Texas runs seven home and community based services (HCBS) waiver programs, but only one is built specifically for seniors: the STAR+PLUS HCBS waiver. If you're trying to keep a parent or loved one at home instead of in a nursing facility, this guide breaks down which Texas HCBS waiver programs they might qualify for, what each one covers, and how to get on the list. The hard truth: approximately 156,161 Texans are waiting for waiver services right now.
In This Guide
- Key Takeaways
- What Is an HCBS Waiver?
- STAR+PLUS HCBS: The Main Waiver for Seniors
- Other Texas Waiver Programs
- The Interest List: How Waitlists Work
- How to Get on the Interest List
- Waivers vs. Regular Medicaid
- Money Follows the Person: Leaving a Nursing Facility
- Frequently Asked Questions
- Next Steps
Key Takeaways
- STAR+PLUS HCBS is the primary Texas HCBS waiver for seniors 65+. It covers in-home nursing, respite care, home modifications, meals, assisted living, and 19 total services.
- Approximately 15,850 people are on the STAR+PLUS HCBS interest list.
- Texas has seven HCBS waivers total, but most serve people with intellectual or developmental disabilities. Only STAR+PLUS HCBS specifically serves seniors.
- Waivers are not entitlements. Meeting eligibility doesn't guarantee a spot. Interest lists can mean months to years of waiting.
- Money Follows the Person helps people leave nursing facilities and skip the interest list entirely.
What Is an HCBS Waiver?
An HCBS waiver is a Medicaid program that "waives" the rule requiring someone to live in an institution (like a nursing home) to get that level of care. Instead, the person receives services at home or in the community.
The federal government approves each waiver under Section 1915(c) of the Social Security Act. Texas then designs the specific services, eligibility rules, and enrollment caps for each program.
Here's why waivers matter: base STAR+PLUS covers medical care and limited attendant services, but it doesn't cover things like home modifications, home-delivered meals, in-home nursing, respite care, or assisted living. Waivers fill that gap for people who need a higher level of support to stay out of a nursing facility.
The catch is that waivers have enrollment caps. Unlike base Medicaid (which is an entitlement), waiver slots are limited. When they're full, you go on an interest list.
Not sure which program fits your family? Ask Brevy's chatbot for a personalized recommendation based on your loved one's needs.
STAR+PLUS HCBS: The Main Waiver for Seniors
If your loved one is 65 or older and needs help staying at home, the STAR+PLUS HCBS waiver is the program to know. It serves adults age 21 and older who would otherwise need nursing facility placement.
Who Qualifies
- Age 21 or older (most enrollees are 65+)
- Texas resident on Medicaid
- Income at or below $2,982/month (300% of SSI FBR)
- Countable assets at or below $2,000 (single)
- Must meet Nursing Facility Level of Care (NFLOC) based on ADL limitations and care needs
- Must be safely servable in the community
What It Covers
The STAR+PLUS HCBS waiver covers 19 services that go well beyond base Medicaid:
- Personal assistance services (bathing, dressing, grooming, eating, household tasks)
- In-home nursing
- In-home and out-of-home respite care
- Home-delivered meals
- Minor home modifications (ramps, grab bars, widened doorways)
- Adaptive aids and medical supplies
- Emergency response systems (personal alert buttons)
- Physical, occupational, speech, and cognitive rehabilitation therapy
- Dental services (up to $5,000/year)
- Assisted living
- Adult foster care
- Transition assistance services
- Employment assistance and supported employment
- Financial management services (for self-directed care)
The Interest List
The STAR+PLUS HCBS waiver has approximately 24,000 annual enrollment slots, but roughly 15,850 people are on the interest list as of late 2025. The list is first-come, first-served. When a slot opens, HHSC contacts the next person on the list to begin the eligibility assessment.
HHSC does not pre-screen applicants before placing them on the interest list. Some people are denied when they reach the top because they don't meet the nursing facility level of care requirement. Getting on the list early, even before you think services are needed, is common advice from Medicaid planners.
