Texas Medicaid waivers can help cover assisted living costs in Houston. The gap between what Medicaid pays and what a facility charges will likely surprise you. In Harris, Fort Bend, Montgomery, and Galveston counties, STAR+PLUS is the primary waiver program for assisted living. It covers only personal care services. It does not cover the room and board that makes up the bulk of your monthly bill. Understanding exactly what each program pays is critical. You must know which managed care organizations (MCOs) operate in your ZIP code. You must also know how long you will wait for benefits. This knowledge means the difference between a workable plan and a financial crisis. In this guide, the Houston Assisted Living Facilities team explores the three Medicaid pathways relevant to Houston-area assisted living. We outline the real cost gaps families face. We also provide specific steps to start an application before a health crisis forces your hand.

Key Takeaways

  • STAR+PLUS covers personal care services inside a licensed ALF. It explicitly excludes room and board expenses.
  • Houston ALF costs run $2,800 to $6,500 monthly. STAR+PLUS reimburses roughly $800 to $1,800 monthly. This leaves a massive gap for families to cover.
  • Four MCOs administer STAR+PLUS in the Houston metro. These include Molina Healthcare, UnitedHealthcare Community Plan, Amerigroup Texas, and Superior HealthPlan.
  • Waitlists in Harris County run six to 24 months. Apply at first eligibility.
  • Only HHSC-licensed Type A or Type B ALFs can legally accept waiver clients. Unlicensed residential care homes cannot participate.

Reviewed by the HALF Publishing Team. Houston Assisted Living Facilities maintains an independent directory of licensed senior care communities across Greater Houston, with facility data sourced from the Texas HHSC, CMS quality ratings, and Google Reviews, updated regularly.

Quick Answers
Q: Does STAR+PLUS Medicaid cover room and board at a Houston, TX assisted living facility?
No, the STAR+PLUS waiver only covers the cost of personal care and habilitation services, not rent or meals. Families must cover room and board costs out of pocket, which typically range from $2,800 to $6,500 per month locally. Most seniors bridge this funding gap using Supplemental Security Income (SSI), family contributions, or a Medicaid spend-down strategy.
Q: What is the difference between Type A and Type B assisted living licenses?
The Texas Health and Human Services Commission (HHSC) classifies facilities based on a resident's ability to evacuate during an emergency. Type A facilities are for seniors who can evacuate unassisted and do not require routine attendance during sleeping hours. Type B facilities are designed for residents who need nighttime assistance or physical help to evacuate, making them the required choice for seniors with advanced mobility or memory care needs.
Q: What is a Medicaid waiver for assisted living?
A Medicaid waiver is a state-run program that allows Medicaid funds to pay for long-term care services outside of a traditional nursing home setting. In Texas, programs like STAR+PLUS and PACE help eligible seniors pay for caregivers, therapies, and medical support while residing in an approved community. Seniors must meet strict income limits and medical necessity requirements to qualify for these specific waiver services.

Texas Medicaid Waiver Programs That Apply to Assisted Living

Three Medicaid programs matter for Houston families considering assisted living. These are STAR+PLUS, the Community Based Alternatives (CBA) waiver, and PACE. None of them eliminate the cost of room and board. Under Texas Administrative Code Title 26, Chapter 553, the Texas Health and Human Services Commission (HHSC) licenses Houston ALFs. They classify them as either Type A or Type B. Type A residents are ambulatory and do not need nighttime supervision. Type B residents require nighttime supervision or assistance. Only facilities holding a current HHSC license under these classifications can legally participate in Medicaid waiver programs. An unlicensed residential care home cannot accept waiver reimbursements. Placing a waiver-eligible family member in one means losing those benefits entirely.

Many families mistakenly believe STAR+PLUS pays for the entirety of assisted living. It actually pays for personal attendant services and habilitation services delivered inside a licensed ALF. The facility's room, meals, and housing costs are excluded from coverage. Families must cover that portion through the resident's income. This includes SSI, family contributions, or the spend-down of assets. The table below lays out how these three programs function side by side.

Program What It Covers in an ALF Room & Board Included? Who Administers It in Houston Waitlist?
STAR+PLUS Personal attendant care, habilitation, therapy coordination No Molina, UnitedHealthcare, Amerigroup, Superior HealthPlan 6 to 24+ months (Harris County)
CBA Waiver Personal care, adaptive aids, minor home modifications No HHSC Region 6 / local providers 12 to 24+ months
PACE All-inclusive: medical, personal care, adult day services Yes (if in PACE housing or enrolled nursing-level care) InnovAge, Amada (Houston service area) Varies; nursing-level eligibility required

For full program details, see the Texas HHSC STAR+PLUS program page and the Texas Medicaid waiver fact sheet on Medicaid.gov. Families exploring assisted living in Houston broadly should confirm which program fits their care level before selecting a facility.

