No, Texas Medicaid does not take every dollar your parent or spouse has when they move into assisted living. This is the biggest fear Houston families face, and it comes from a misunderstanding of the Texas HHS STAR+PLUS program. The program uses a cost-of-participation formula, not a complete seizure of income. Federal rules also protect a portion of that income for personal use. In this guide, we break down how Medicaid calculates your share, what you get to keep, and how spouses living at home are protected under Texas rules.
Key Takeaways
- Texas STAR+PLUS uses a cost-of-participation formula, not full income confiscation. Medicaid covers the gap between your calculated contribution and the facility's contracted rate.
- Residents keep a Personal Needs Allowance (PNA) each month. The current STAR+PLUS PNA for assisted living is higher than the standard $60/month nursing home PNA, and facilities cannot touch it.
- Spouses at home are protected by the Minimum Monthly Maintenance Needs Allowance (MMMNA, approximately $2,555/month) and the Community Spouse Resource Allowance (CSRA, up to approximately $154,140 in assets).
- If your income exceeds the Medicaid cap (approximately $2,901/month), a Miller Trust is the only legal path to eligibility in Texas. An elder law attorney in Houston typically charges $500–$1,500 to set one up.
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.
The Short Answer: Texas Medicaid Does NOT Take All Your Income
The old nursing home model is what most families picture when they hear "Medicaid." In that system, residents pay nearly everything toward care and keep only a small allowance. But STAR+PLUS assisted living works differently. The state calculates a cost-of-participation amount based on your income, subtracts legally protected deductions, and then pays the facility the rest of the approved rate. You are not handing over a blank check. You are contributing a calculated share, and the program covers what you cannot. Spousal protections are built into federal law and apply directly to STAR+PLUS waiver cases in Harris County and across the Houston metro.
The STAR+PLUS Cost-of-Participation Formula: Step-by-Step Breakdown
The calculation is straightforward once you see the steps. Texas Health and Human Services Commission (HHSC) follows this process to determine what a resident owes each month:
- Start with total gross monthly income from all sources (Social Security, pension, annuities, etc.).
- Deduct health insurance premiums, including Medicare Part B, supplemental coverage, and any prescription drug plan premiums.
- Deduct the Personal Needs Allowance (PNA). For STAR+PLUS assisted living, this is currently $85/month—a meaningful increase over the $60/month nursing home PNA.
- Deduct the spousal allowance if a community spouse needs income support to meet the MMMNA (more on this below).
- The remaining amount is the resident's monthly contribution. Medicaid pays the difference between that contribution and the facility's contracted rate.
Here is how this plays out for a typical Houston-area scenario:
| Calculation Step | Amount |
|---|---|
| Monthly Social Security income | $1,800.00 |
| Minus Medicare Part B premium | – $174.70 |
| Minus STAR+PLUS PNA | – $85.00 |
| No spousal deduction (single resident) | $0 |
| Resident monthly contribution | $1,540.30 |
| Typical Harris County ALF monthly cost (Type A) | $3,250 – $4,800 (Source: Genworth Cost of Care Survey) |
| STAR+PLUS pays the gap | ~$1,710 – $3,260/month |
This example uses a Harris County Type A facility. Houston-area costs can run from around $3,250/month in outer suburbs to over $7,000/month for Type B memory care in affluent neighborhoods. The math changes, but the structure of the calculation remains the same. You can use our Cost Calculator to model your specific numbers.
"Most Houston families overestimate what Medicaid demands and underestimate what it pays. In Harris County, where over 180 facilities contract with STAR+PLUS, the real obstacle is usually the waitlist and the paperwork—not the income formula."
HALF Publishing Team
Your Personal Needs Allowance in STAR+PLUS: What Houston Residents Keep
The Personal Needs Allowance is protected by federal Medicaid law. It is not optional. No facility in Houston can require a resident to spend it on add-on services or facility-controlled amenities. The current STAR+PLUS assisted living PNA is $85/month, while the nursing home PNA is $60/month. That $25 difference matters. Assisted living residents typically have more out-of-pocket personal expenses for things like clothing, toiletries, a cell phone plan, or transportation to outside appointments. A common point of confusion: if a facility tries to apply the $60 nursing home figure to an assisted living resident on STAR+PLUS, that is incorrect. The higher STAR+PLUS figure controls for waiver participants.
Spousal Income Protection in Houston: MMMNA and CSRA Rules
Federal Medicaid law contains strong protections for the spouse who stays at home, known as the community spouse. Two key rules govern this. The Minimum Monthly Maintenance Needs Allowance (MMMNA) sets a floor for the income the community spouse is allowed to keep, which is approximately $2,555/month. If the community spouse's own income is below that floor, they can claim a portion of the institutionalized spouse's income to make up the difference. The second rule is the Community Spouse Resource Allowance (CSRA), which protects up to approximately $154,140 in countable assets for the community spouse, shielding those funds from Medicaid spend-down rules.
For example, a resident moves from their home in Katy into a STAR+PLUS-contracted assisted living facility. Their total household income is $2,200/month ($1,400 from the resident's Social Security, $800 from the spouse's pension). The community spouse's $800 income is far below the $2,555 MMMNA floor. The state allows the community spouse to receive an income allocation from the resident's Social Security to bring them up to the MMMNA. Only after that allocation is made does the remaining resident income run through the cost-of-participation formula. This calculation is highly fact-specific and the numbers change annually. Always consult a Texas elder law attorney before relying on any projection.
What STAR+PLUS Covers (and Doesn't Cover) in Houston Assisted Living
Families often assume STAR+PLUS is an all-inclusive benefit, but it is not. The program is designed to cover specific services related to daily living and personal care assistance within a licensed assisted living facility. Understanding the line between covered and non-covered costs is critical for financial planning.
