Texas' STAR+PLUS Medicaid Waiver
What are Medicaid Waivers?
Medicaid pays for long term care services in nursing homes. For nursing home qualified persons that choose to live at home or in a residential community, Medicaid will pay for those services if they can be obtained at a lower cost. These are called Home and Community Based Services, Waiver Funded Services, Medicaid Waivers or simply Waivers.
STAR+PLUS Waiver Overview
This waiver allows elderly persons, aged 65 or older, and require a nursing facility level of care, to reside at home or in assisted living residences and receive care services in those locations. This differs from other Medicaid programs in that services are provided by managed care organizations (MCO). There are specific MCOs in each county and participants are given the choice to select their preferred provider.
The STAR+PLUS waiver is offered in certain areas of Texas as an alternative to the Community Based Alternatives
(CBA) Waiver. However, unlike the CDA Waiver, STAR+PLUS does not offer individuals the option of self-directing their own care.
Other programs in Texas that may be relevant to the reader include the Community Attendant Services Program
, Primary Home Care Program
and Day Activity and Health Services Program
STAR+PLUS Waiver Eligibility Guidelines
The STAR+PLUS Waiver has financial, functional and geographic restrictions. From a functional perspective, candidates must have a need for care services typically provided in nursing homes. Geographically, they must reside in one of the counties in which the program is offered and financially they must meet the income and assets levels for Texas Medicaid.
The Texas Medicaid thresholds for 2013 are as follows: an individual can have up to $2,130 / month in income and $2,000 in assets, which does not include their home or primary vehicle. However, if the individual is married and their spouse is not also applying for Medicaid, these amounts go up considerably with the objective of enabling the healthy spouse to continue living on their own. In these circumstances, the spouse can have assets valued at approximately $115,920.
This split spouse circumstance makes the Medicaid application complicated. It is recommended that individuals consult with a Medicaid eligibility expert
to ensure the spouse will have adequate resources on which to live.
Since Texas has extremely rigid eligibility guidelines, persons with income or assets over the limits might consider putting their additional funds into pooled income trusts
or irrevocable funeral trusts
. However, be aware while both these financial vehicles help persons qualify for Medicaid, it may be necessary to get planning assistance
to create them.
Services Provided under the STAR+PLUS Waiver
Under STAR+PLUS traditional health care and long-term care support are integrated and accordingly a broad range of services can be paid for including:
-Personal Care (assistance with the activities of daily living)
-Environmental Adaptive Aids
-Adult Day Care
Program Availability / How to Apply
Use our Locator Tool to Find Other Options for which You're Eligible
Page Reviewed / Updated - Feb. 2013