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Texas Senior Care Costs in 2026: STAR+PLUS HCBS Assisted Living Guide

Published 2026-02-27

A source-backed Texas guide to STAR+PLUS HCBS eligibility, the interest list and upgrade paths, MCO assessment, individual service plans, assisted-living services, room and board, licensing, and complaints.

Texas delivers Medicaid community long-term services through STAR+PLUS managed care. For assisted living, the meaningful cost record is the member’s individual service plan plus the facility’s room-and-board agreement—not a statewide private-pay average. Access also differs depending on whether the person is on the interest list, already enrolled in STAR+PLUS, or transitioning from a nursing facility.

STAR+PLUS HCBS eligibility

Texas’s current STAR+PLUS HCBS eligibility handbook lists the program conditions. The applicant must:

  • be age 21 or older;
  • be a Texas resident and meet citizenship requirements;
  • have full Medicaid financial eligibility;
  • meet nursing-facility medical-necessity and level-of-care criteria;
  • have an unmet need for at least one STAR+PLUS HCBS service;
  • have an individual service plan within the program cost limit;
  • live in an appropriate community arrangement; and
  • not be enrolled in another Medicaid HCBS waiver at the same time.

These decisions involve both HHSC and the person’s managed-care organization. Medicaid eligibility alone does not authorize assisted-living services, and a medical-necessity decision alone does not complete financial eligibility.

Three routes into the assessment process

Interest list release

People not already able to use an upgrade or transition pathway may enter through the statewide interest list. Texas says a person can request placement by calling 1-855-937-2372, making a written request to HHSC, or using the Find Support Services referral tool through Your Texas Benefits.

An interest-list entry is not enrollment. When the person reaches the top and confirms interest, the person becomes an applicant after submitting the required Medicaid assistance application. The managed-care organization then conducts eligibility and service-planning activities.

Upgrade for an existing STAR+PLUS member

Some people already receiving Medicaid and enrolled with a STAR+PLUS managed-care organization may be assessed through an upgrade process without waiting for a standard interest-list release. Ask the MCO service coordinator whether the member qualifies; do not assume existing STAR+PLUS enrollment automatically includes HCBS.

Money Follows the Person

An eligible nursing-facility resident seeking to return to the community may enter through the Money Follows the Person process. Texas permits the MCO to use certain current nursing-facility assessment information when completing the community transition and service plan.

Ask HHSC or the MCO to name the route being used. The required notices, timing, and next action depend on it.

The MCO turns eligibility into a service plan

The managed-care organization assesses medical necessity and develops the person-centered individual service plan. Texas uses that plan to record the services, effective period, and estimated annual service cost.

Before looking for an assisted-living placement, ask the service coordinator to confirm:

  • the approved level of care;
  • the services and units in the individual service plan;
  • the effective date;
  • the member’s selected provider or required network status;
  • any cost-limit issue; and
  • the amount the member must pay for room, board, or an applicable copayment.

A facility’s assessment may help determine whether it can accept the person, but it does not replace the MCO’s authorization.

What Texas calls assisted-living services

The STAR+PLUS assisted-living policy describes a 24-hour living arrangement for an eligible member who cannot continue independent functioning at home. Authorized services can include personal care, home management, meal services, transportation coordination, social and recreational activities, and supervision according to the member’s plan.

Texas allows different residential models within the policy framework, and the setting must satisfy licensing and contract requirements. Ask the service coordinator which model and daily service arrangement apply to the proposed facility.

The policy also draws a firm payment line: the member is responsible for room and board and any applicable copayment. STAR+PLUS HCBS payment covers authorized services, not the entire facility invoice.

Build the Texas resident-cost worksheet

Ask for an itemized agreement that separates:

  • room and board;
  • STAR+PLUS HCBS services in the individual service plan;
  • any member copayment identified by HHSC or the MCO;
  • services not included in the authorized daily arrangement;
  • medication administration, nursing, supplies, and transportation;
  • deposits and move-in fees;
  • changes following reassessment; and
  • charges during hospitalization or another temporary absence.

Then ask the MCO service coordinator to verify the facility’s network and contract status. A Texas assisted-living license does not prove STAR+PLUS participation, and an MCO contract does not prove that the specific service level or room is available.

Verify the license and contract separately

Texas licenses assisted-living facilities through Health and Human Services. The Texas Unified Licensure Information Portal covers Assisted Living Facility licensing and makes an important distinction: TULIP handles licensing, while HHSC contracts are updated through a separate process.

For the offered location, verify:

  • the active Assisted Living Facility license;
  • the facility type and licensed capacity;
  • the MCO contract for STAR+PLUS HCBS assisted-living services;
  • whether the provider can meet the individual service plan; and
  • state inspection or enforcement information available for the site.

Texas also provides an official long-term-care complaint portal. The portal accepts complaints about assisted-living facilities and lets a complainant search by name, license number, or address. A licensing or care complaint uses that route; an MCO service denial follows the plan and Medicaid appeal instructions on the member’s notice.

Texas-specific next steps

  1. Ask HHSC whether the person is on the interest list, eligible for an MCO upgrade, or using Money Follows the Person.
  2. Complete financial eligibility and the MCO medical-necessity assessment.
  3. Review the individual service plan before selecting a residence.
  4. Confirm the facility’s license in TULIP.
  5. Have the MCO verify the facility contract and proposed service model.
  6. Obtain the room-and-board and copayment obligations in writing.
  7. Compare the resident agreement with the individual service plan line by line.

Questions for HHSC, the MCO, and the facility

For HHSC or the MCO

  • Which entry route applies, and what is the current status?
  • Has medical necessity and nursing-facility level of care been approved?
  • Which assisted-living services appear in the individual service plan?
  • Is the proposed site contracted with this MCO for those services?
  • What room-and-board or copayment amount is the member responsible for?

For the facility

  • What is the legal name and license number for this address?
  • Which STAR+PLUS MCO contracts are active here?
  • Which authorized tasks are included in the service arrangement?
  • What private charges remain after the MCO payment?
  • How are reassessment, hospitalization, discharge, and refunds handled?

Official sources

Keep interest-list status, MCO authorization, license, contract, and room-and-board terms separate. Compare Texas care options on SLINQ →