Texas Medicaid Waiver for Dementia: Houston

What Is the Texas Medicaid Waiver for Dementia Care?

The Texas Medicaid program families use for dementia-related long-term care at home is STAR+PLUS Home and Community-Based Services (HCBS), which funds support in the community instead of a nursing facility. There is no separate Texas Medicaid waiver that exists only because someone has a dementia diagnosis. STAR+PLUS HCBS is the pathway that can cover attendant care and related home services when an applicant meets both the functional Nursing Facility Level of Care standard and the financial rules. Texas Health and Human Services publishes STAR+PLUS HCBS program eligibility procedures that describe the overall program framework.

What Is the Dementia-Specific Eligibility Threshold?

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. A diagnosis is considered as part of how the person functions day to day, not as a shortcut around the usual clinical threshold. Families should be ready to describe supervision needs, safety concerns, and daily living challenges during that standard assessment.

What Are the Asset Limits and Look-Back Rules?

A single STAR+PLUS HCBS applicant generally must meet a $2,000 asset limit, while the asset limit for a couple varies with spousal allowance rules. Texas also applies a 60-month asset transfer look-back period. Transfers for less than fair market value during that window can affect eligibility. These financial tests are separate from the Nursing Facility Level of Care review.

How Does the STAR+PLUS HCBS Application Process Work?

Applicants join the STAR+PLUS HCBS interest list, and once reached, an assigned managed care organization completes the eligibility determination. Joining the interest list is the first official step when long-term home support is needed. After a name is reached, the assigned managed care organization reviews both functional and financial eligibility. Approval is not automatic simply because someone has dementia.

What Makes STAR+PLUS HCBS Different?

Texas caps STAR+PLUS HCBS services at 202% of what nursing facility care would otherwise cost, and offers a Consumer Directed Services option. The cost cap means waiver services are not unlimited even after approval. Consumer Directed Services lets some members hire and manage their own attendants rather than using only agency-sent staff. Those two features shape how far Medicaid hours can stretch for someone who needs close supervision.

How Can Houston Families Combine Medicaid With Private Home Care?

Houston families can use STAR+PLUS HCBS for eligible home and community-based services and add private help for hours the waiver does not cover. Private personal care can assist with bathing, dressing, and other daily tasks. Companion care can provide supervision and social presence when wandering or restlessness is a concern. Respite care gives family caregivers a break, and 24-hour live-in care is sometimes arranged when someone cannot safely be left alone overnight. These private options do not replace the Medicaid application and are not an official part of STAR+PLUS.

Frequently Asked Questions

Does Texas Medicaid cover dementia care at home?

Yes. Texas covers qualifying long-term care at home through STAR+PLUS Home and Community-Based Services (HCBS), not through a separate dementia-only waiver. Eligible members can receive home and community-based services instead of nursing facility care when they meet both the functional and financial rules.

Is a dementia diagnosis enough to qualify for STAR+PLUS?

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 rather than creating a separate, easier pathway.

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

Applicants join the STAR+PLUS HCBS interest list, and once reached, an assigned managed care organization completes the eligibility determination. The program is administered by private managed care organizations under contract with Texas Health and Human Services.

What is the Medicaid look-back period in Texas for long-term care?

Texas uses a 60-month asset transfer look-back period for STAR+PLUS HCBS. Reviewers look at whether assets were transferred for less than fair market value during that time.

Can I hire my own caregiver through Texas Medicaid?

Yes, in many cases. STAR+PLUS offers a Consumer Directed Services option that allows some members to hire and manage their own attendants. That option sits alongside the program's overall service cap of 202% of what nursing facility care would otherwise cost.