Texas' STAR+PLUS Medicaid Waiver

Page Reviewed / Updated - Mar. 2014

What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through "Medicaid Waivers" which are also called Home and Community Based Services (HCBS Waivers) or Waiver Funded Services.

Waiver Description

This waiver allows elderly Texans, aged 65 or older, that require a nursing facility level of care, to reside at home or in assisted living residences and receive care services in those locations.   Under STAR+PLUS, both medical care and non-medical long term care services as covered.   STAR+PLU differs from other Texas Medicaid programs in that the 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 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.

 

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 2014 are as follows: an individual can have up to $2,163 / 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 $117,240 and monthly income up to $2,931.  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 just over the limits might consider putting their additional funds into pooled income trusts or irrevocable funeral trusts.  Be aware that both these financial vehicles may require assistance in their creation.  Read more about Medicaid planning.  

 

Benefits and Services

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:

  • Adult Day Care
  • Assisted Living
  • Delivered Meals
  • Environmental Adaptive Aids
  • Home Modifications
  • Home Care
  • Medical Care
  • Personal Care (assistance with the activities of daily living)
  • Personal Emergency Response Service
  • Respite Care

 

How to Apply / Learn More

The STAR+PLUS program is not available statewide however its service area is continuing to expand.  A list of current participating counties is below. One can also see a map of which Texas counties are currently participating. One can learn more about the program on the STAR+PLUS website.

Aransas
Atascosa
Austin
Bandera
Bastrop
Bee
Bexar
Brazoria
Brooks
Burnet
Caldwell
Calhoun
Cameron
Carson
Chambers
Collin
Comal
Crosby
Dallas
Deaf Smith
Denton
Duval
El Paso
Ellis
Fayette
Floyd
Fort Bend
Galveston
Garza
Goliad
  Guadalupe
Hale
Hardin
Harris
Hays
Hidalgo
Hockley
Hood
Hudspeth
Hunt
Hutchinson
Jasper
Jefferson
Jim Hogg
Jim Wells
Johnson
Karnes
Kaufman
Kendall
Kenedy
Kleberg
Lamb
Lee
Liberty
Live Oak
Lubbock
Lynn
Matagorda
Maverick
McMullen
  Medina
Montgomery
Navarro
Newton
Nueces
Orange
Parker
Polk
Potter
Randall
Refugio
Rockwall
San Jacinto
San Patricio
Starr
Swisher
Tarrant
Terry
Travis
Tyler
Victoria
Walker
Waller
Webb
Wharton
Willacy
Williamson
Wilson
Wise
Zapata