Texas Medicaid Waiver for Dementia: Dallas

STAR+PLUS Home and Community-Based Services (HCBS) is Texas Medicaid's main long-term care program for people who need nursing-facility-level help at home, including many people living with dementia. Texas does not treat a dementia diagnosis as an automatic qualifier. This page explains the functional eligibility standard, asset limits, the look-back period, and how the interest-list application process works. It is general information, not medical, legal, or benefits advice.

What Is STAR+PLUS HCBS in Texas?

STAR+PLUS Home and Community-Based Services (HCBS) is the Texas Medicaid program that can pay for long-term services in the home or community when a person meets a nursing facility level of care. Private managed care organizations administer STAR+PLUS under contract with Texas Health and Human Services. Texas caps STAR+PLUS HCBS services at 202% of what nursing facility care would otherwise cost, and the program offers a Consumer Directed Services option.

For a general overview of how the program is organized, read more about Texas STAR+PLUS. That overview describes the program's existence and structure. It is not a substitute for an eligibility decision by the state or an assigned managed care organization.

What Is the Dementia Eligibility Threshold in Texas?

Texas does not automatically lower the eligibility bar for a dementia diagnosis alone. Dementia-related behaviors such as wandering are factored into the standard Nursing Facility Level of Care assessment. Case reviewers look at daily functioning, safety, and supervision needs rather than the diagnosis name by itself. A clinician's note confirming dementia does not replace that nursing facility level of care finding.

Families who are planning supervision and daily routine while they sort out benefits often compare memory care at home with other in-home supports. Those services are not a diagnosis, a treatment plan, or a guarantee that STAR+PLUS HCBS will be approved.

What Are the STAR+PLUS Asset Limits?

The countable asset limit for a single STAR+PLUS HCBS applicant is $2,000. The asset limit for a couple varies with spousal allowance rules. Texas also uses a 60-month asset transfer look-back period, which means gifts or transfers for less than fair market value during those 60 months can affect eligibility. These financial rules apply whether the underlying condition is dementia or another cause of nursing-facility-level need.

Texas Health and Human Services publishes operational procedures for STAR+PLUS HCBS eligibility. You can review the STAR+PLUS HCBS eligibility handbook for official procedure language. That state handbook does not endorse any private care company.

How Do You Apply for STAR+PLUS HCBS?

Applicants join the STAR+PLUS HCBS interest list, and once reached, an assigned managed care organization completes the eligibility determination. There is not a separate dementia-only application track. After a name comes up on the interest list, the managed care organization works through both the functional Nursing Facility Level of Care review and the financial rules.

Families in Dallas follow the same statewide STAR+PLUS HCBS path as the rest of Texas. Because the interest list can mean waiting before an organization is assigned, some households arrange private personal care in the meantime. Private help does not replace a completed Medicaid determination.

How Does Consumer Directed Services Work With Home Care?

STAR+PLUS offers a Consumer Directed Services option that can give eligible members more control over who provides certain waiver services. That option does not remove the 202% cap on HCBS services compared with the cost of nursing facility care. When waiver hours do not cover every need, families sometimes add unpaid family help or privately arranged respite care so primary caregivers can rest.

A dementia diagnosis, including Alzheimer's disease, still does not create a special lower Medicaid bar in Texas. For general public-health background only, see the CDC overview of Alzheimer's disease and dementia. That page is not a Texas Medicaid rulebook, and it cannot diagnose any person or approve any benefit.

Frequently Asked Questions

Does a dementia diagnosis automatically qualify someone for Texas Medicaid long-term care?

No. Texas does not automatically lower the eligibility bar for a dementia diagnosis alone. Dementia-related behaviors such as wandering are factored into the standard Nursing Facility Level of Care assessment.

Does Texas Medicaid cover dementia care at home through STAR+PLUS?

STAR+PLUS HCBS can pay for home and community-based services when a person meets a nursing facility level of care and the financial rules. Texas caps STAR+PLUS HCBS services at 202% of what nursing facility care would otherwise cost.

What is the STAR+PLUS asset limit for a single person in Texas?

The countable asset limit for a single applicant is $2,000. The asset limit for a couple varies with spousal allowance rules.

How do I apply for STAR+PLUS HCBS in Dallas, Texas?

Dallas applicants join the statewide STAR+PLUS HCBS interest list, and once reached, an assigned managed care organization completes the eligibility determination. There is not a separate Dallas-only or dementia-only application form.

How far back does Texas look at asset transfers for STAR+PLUS?

Texas uses a 60-month asset transfer look-back period. Transfers for less than fair market value during that window can affect eligibility.

What is Consumer Directed Services in STAR+PLUS?

STAR+PLUS offers a Consumer Directed Services option so eligible members can have more control over who provides certain services. Private managed care organizations administer STAR+PLUS under contract with Texas Health and Human Services.