state agencies and the MCOs. For families new to the system, it can seem daunting, but it follows a logical sequence designed to confirm both financial and functional eligibility. The primary intake point for new applicants in the Houston metro is 2-1-1 Texas, which serves as a centralized referral line for state health and human services.

Here is the typical enrollment sequence for a Houston-area resident:

Confirm Medicaid Eligibility: The first step is to establish financial eligibility for Texas Medicaid. This is done by applying through the state's Your Texas Benefits portal or by visiting a local Harris County HHSC office. The application requires detailed information about income and assets.
Initiate a Functional Needs Assessment: Once financial eligibility is confirmed, contact the Harris County HHSC office or call 2-1-1 Texas to request a functional assessment for long-term care services. This signals your intent to use the STAR+PLUS HCBS waiver.
Complete the Level of Care (LOC) Evaluation: HHSC will schedule an in-person assessment with a nurse or social worker to determine if the applicant meets the medical necessity criteria for an institutional level of care (i.e., they would otherwise qualify for a nursing home). This evaluation is what qualifies them for the HCBS waiver.
Select a Managed Care Organization (MCO): After the LOC is approved, the applicant will receive a packet to choose one of the MCOs serving Harris County. If a choice is not made within the specified timeframe, one will be assigned.
Identify a Participating Assisted Living Facility: Work directly with your MCO's care coordinator. They will provide a list of STAR+PLUS-participating Type A or Type B licensed assisted living facilities in the Houston area and help facilitate the placement process.
Transition and Begin Services: Once a facility is chosen and a move-in date is set, the MCO care coordinator will finalize the service plan, which authorizes the facility to begin providing and billing for the covered HCBS supports.

Applicants who are already residing in a nursing facility and wish to transition to an assisted living community have a specific "Money Follows the Person" pathway designed to streamline this process. Their nursing home social worker and MCO care coordinator are the best resources for navigating this transition.

The Houston Cost Gap: What STAR+PLUS Doesn't Pay and How Families Bridge It

The most significant challenge for Houston families using STAR+PLUS for assisted living is the room-and-board cost gap. As Genworth's 2024 data shows, with median monthly costs in the Houston metro area falling between $3,500 and $5,500, the portion not covered by STAR+PLUS is substantial. After the program pays for the HCBS services, the resident is still responsible for a monthly bill of roughly $2,000 to $4,500. This financial reality makes it critical for families to have a clear plan for covering these expenses.

Unlike some other states, Texas does not offer a state supplemental payment to help low-income seniors cover room-and-board costs in assisted living. This makes the out-of-pocket burden particularly acute for Houston-area seniors who rely solely on SSI. Families typically use a combination of strategies to bridge this gap:

SSI/Social Security Income: The resident's monthly federal benefits (up to $943/month for an individual on SSI in 2025) are almost always applied directly to the room-and-board cost.
Veteran's Benefits: Eligible veterans and their surviving spouses may qualify for the VA's Aid and Attendance pension, which can provide over $2,000 per month to help pay for long-term care.
Personal Savings or Pensions: Any remaining retirement funds, pensions, or savings are used to cover the costs.
Family Contributions: It is common for adult children to pool resources to help cover the monthly shortfall for a parent's care.

Families should also be aware that costs can vary significantly across the Houston metro. For example, assisted living communities in affluent suburbs like Sugar Land and The Woodlands often have higher monthly rates than the median, widening the payment gap. Our guide on how to pay for assisted living in Texas offers more detailed strategies, and our directory can help you find options like a STAR+PLUS-participating community in Sugar Land that may fit your budget.

Q: How does STAR+PLUS assisted living compare to private pay options in Houston?

STAR+PLUS is a Medicaid waiver program that covers the cost of care services, but not room and board, significantly reducing the resident's out-of-pocket expenses. Private pay covers all costs and offers a much wider selection of communities, as many Houston-area facilities do not participate in STAR+PLUS. Your choice depends on balancing your budget against the number of available community options.

Q: Does STAR+PLUS cover the full cost of assisted living, including room and board?

No, this is a critical distinction for financial planning. The STAR+PLUS program only pays for the cost of personal care services, such as assistance with bathing, dressing, and medication management. The resident remains responsible for paying the facility's monthly room and board fee, typically using their Social Security or other income.