What Is Typically Covered by STAR+PLUS:
- Room and Board: This includes the resident's living space and meals.
- Personal Care Assistance: Help with Activities of Daily Living (ADLs) like bathing, dressing, grooming, and mobility.
- Medication Management: Assistance with storing and taking medications as prescribed.
- 24-Hour Supervision: The presence of staff for safety and emergency response.
- Housekeeping and Laundry: Basic services to maintain a clean living environment.
What Is NOT Covered by STAR+PLUS:
- Private Room Surcharges: STAR+PLUS pays a set rate for a semi-private room. If a resident wants a private room, the family is responsible for the difference.
- Medical Care: Doctor visits, hospital stays, prescription drugs, and therapies (physical, occupational) are billed separately through Medicare or other health insurance.
- Specialized Memory Care Units: While STAR+PLUS covers care in a memory care setting, it may not cover the premium for secured units with specialized programming.
- Personal Items: The Personal Needs Allowance is intended to cover toiletries, clothing, cell phone bills, and other personal incidentals.
- Beauty/Barber Services and Outings: These are considered optional amenities and are paid for out-of-pocket.
Before signing any admission agreement at a Houston-area facility, ask for a detailed list of services covered by the STAR+PLUS rate versus those that are considered ancillary and require private payment. This prevents unexpected bills down the road.
Harris, Fort Bend, Montgomery, and Galveston County MCO Differences
STAR+PLUS is administered through private insurance companies called Managed Care Organizations (MCOs), and your MCO determines which facilities will accept your coverage. The MCOs operating across the Houston metro include Molina Healthcare of Texas, UnitedHealthcare Community Plan, and Aetna Better Health of Texas. Harris County has the most contracted STAR+PLUS facilities in the state, with over 180 licensed communities in the network. This gives families the widest selection of assisted living facilities in Houston.
Families in surrounding counties face a different reality. Fort Bend and Montgomery County enrollees have a much smaller network of contracted facilities, which often leads to longer waitlists, especially for communities near Sugar Land or The Woodlands. Galveston County has fewer large, urban ALFs than Harris County, and its coastal geography limits facility density. The supply and demand imbalance in the suburbs is a major factor in the search process.
| County | Available MCOs | STAR+PLUS ALF Density | Waitlist Pressure |
|---|---|---|---|
| Harris | Molina, UHC, Aetna | High (180+ facilities) | Lower than suburbs |
| Fort Bend | Molina, UHC, Aetna | Moderate | Higher |
| Montgomery | Molina, UHC, Aetna | Moderate | Higher |
| Galveston | Molina, UHC, Aetna | Lower | Moderate to High |
MCO choice is made during the Medicaid enrollment process, not at the facility level. Switching MCOs is possible but is restricted to certain enrollment periods. Before you tour any facility, confirm that it contracts with your specific MCO. Not every STAR+PLUS facility contracts with every MCO in every county.
Miller Trust Mechanics: When Your Income Exceeds the Medicaid Cap
Texas uses a strict income cap for Medicaid eligibility: approximately $2,901/month for an individual, based on 300% of the Supplemental Security Income (SSI) Federal Benefit Rate. If your gross monthly income is even one dollar over that figure, you cannot qualify for STAR+PLUS. There is one exception: establishing a Miller Trust, also called a Qualified Income Trust (QIT).
That Miller Trust sounds like a loophole, but for Texas Medicaid, it's the only door. There is no "almost eligible" status.
Here is how it works. A special bank account is opened in the name of the trust. Each month, income above the Medicaid cap is deposited directly into this account before it reaches the resident. The trust then distributes funds in a specific, legally required order: the cost-of-participation goes to the facility, administrative fees are paid, and any remaining balance at the resident's death goes to the Texas Health and Human Services Commission (HHSC) as reimbursement for care paid. Setting up a Miller Trust requires a licensed elder law attorney; this is not a DIY project. Houston-area attorneys typically charge between $500 and $1,500 for the trust setup. For families whose income is just over the cap, this is a necessary cost to access benefits worth thousands per month. Check Medicaid.gov for federal guidance on income and trust rules.
What to do next:
- Run your income through the cost-of-participation formula above. If your gross income exceeds $2,901/month, contact a Texas elder law attorney about a Miller Trust before starting the STAR+PLUS application.
- Confirm which MCO covers your county and call them to verify which local facilities are contracted. Harris County families have the most options; Fort Bend and Montgomery families should ask about waitlist timelines.
- Use the Find Care assessment on this site to identify STAR+PLUS-contracted facilities that match your care level and location.
Find the Right Facility on Houston Assisted Living Facilities
You found this guide through a search — and that is exactly how Houston Assisted Living Facilities is designed to work. We are a free, independent directory built for families actively comparing assisted living, memory care, nursing homes, and residential care homes across Greater Houston. No placement fees. No lead selling. Just verified data from the Texas Health and Human Services Commission (HHSC), updated regularly.
What to do next:
- Take the Care Assessment — Our Find Care page includes a free care-level assessment. Answer eight questions about daily living activities, get a recommended care level based on your answers, and browse matching facilities in Houston. The entire process takes about two minutes.
- Search by city — We index licensed facilities in every major Houston suburb. Start with a city page like Katy, Sugar Land, or The Woodlands to see what is available near your family.
- Ask our AI Senior Care Guide — Houston Assisted Living Facilities is the only local directory with a built-in AI Senior Care Guide grounded in Houston-area facility data and Texas HHSC licensing records. Describe your situation and get a personalized response — not a generic answer from a national chatbot that does not know the difference between Katy and Kingwood.
- Compare side by side — Use the Compare tool to evaluate facilities on cost, care types, and location, or estimate monthly expenses with the Cost Calculator.