How Services Are Delivered
STAR+PLUS HCBS services are delivered through your MCO (managed care organization). Your MCO's service coordinator develops your Individual Service Plan (ISP), coordinates your care, and conducts at least two face-to-face visits per year.
You can choose the Consumer Directed Services (CDS) option to hire and manage your own attendants, including adult children and grandchildren (but not spouses).
Want to understand the STAR+PLUS HCBS waiver in detail? Chat with Brevy for help with eligibility and the interest list process.
Other Texas Waiver Programs
While STAR+PLUS HCBS is the main waiver for seniors, Texas operates six other waivers. Most serve people with intellectual or developmental disabilities (IDD) and have extremely long wait times.
CLASS (Community Living Assistance and Support Services)
CLASS has operated since 1991 and serves Texans of all ages with a primary diagnosis of an intellectual disability or related condition. To qualify, you need an ICF/IID Level of Care determination showing moderate to extreme deficits in adaptive behavior.
Interest list: approximately 48,169 people. The wait can be many years. Services are delivered through contracted case management agencies.
CLASS could apply to an older adult who has an intellectual disability or related condition diagnosed earlier in life and now needs community support as they age.
HCS (Home and Community-based Services)
HCS is the largest IDD waiver in Texas, operating since 1985. It serves all ages but requires an intellectual disability (full scale IQ of 69 or below) or a related condition with adaptive behavior deficits.
Interest list: approximately 67,909 people -- the longest in the state. Service coordination is provided by the local LIDDA (Local Intellectual and Developmental Disability Authority).
TxHmL (Texas Home Living)
TxHmL has the same eligibility as HCS but provides a smaller service package at a lower cost cap ($31,684/year as of September 2025). It's designed for people who need less intensive support. Also coordinated through LIDDAs.
DBMD (Deaf Blind with Multiple Disabilities)
DBMD serves Texans of all ages with deafblindness and additional disabilities that impair independent functioning. Interest list: approximately 543 people.
Youth-Focused Waivers
Two waivers serve children and young adults exclusively:
- MDCP (Medically Dependent Children Program): Ages 0-20, waives nursing facility placement. Interest list: approximately 27,012 people.
- YES (Youth Empowerment Services): Ages 3-18, for youth with serious emotional disturbances.
| Waiver | Ages | Who It Serves | Interest List | Managed By |
|---|---|---|---|---|
| STAR+PLUS HCBS | 21+ | Seniors and adults with disabilities who need nursing-facility-level care | ~15,850 | MCO |
| CLASS | All ages | People with intellectual or developmental disabilities (IDD) or related conditions | ~48,169 | Contracted agency |
| HCS | All ages | People with intellectual disabilities (IQ 69 or below) or related conditions | ~67,909 | LIDDA |
| TxHmL | All ages | Same as HCS but lower support needs (cost cap $31,684/year) | Shared with HCS | LIDDA |
| DBMD | All ages | People who are deaf-blind with additional disabilities | ~543 | Contracted agency |
| MDCP | 0-20 | Children who are medically dependent and would otherwise need nursing facility care | ~27,012 | MCO |
| YES | 3-18 | Youth with serious emotional disturbances | Varies | LMHA |
The Interest List: How Waitlists Work
Texas calls its waiver waitlists "interest lists." Approximately 156,161 people are waiting across all programs.
How It Works
- You request to be added to the interest list for a specific waiver
- You're placed based on the date of your request (first-come, first-served)
- When a slot opens, HHSC contacts you for an eligibility assessment
- If you meet all requirements, services begin
- If you don't qualify, you're removed from the list
Important Details
- You can be on multiple interest lists at once
- Being on the list does not mean you'll qualify when your turn comes
- HHSC does not pre-screen for eligibility before placing you on the list
- The STAR+PLUS HCBS list moves faster than IDD waiver lists because it has more annual slots
How to Get on the Interest List
For STAR+PLUS HCBS
Call HHSC at 1-877-438-5658 or register through Your Texas Benefits. You don't need to have a Medicaid determination first, though you'll need to qualify for Medicaid before you can actually enroll.
