Texas' STAR+PLUS Medicaid Waiver
Page Reviewed / Updated - Mar. 2016
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+PLUS 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.
As of September 2014, the STAR+PLUS waiver has replaced the Community Based Alternatives Waiver and all former CBA waiver participants have completed a transition to STAR+PLUS. Two other Texas Medicaid waivers were not replaced by Managed Medicaid under STAR+PLUS. The Primary Home Care Program and Day Activity and Health Services Program continue to help resource-constrained seniors throughout the state.
Eligibility Guidelines
The STAR+PLUS Waiver has financial and functional restrictions. From a functional perspective, candidates must have a need for care services typically provided in nursing homes. Aged Texas residents must meet the income and assets levels for Texas Medicaid.
The Texas Medicaid thresholds for 2016 are as follows: an individual can have up to $2,199 per month in income and $2,000 in assets. The state permits applicants to not include the value of their home or primary vehicle.
Additionally, if the applicant is married and their spouse is not 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 and savings valued up to $119,220 and monthly income up to a maximum of $2,980.50. This split spouse circumstance makes the Medicaid application complicated. It is recommended that individuals consult with a Medicaid eligibility expert to ensure the non-applicant spouse will have adequate means 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. Accordingly, the program helps pay for a broad range of medical and care services, including:
- Adult Day Care
- Adult Foster 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 available statewide. One can learn more about the program on the STAR+PLUS website and apply for the waiver through your local Area Agency on Aging. Search for your local AAA now.
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