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
STAR+PLUS allows disabled adults and elderly Texans, aged 65 or older, who require a nursing facility level of care to reside at home, adult foster care, or in assisted living residences and receive care services in those locations. Under this Medicaid waiver, both medical care and non-medical long term care services are covered. Benefits such as personal care, adult day care, assistance for home modifications, and personal emergency response systems are available. Some of these services are permitted as “Consumer Directed Services,” meaning the participant can choose his/her own personal caregiver. Friends and some family members are eligible to be hired as caregivers.
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. In September 2014, the STAR+PLUS waiver replaced the Community Based Alternatives (CBA) Waiver, and all former CBA waiver participants have completed a transition to STAR+PLUS. Managed Medicaid under STAR+PLUS did not replace two other Texas Medicaid waivers. The Primary Home Care Program and Day Activity and Health Services Program continue to help resource-constrained seniors throughout the state.
Enabled by the Affordable Care Act, in 2015, Texas began offering the Community First Choice option. Elderly residents should also investigate this program for long term care benefits without waiting times.
Eligibility Guidelines
The STAR+PLUS Waiver has financial and general restrictions.
General Requirements
Candidates must have a need for care services typically provided in nursing homes. This means they are unable to manage their activities of daily living without significant assistance or they require full time medical supervision. A more formal definition of nursing home level of care is available here. All candidates require an assessment of their needs.
Financial Requirements
Income Limits
The following is relevant for Texas residents age 65 or older in 2022. The monthly income limit for a single applicant to be eligible for STAR+PLUS from Texas Medicaid is $2,523. Calculated annually, applicants must earn less than $30,276.
For married applicants, the limits depend on whether both spouses are seeking Medicaid assistance. If the applicant is married and his/her spouse is not applying for Medicaid, the non-applicant spouse’s income is not considered for eligibility. In addition, the applicant spouse can transfer monthly income up to $3,435 to his or her non-applying spouse. This is known as a “needs allowance.” It both ensures the non-applicant has sufficient monthly income and effectively lowers the applicant spouse’s countable income for eligibility purposes.
When both spouses are applying, they are allowed a combined monthly income of $5,046.
Asset Limits
Divorced, widowed or otherwise single applicants are allowed “countable assets” valued up to $2,000. However, many assets are exempt, including one’s home (provided the value of one’s home equity is less than $636,000 and the applicant or his/ her spouse lives in the home). Also, in these circumstances, the non-applicant spouse can have investments, retirement accounts, and savings valued up to $137,400. This is known as a community spouse resource allowance.
Due to the complications, it is recommended that individuals consult with a Medicaid eligibility expert to ensure the non-applicant spouse receives the maximum funds permitted under the law.
Benefits and Services
STAR+PLUS allows family members to be hired to provide personal care. Spouses, however, are excluded.
Under STAR+PLUS, traditional health care and long-term care support are integrated. Accordingly, in addition to service coordination, the program helps pay for a broad range of medical and care services, including:
- Adult Day Care / Adult Day Health
- Adult Foster Care
- Assisted Living
- Delivered Meals
- Environmental Adaptive Aids
- Home Modifications
- Home Care
- Medical Care / Medical Supplies
- Nursing Services
- Personal Care (assistance with the activities of daily living) – can be self-directed. Read more.
- Physical Therapy / Occupational Therapy / Speech Therapy
- Personal Emergency Response Service
- Respite Care
- Transitional Services
How to Apply / Learn More
The STAR+PLUS program is available statewide. One can learn more about this program on the STAR+PLUS website or by contacting your local Area Agency on Aging. To apply for this Waiver or Texas Medicaid (if not already enrolled), one should visit the Your Texas Benefits website.
A wait list for STAR+PLUS may exist, specifically for services provided at-home. Waiting times can be as long as a year and current nursing home Medicaid participants are prioritized over at-home applicants. If your loved one is in a Medicaid-funded nursing home on Medicaid and wants to return home or move to assisted living, you should contact a STAR+PLUS caseworker to discuss the options.
