Under Texas STAR+PLUS Home and Community-Based Services, a Houston-area resident in a licensed assisted living facility keeps exactly $60 per month as their Personal Needs Allowance. The rest of their Social Security income applies directly toward room and board. That single number shapes every conversation about Medicaid and assisted living costs across Harris, Fort Bend, Montgomery, and Galveston counties. The calculation itself is not complicated. However, the rules around income limits, Qualified Income Trusts, and the three managed care organizations serving Greater Houston trip up families every week. In this guide, we explain exactly how Social Security income flows once a resident moves into a STAR+PLUS assisted living facility in the Houston metro.
Key Takeaways
- The $60 Personal Needs Allowance is a Texas-mandated floor. Set under the Texas Administrative Code, it is lower than the allowance in many other states. Houston STAR+PLUS residents keep less discretionary income than Medicaid beneficiaries elsewhere.
- Income above approximately $2,742 per month requires a Miller Trust (QIT). Without one, the Texas Health and Human Services Commission (HHSC) will not approve STAR+PLUS enrollment.
- Your managed care organization authorizes care services, not room and board. The room and board payment is a separate financial relationship between the resident and the facility.
- Harris County has two HHSC Benefits Offices. These offices process STAR+PLUS applications and QIT submissions. The correct office depends entirely on your zip code.
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.
How Texas STAR+PLUS Calculates Your Social Security Income in Houston Assisted Living
Every dollar of Social Security income is counted in a cost-of-participation calculation. This applies under the STAR+PLUS HCBS assisted living pathway. It includes both SSDI and standard Social Security retirement benefits. The resident keeps $60 per month as the Personal Needs Allowance. The remainder applies toward the room and board cost at the Texas Type A and Type B assisted living facilities enrolled in the program. If the room and board rate exceeds what remains after the allowance, the resident is responsible for that gap. Medicaid through STAR+PLUS HCBS covers the authorized care services. These include a personal attendant, physical therapy, and medication management. It does not cover the room and board itself.
Per the HHSC STAR+PLUS Handbook Section 7200, the facility cannot charge the resident more than the HHSC-established room and board rate. This pathway is the HCBS assisted living benefit. It is not the STAR+PLUS Nursing Facility benefit. The nursing home benefit uses an entirely different institutional Medicaid income formula. Conflating the two is the most common mistake families make. It leads to wildly incorrect cost estimates before move-in. The table below shows exactly how income flows under the HCBS pathway.
| Income Step | Amount / Action | Who Handles It |
|---|---|---|
| Gross Social Security income | Resident's full monthly benefit | Social Security Administration to resident |
| Subtract Personal Needs Allowance | $60 per month (Texas floor) | HHSC sets limit; resident retains funds |
| Remaining income | Gross SS minus $60 | Resident pays to facility as room and board |
| Room and board gap | Room and board rate minus remaining income | Resident pays directly; no STAR+PLUS coverage |
| Covered care services | Personal attendant, therapy, medication | MCO authorizes; facility bills MCO directly |
One detail is worth knowing before you tour. Only Type B facilities can accept residents who need nighttime care or higher acuity. If a family is considering assisted living options in The Woodlands or Sugar Land assisted living facilities, confirming the license type matters. Not every Type A facility can enroll HCBS-eligible residents at higher care levels. Always ask to see the facility's current HHSC license during your initial visit.
Navigating Room and Board Gaps in Harris and Fort Bend Counties
Many residents discover their Social Security check does not cover the full room and board rate. This happens frequently in Houston. The average monthly Social Security benefit often falls short of the facility's baseline room charge. When this gap occurs, the resident or their family must make up the difference. STAR+PLUS does not pay this gap. The program strictly separates medical care from housing costs.
If your parent receives $1,200 a month from Social Security, they keep $60. The remaining $1,140 goes to the facility. If the facility's Medicaid room and board rate is $1,500, the family owes $360 out of pocket every month. Families must plan for this expense. You cannot use the $60 Personal Needs Allowance to cover it. That money pays for haircuts, clothing, and personal items. Some families use pooled resources from adult children to cover the room and board gap. Others rely on small pensions or VA benefits. Always ask the facility for their exact Medicaid room and board rate in writing before signing a contract.
The gap can vary widely depending on the neighborhood. Facilities in the Inner Loop often have higher baseline costs than those in Katy or Spring. Ask for a written breakdown of the Medicaid room and board rate versus the private pay rate. This ensures you know exactly what your monthly obligation will be.
What Happens to Spousal Income When One Person Needs STAR+PLUS
Married couples face a specific set of rules under Texas Medicaid. When one spouse needs assisted living and the other stays home, income calculations change drastically. The spouse remaining at home is called the community spouse. The state does not expect the community spouse to live in poverty. Texas uses the Minimum Monthly Maintenance Needs Allowance to protect families.
This rule protects a portion of the couple's combined income. If the community spouse's income falls below a certain threshold, they can keep some of the institutionalized spouse's Social Security check. This prevents financial ruin for the healthy spouse living independently. However, the community spouse's income does not count toward the applicant's eligibility. If the healthy spouse earns $4,000 a month, that money is completely safe.
HHSC only looks at the applicant's income when determining STAR+PLUS eligibility. This separation of income surprises many couples. It is a vital protection for Houston families navigating long-term care. Consult an elder law attorney to maximize these spousal protections before submitting any paperwork to HHSC.