Quick Answers
Q: Which MCOs administer STAR+PLUS Medicaid in Houston, TX?
The four Managed Care Organizations (MCOs) operating in the Houston STAR+PLUS service area are Molina Healthcare, UnitedHealthcare Community Plan, Amerigroup Texas, and Superior HealthPlan. To avoid unexpected out-of-pocket costs, call 2-1-1 Texas or the HHSC Region 6 office to confirm your chosen facility is in-network before moving in.
Q: How long does the approval process take for the STAR+PLUS waiver program?
The initial financial and medical eligibility review typically takes 45 to 90 days, but actual enrollment can take much longer due to state interest lists. Families should contact the Harris County Area Agency on Aging immediately to get on the list and prepare a financial plan to cover private-pay costs during the wait.
Q: What happens to my assisted living costs if my income exceeds the Medicaid limit?
If your monthly income is over the limit, you can establish a Qualified Income Trust (Miller Trust) to legally lower your countable income for Medicaid eligibility. You will still need to pay nearly all of your income toward your facility costs, but the STAR+PLUS program will step in to cover the remaining approved care charges.

STAR+PLUS in Harris County: MCOs, Eligibility, and What It Actually Pays

STAR+PLUS income eligibility is set at 300% of the SSI federal benefit rate. This equals approximately $2,742 per month for an individual as of 2026. The asset limit is $2,000. Meeting those thresholds still does not guarantee immediate coverage. The spend-down rule applies if your income exceeds the limit. You subtract qualifying medical expenses from monthly income until you reach the eligibility threshold. Then Medicaid kicks in for that month. Asset counting excludes a primary home, one vehicle, and personal property. Cash, savings accounts, and most investments count toward the $2,000 ceiling. Eligibility details are maintained at the HHSC Region 6 Gulf Coast regional office. This office serves Harris, Fort Bend, Montgomery, and Galveston counties directly.

Even after approval, the reimbursement math is sobering. STAR+PLUS typically reimburses $800 to $1,800 per month for personal attendant and habilitation services. Standard assisted living in Houston runs $2,800 to $6,500 per month for a Type A or Type B unit. That leaves a gap of $1,000 to $4,700 per month. The family must fund this difference. You can use the resident's Social Security income, SSI payments, family contributions, or asset liquidation. Application timelines add serious pressure. HHSC pre-enrollment determinations take 30 to 60 days. MCO enrollment adds another 45 to 90 days after documentation is complete. Call 2-1-1 Texas as your first step. It connects you to the Harris County Aging and Disability Resource Center (ADRC). The ADRC coordinates waiver referrals locally.

"Families who wait until a hospital discharge to start the STAR+PLUS application are already 90 to 150 days behind. In Harris County, the application clock starts when you call the ADRC, regardless of when the actual health crisis hits."

HALF Publishing Team

Step-by-Step: How to Apply for STAR+PLUS in Houston

The application process for Medicaid waivers in Texas is notoriously slow. You must follow specific steps to avoid unnecessary delays. Missing a single document can push your application to the back of the line.

First, gather all financial documents. You need bank statements, property deeds, and proof of income. You must account for every asset. The state will look back at financial transfers over the past five years.

Second, call 2-1-1 Texas. Request the Harris County ADRC. Ask specifically to be placed on the STAR+PLUS interest list. Write down the date, time, and the representative's name. This establishes your official place in line.

Third, wait for the HHSC packet. The state will mail you an application packet when your name reaches the top of the interest list. Fill this out immediately. Return it with all required financial documentation.

Fourth, complete the medical assessment. An HHSC caseworker or a nurse from the MCO will evaluate the applicant. They use the Medical Necessity and Level of Care (MN/LOC) assessment. This determines if the applicant requires the level of care provided in a nursing facility or an assisted living setting.

Finally, choose your MCO. Once approved financially and medically, you must select a managed care organization. In the Greater Houston area, your choices typically include Molina Healthcare, UnitedHealthcare Community Plan, Amerigroup Texas, and Superior HealthPlan. Research which MCO contracts with your preferred facilities before making this choice.

Quick Answers
Q: Can an unlicensed residential care home in Houston, TX accept STAR+PLUS Medicaid waivers?
No, only facilities licensed as Type A or Type B Assisted Living Facilities by the Texas Health and Human Services Commission (HHSC) can participate in Medicaid waiver programs. If you choose an unlicensed residential care home in Harris County, your loved one cannot legally use their waiver benefits to cover care costs. Always verify a community's state license status before making a placement decision.
Q: How should I choose between the different Managed Care Organizations (MCOs) available for assisted living?
The most practical approach is to first identify your preferred assisted living communities and ask which specific MCOs they currently contract with. Since a facility might accept UnitedHealthcare but not Molina, selecting your community first ensures your health plan aligns with your housing decision. Always confirm this network status directly with the facility's admissions director before locking in your MCO choice.
Q: Does the Texas Medicaid waiver cover both Type A and Type B assisted living facilities?
Yes, the STAR+PLUS waiver can be used at both Type A and Type B licensed facilities, provided the community holds an active HHSC provider agreement. Your decision between the two should be based strictly on the applicant's mobility and care needs. Type B facilities are required for residents who need nighttime assistance or cannot evacuate the building unassisted during an emergency.

