Texas Medicaid Waiver for Dementia: San Antonio

STAR+PLUS Home and Community-Based Services (HCBS) is Texas Medicaid's main path for long-term care at home, including for people in San Antonio living with dementia. This guide covers the dementia-related eligibility threshold, financial rules, how the interest list works, and where private home care can fill gaps while a family waits or after hours Medicaid does not cover.

If you are comparing local options, start with the San Antonio care hub and then use the sections below to see how STAR+PLUS HCBS actually decides who qualifies.

What Is Texas STAR+PLUS HCBS?

STAR+PLUS Home and Community-Based Services (HCBS) is Texas Medicaid's long-term care program that delivers home and community supports through private managed care organizations under contract with Texas Health and Human Services. It is the program San Antonio families most often hear about when they want help at home rather than a nursing facility stay.

STAR+PLUS is not a dementia-only benefit. It is a statewide managed long-term care structure. A dementia diagnosis can be part of the clinical picture, but enrollment still depends on functional need, financial eligibility, and reaching the interest list.

For a plain-language overview of how this Texas Medicaid program is structured, see this STAR+PLUS explainer. Texas Health and Human Services also maintains operational procedures on STAR+PLUS HCBS eligibility.

Dementia-Specific Eligibility Threshold

Texas does not automatically lower the STAR+PLUS HCBS eligibility bar for a dementia diagnosis alone. Wandering, confusion, and other dementia-related behaviors are factored into the standard Nursing Facility Level of Care assessment instead of creating a separate, easier doorway into the program.

In practice, that means an Alzheimer's or other dementia diagnosis is not enough by itself. Assessors look at whether the person needs the kind of help usually associated with nursing facility care, including how memory loss and behavior affect safety and daily tasks. Families should gather examples of missed medications, unsupervised wandering, or help needed with bathing, dressing, and meals, because those details matter more than the diagnosis name on a chart.

The CDC describes Alzheimer's disease as a type of dementia that can cause memory loss and problems with thinking and daily function. Those day-to-day difficulties are what a Nursing Facility Level of Care review is built to weigh. This page does not diagnose dementia or recommend treatment; only a qualified clinician can evaluate symptoms.

Asset Limits and Look-Back Rules

A single STAR+PLUS HCBS applicant generally faces a $2,000 asset limit, while the limit for a couple varies with spousal allowance rules, and Texas applies a 60-month look-back on asset transfers. Income rules, countable resources, and what a community spouse may keep are separate from the medical assessment described above.

The $2,000 figure is the common single-person resource cap used when talking about this program. Married couples should not assume the same number applies to both spouses. Spousal allowance rules can change how much the spouse who is not applying may retain, so couples in San Antonio often need a careful review of whose name is on accounts, vehicles, and the home.

The 60-month look-back period means caseworkers can review transfers of assets during the five years before application. Gifts, below-market sales, or moving money to relatives can create a penalty period if they are treated as transfers for less than fair market value. Keep records of any large transfers and do not assume a transfer is invisible because it happened a few years ago.

These dollar amounts and time frames are general information about how Texas Medicaid long-term care is commonly described. They are not a personal eligibility determination, and an assigned managed care organization still has to complete the official review.

Service Caps and Consumer Directed 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. The cap is a budget ceiling relative to institutional care, not a promise of round-the-clock staffing.

If a care plan would cost more than that 202% cap, families may need to reduce hours, change the mix of services, or pay privately for extra help. That is one reason San Antonio caregivers often plan for a blend of Medicaid-authorized visits and family or private-pay coverage, especially when someone with dementia cannot be left alone.

Consumer Directed Services lets eligible members have more say in who comes into the home. It is Texas's self-direction path under STAR+PLUS, not a separate diagnosis-based program. Households that already have a trusted aide, or that want a family member involved in scheduling, often ask about this option once an MCO is assigned. It does not skip the interest list, the Nursing Facility Level of Care test, or the financial rules.

Application Process for San Antonio Families

Applicants join the STAR+PLUS HCBS interest list, and once reached, an assigned managed care organization completes the eligibility determination. There is no San Antonio shortcut that bypasses the statewide interest-list step.

The sequence most families should expect is: get on the interest list, wait until the name is reached, then work with the managed care organization that Texas Health and Human Services has contracted to handle the case. That organization, not a private home care agency, completes the eligibility determination. Functional assessment and financial review both have to come out favorable before HCBS can start.

While you wait, write down how dementia shows up at home. Notes about wandering, sundowning, missed meals, or unsafe stove use help the later Nursing Facility Level of Care review. Keep bank statements and a simple list of assets ready for the $2,000 single-person resource test and the 60-month look-back. If a spouse still lives in the home, gather information that may be needed for spousal allowance rules.

Do not delay medical follow-up or hospital discharge planning just because the interest list is long. After a hospital stay, short-term hospital discharge care can stabilize the first days at home even when STAR+PLUS HCBS has not started yet.

Pairing STAR+PLUS With In-Home Dementia Care

San Antonio families often combine STAR+PLUS HCBS with private home care so a person with dementia has companion support, personal care, or overnight help that the interest list or the 202% service cap may not fully cover. Medicaid enrollment and private-pay help are different tracks; one does not automatically replace the other.

Companion visits can cover supervision, conversation, and simple household presence when someone should not be left alone. Learn more about companion care if isolation, wandering risk, or missed meals are the main problems. Hands-on help with bathing, dressing, toileting, and mobility is a different layer; personal care is the usual fit for those tasks.

When memory loss is the driver, specialized memory care at home focuses on routine, safety, and dementia-aware cueing rather than a facility placement. Families who cannot be in the house overnight sometimes look at 24-hour live-in care. Relatives who provide most of the unpaid care may need a break; respite care is designed for those short coverage windows.

None of those service pages is a STAR+PLUS application, and using a home care agency does not mean Texas Health and Human Services or any managed care organization endorses that agency. Keep the Medicaid process and any private care plan on parallel calendars so a wait on the interest list does not leave someone with dementia unsupervised.

Frequently Asked Questions

Does a dementia diagnosis automatically qualify someone in San Antonio for Texas Medicaid home 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, and the person still has to meet financial rules and come up on the STAR+PLUS HCBS interest list.

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

The asset limit commonly used for a single applicant is $2,000. The limit for a couple varies with spousal allowance rules, so a married household in San Antonio should not copy the single-person figure onto both spouses without checking those rules.

How do I apply for STAR+PLUS HCBS in San Antonio?

Join the STAR+PLUS HCBS interest list first. When that name is reached, an assigned managed care organization completes the eligibility determination. Getting on the list is the starting step; it is not the same as being approved for services.

How far back does Texas look at money or property that was given away?

Texas uses a 60-month asset transfer look-back period. Transfers during those five years can affect eligibility if they are treated as gifts or sales for less than fair value, so families should keep records before they apply.

Is there a cap on how much home care STAR+PLUS HCBS will pay for?

Yes. Texas caps STAR+PLUS HCBS services at 202% of what nursing facility care would otherwise cost. If a proposed home plan would exceed that cap, the authorized hours may be lower than a family hoped, which is why some households add private care.

What is Consumer Directed Services under STAR+PLUS?

Consumer Directed Services is the self-direction option inside STAR+PLUS. It can give eligible members more control over who provides care at home. It does not replace the interest list, the Nursing Facility Level of Care assessment, or the financial eligibility review.

Who actually runs STAR+PLUS for people living in San Antonio?

Private managed care organizations run STAR+PLUS under contract with Texas Health and Human Services. After someone comes off the interest list, the assigned organization is the entity that completes the eligibility determination for that case.