Q: Should I choose a Houston facility that accepts STAR+PLUS or one that only accepts Long-Term Care Insurance?

This decision depends entirely on your financial situation and eligibility. If you qualify for Medicaid, a STAR+PLUS facility is your most affordable path, though your choices will be limited. If you have a Long-Term Care Insurance policy, you will have a broader selection of communities, but you must ensure your policy's benefits cover the facility's costs and meet its specific requirements.

Finding STAR+PLUS-Participating ALFs in Houston: What to Look For

A common hurdle for families is identifying which of the hundreds of assisted living facilities in the Houston area actually accept STAR+PLUS. Participation is voluntary, so it's essential to verify this directly with both the facility's admissions director and your MCO care coordinator before proceeding. The first step is often to use the HHSC Provider Search to confirm a facility holds a current Type A or Type B license, which is a prerequisite for participation. Harris County has the highest concentration of licensed ALFs in Texas, with options ranging from small, residential care homes in neighborhoods like Sharpstown and Greenspoint to larger, resort-style communities in suburbs like the Katy senior living options.

When evaluating STAR+PLUS-eligible communities in Houston, there are two critical, location-specific factors to consider. First is hurricane preparedness. Given Houston's history with hurricanes and flooding, HHSC regulations require Type B facilities—which serve residents who may need evacuation assistance—to maintain and file detailed emergency evacuation plans. Ask to see this plan. Second is heat safety. Texas summers are brutal, and state regulations mandate that all assisted living facilities maintain functional air conditioning. This is a non-negotiable safety requirement.

As you tour and evaluate potential communities, use this checklist to guide your questions:

STAR+PLUS Contract: Do you have a current, active contract with my loved one's MCO (e.g., Molina, Superior, etc.)?
License Type: Are you licensed as a Type A or Type B facility? Can I see your latest HHSC inspection report?
Cost Breakdown: Can you provide a clear, written breakdown of the monthly room-and-board rate and any other fees not covered by STAR+PLUS?
Care Coordination: How does your staff work with the MCO care coordinator to manage resident care plans?
Emergency Plans: Can you walk me through your hurricane evacuation and emergency preparedness plans?

The Houston Senior Living Guide directory is a practical starting point, allowing you to filter by care type and location to begin building your list of potential communities to investigate further.

Why Houston Senior Living Guide

Houston Senior Living Guide is the largest free directory of senior care in the Greater Houston metro, with more than 1,500 licensed facilities indexed across Harris, Fort Bend, Montgomery, Galveston, and Brazoria counties. Our directory data is sourced directly from the Texas Health and Human Services Commission (HHSC) and updated regularly, so families are working from verified information rather than outdated national aggregates. We combine that data infrastructure with genuine neighborhood-level expertise — the kind of local context that national senior care websites simply cannot replicate. Whether a family is navigating the Inner Loop or evaluating options in a fast-growing suburb, Houston Senior Living Guide exists to make that search more informed and less overwhelming.

Q: What's the difference between a Type A and Type B assisted living license in Texas, and how does that affect my search in Houston?

A Type A facility is for residents who can evacuate on their own, while a Type B facility is for residents who need staff assistance. Both types can accept STAR+PLUS, but Type B facilities in the Houston area must meet stricter state requirements for hurricane evacuation plans. This is a critical safety consideration when choosing a community for a loved one with mobility challenges.

Q: I've found a few Houston assisted living facilities that accept STAR+PLUS. Does the program cover the full cost, including room and board?

No, the STAR+PLUS Home and Community Based Services (HCBS) waiver does not cover room and board costs. The waiver pays for care services, while the resident is responsible for the room and board portion, typically using their Social Security or other income. Always ask each community about their specific room and board fees for Medicaid residents.

Q: I think my parent qualifies for STAR+PLUS. What's the first step to start the application process for assisted living?

The first step is to apply for Texas Medicaid benefits and then contact the STAR+PLUS support line to request a functional assessment for long-term services. Once approved, a service coordinator will help you choose a participating assisted living facility that meets your loved one's needs. You can begin this process by calling 2-1-1 or visiting the Your Texas Benefits website.

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.