How to Verify if a Facility Actually Accepts Your Waiver

Finding a facility that accepts Medicaid waivers requires direct questions. Many communities advertise that they accept Medicaid. This often means they accept it for specific, limited services. It rarely means they accept it for standard assisted living rent.

You must ask the admissions coordinator very specific questions. Ask them if they hold an active HHSC provider agreement. Ask which specific MCOs they contract with. A facility might accept Molina but reject Superior HealthPlan.

Request this information in writing. A verbal confirmation is meaningless if the facility changes ownership or management. You need documentation proving their current waiver status.

Check the facility's license type. Remember that only Type A and Type B facilities can accept STAR+PLUS. Unlicensed residential care homes cannot participate. You can verify a facility's license status through the Texas Health and Human Services online portal.

Be prepared for limited inventory. Facilities often cap the number of Medicaid waiver beds they offer. A community might have 50 total beds but only allocate five for STAR+PLUS residents. Ask about the waitlist specifically for waiver beds. Families comparing options in the northwestern suburbs can start with The Woodlands assisted living options. Those in Fort Bend County can review Sugar Land assisted living facilities for licensed Type A and Type B availability.

Waitlists, PACE, and What to Do While You Wait

STAR+PLUS waitlists in Harris County currently range from six to 24 months depending on the service category. CBA waiver waitlists frequently exceed 12 to 24 months. The time to apply is right now. Do not wait for a fall or hospitalization.

During the wait, confirm that any ALF you are considering holds active HHSC provider agreements with your chosen MCO. A facility that accepts Molina Healthcare clients may not have a contract with UnitedHealthcare Community Plan. If an admissions coordinator hesitates, contact the MCO's provider relations line to verify.

PACE is the only Medicaid pathway that covers essentially all care costs. This includes medical, personal, and housing expenses. It eliminates the separate room-and-board gap. Eligibility requires a nursing-home level of care determination. You must also reside within the PACE service area. Houston-area PACE organizations include InnovAge and Amada. Program availability and enrollment capacity vary by ZIP code.

If a family member qualifies for PACE, it provides a very complete financial solution. Families consistently make one major mistake. They assume the ALF will handle MCO enrollment on their behalf. Facilities help with onboarding documentation once enrollment is complete. The HHSC application itself must be initiated by the family. Call 2-1-1 Texas. Request the Harris County ADRC. Ask specifically for a Medicaid waiver referral. That call starts the clock.

Quick Answers
Q: How do I start the STAR+PLUS application process in Houston, TX?
Begin by calling 2-1-1 Texas to reach the Harris County ADRC and specifically request a Medicaid waiver referral. Next, apply for Texas Medicaid through the Your Texas Benefits portal or at a local HHSC office. Once approved, you can enroll in a STAR+PLUS plan through one of the local Managed Care Organizations (MCOs) and select an in-network assisted living facility.
Q: How long does it take to get approved for Medicaid waiver services for assisted living?
The entire process typically takes between 75 and 150 days from your initial application to receiving your first services. Because of this timeline, families should initiate the HHSC application and contact the Harris County ADRC well before their loved one actually needs to move. Keep detailed records of all your submission dates and representative names to help prevent unnecessary delays.
Q: What should I do before contacting a Managed Care Organization (MCO) about facility coverage?
Before reaching out to an MCO, verify that your family member meets the strict financial eligibility requirements, including the 300% SSI income threshold and the $2,000 asset limit. You must also formally initiate the Texas Medicaid application process through HHSC. Confirming these steps first ensures you don't waste time evaluating MCOs before your loved one is officially eligible for coverage.

What to do next:

  • Call 2-1-1 Texas today and request the Harris County ADRC. Ask for a Medicaid waiver referral and document the date and representative name.
  • Confirm income and asset eligibility using the 300% SSI threshold ($2,742 per month, $2,000 in assets) before investing time in MCO outreach.
  • Ask any ALF under consideration to confirm in writing which STAR+PLUS MCOs they hold provider agreements with. This single step prevents the most common placement mistake.

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About This Guide

Houston Assisted Living Facilities is a free, independent directory helping families find licensed assisted living, memory care, nursing, and residential care homes across the Greater Houston metro area. Our data is sourced from the Texas Health and Human Services Commission (HHSC) and updated regularly. We combine verified licensing data with neighborhood-level detail — the kind of local context that national directories cannot provide. Whether you're evaluating options in the Inner Loop or comparing suburbs, Houston Assisted Living Facilities exists to make that search faster and more informed.