When Social Security Exceeds the STAR+PLUS Income Limit: The Miller Trust Process
The STAR+PLUS HCBS income limit for a single adult is approximately $2,742 per month. This figure represents 300% of the Federal Benefit Rate. Income above that number does not automatically disqualify a resident. It does require a Qualified Income Trust (Miller Trust) before HHSC will approve enrollment. The trust must be established by an elder law attorney. It is funded each month with the excess Social Security income before HHSC processes the application.
In Harris County, QIT submissions are processed through specific local offices. The Houston South HHSC Benefits Office near Cullen Blvd handles many applications. The Houston North office near Antoine Dr handles the rest. Your zip code determines the correct location. Fort Bend County families use the Richmond HHSC office. Montgomery County residents go through the Conroe office. Galveston County residents use the Texas City office.
The QIT window is incredibly time-sensitive. Delays in establishing the trust delay Medicaid enrollment. This means the facility may not have confirmed STAR+PLUS coverage when the resident moves in. Many families assume income over the limit means Medicaid is simply off the table. It does not. Waiting to start the attorney consultation until after move-in is a costly mistake.
Not every family needs a Miller Trust, and some elder law attorneys will sell you one anyway. Always verify your gross income against the current HHSC limits before paying legal fees.
What to do next:
- Confirm your county office: Locate the correct HHSC Benefits Office for your zip code.
- Retain legal counsel: Hire an elder law attorney to draft the Qualified Income Trust.
- Fund the trust: Deposit the excess income into the trust account every single month.
- Notify your coordinator: Tell your assigned MCO care coordinator once the trust is active and approved.
"In Greater Houston, we see families lose two to three months of STAR+PLUS coverage every year because they did not know the Miller Trust had to be in place before HHSC would process the application. The income limit is not a hard stop. The QIT timeline is."
HALF Publishing Team
MCO Roles in Houston: How Amerigroup, Molina, and UnitedHealthcare Handle Your Benefits
Three managed care organizations serve STAR+PLUS enrollees across Greater Houston. These are Amerigroup (now operating as Wellpoint), Molina Healthcare, and UnitedHealthcare Community Plan. Each is assigned by zip code at enrollment. Residents do not choose their initial MCO. The MCO's care coordinator works directly with the HHSC-licensed assisted living facility to authorize covered services. These services include personal attendant hours, physical therapy, and medication management.
That is where the MCO's financial role ends. The MCO does not handle the resident's Social Security check. They do not collect room and board payments. They do not administer the QIT. Families who call their MCO care coordinator with income questions will be redirected to HHSC. That redirect costs valuable time.
The table below clarifies who controls each piece of the financial picture under STAR+PLUS HCBS assisted living. National directories consistently conflate the nursing facility benefit with the HCBS assisted living pathway. They are completely different programs with different financial rules.
| Function | HHSC | MCO (Amerigroup / Molina / UHC) | Facility |
|---|---|---|---|
| Receives Social Security income data | Yes (at application and annually) | No | No (resident self-reports) |
| Authorizes covered care services | Sets general policy and rates | Yes (coordinator issues authorization) | Delivers services per authorization |
| Collects room and board payment | No | No | Yes (directly from resident) |
| Processes QIT / Miller Trust | Yes (through county office) | No | No |
For income and cost-of-participation questions, contact your county HHSC Benefits Office directly. For service authorization gaps or care plan changes, contact the MCO care coordinator. The two lines of communication run parallel and should not be crossed. Keeping them separate saves weeks of confusion at a moment when most families are already stretched thin.
What is the Personal Needs Allowance in Texas?
The Personal Needs Allowance in Texas is currently set at $60 per month for residents in Medicaid-funded assisted living facilities. This money is deducted from your Social Security check before the rest is applied to your room and board. You can use these funds for personal items, haircuts, clothing, or snacks.
Does STAR+PLUS pay for room and board in Houston?
No. STAR+PLUS Home and Community-Based Services strictly pays for your authorized medical and personal care services. The resident is responsible for paying the room and board costs directly to the facility using their remaining Social Security income.
What if my Social Security does not cover the room and board rate?
If your remaining Social Security income is less than the facility's Medicaid room and board rate, you must pay the difference out of pocket. Families often use pensions, VA benefits, or contributions from adult children to cover this monthly gap.
Can I change my assigned MCO in Houston?
Yes. While you are initially assigned an MCO based on your zip code, you can request a change by contacting the STAR+PLUS enrollment broker. Changes typically take effect on the first day of the following month, provided you make the request before the monthly cutoff date.
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Houston Assisted Living Facilities Authority
Houston Assisted Living Facilities is the only local directory that combines Texas HHSC licensing data, CMS quality ratings, and neighborhood-level detail across the full Greater Houston metro. We cover everything from Harris County's dense urban core to the sprawling suburbs of Fort Bend, Montgomery, and Galveston counties. Our team monitors STAR+PLUS program updates, HHSC rule changes, and MCO contract shifts so families searching during a crisis have current, accurate information. When the rules change in Austin, we update the directory. We know the difference between a Type A and Type B license, or a QIT deadline missed by one week, is not an abstract policy question in Houston. It is a real family's move-in date.