For HCS and TxHmL
Contact your local LIDDA (Local Intellectual and Developmental Disability Authority). Find yours at hhs.texas.gov or call 2-1-1.
For CLASS, DBMD, and MDCP
Call HHSC at 1-877-438-5658.
Getting on the list as early as possible is the single most useful thing you can do. Families who wait until care needs are urgent often face the hardest choices because the wait can stretch for years on some lists.
Have questions about the interest list process? Brevy's chatbot can walk you through the steps for your specific situation.
Waivers vs. Regular Medicaid
If your parent is already on STAR+PLUS, they're getting base Medicaid services: doctor visits, hospital care, prescriptions, personal attendant services, and behavioral health. So why bother with a waiver?
The waiver unlocks services that base Medicaid doesn't cover:
What base STAR+PLUS already covers: doctor visits, hospital, prescriptions, limited personal attendant services, behavioral health, vision, labs, and imaging.
What the HCBS waiver adds on top: in-home nursing, respite care (in-home and out-of-home), home-delivered meals, minor home modifications, emergency response systems, assisted living, adult foster care, dental up to $5,000/year, and therapies (PT, OT, speech, cognitive).
Meanwhile, Community First Choice (CFC) is a Medicaid state plan option (not a waiver) that provides personal attendant services with no waitlist. It bridges the gap between base services and waiver services for people who need personal care but don't yet have a waiver slot.
Money Follows the Person: Leaving a Nursing Facility
If your loved one is currently in a nursing facility and wants to come home, Money Follows the Person (MFP) can help, and it skips the interest list entirely.
Who Qualifies
- Currently on Medicaid
- Living in a nursing facility, state supported living center (SSLC), or ICF/IID for at least 60 consecutive days (hospital or SNF days count toward the 60)
- Eligible for a Texas Medicaid waiver program
What You Get
- Transition Assistance Services (TAS): Up to $2,500 one-time for relocation expenses like furniture, deposits, and moving costs
- Supplemental Transition Services (STS): An additional $2,500 for NF transitions for expenses TAS doesn't cover
- Enhanced Community Coordination: Emergency assistance, rental and utility help, nutritional supplements, clothing, minor home modifications, and transportation for trial community visits
- Help with daily needs like bathing, shopping, cooking, and house cleaning once in the community
Who Can Help
A nursing facility social worker, long-term care ombudsman, your LIDDA habilitation coordinator, a relocation specialist, or your MCO service coordinator can start the process. Anyone can make a referral, including family members.
This is one of the most underused programs in Texas. If your parent ended up in a nursing home and you're wondering if they could come back, MFP is the first call to make.
Frequently Asked Questions
The STAR+PLUS HCBS waiver is the primary program for seniors. It serves adults 21 and older who need nursing facility level of care but can be safely served in the community. Other waivers (CLASS, HCS, TxHmL, DBMD) serve all ages but require an intellectual or developmental disability diagnosis.
It varies by program. The STAR+PLUS HCBS interest list has approximately 15,850 people with about 24,000 annual slots. The HCS waiver has approximately 67,909 people waiting, and CLASS has approximately 48,169. IDD waiver waits can stretch for years. Get on the list as early as possible.
Yes, through Money Follows the Person (MFP). If your parent is in a nursing facility for at least 60 days and qualifies for a waiver program, MFP can transition them to the community without going on the interest list. MFP also provides up to $5,000 in transition funding.
Base STAR+PLUS covers medical care (doctors, hospitals, prescriptions) and limited attendant services. HCBS waivers add expanded home services like in-home nursing, respite care, home modifications, meals, assisted living, and therapies. Waivers have enrollment caps and waitlists; base Medicaid is an entitlement.
Next Steps
- Learn about STAR+PLUS in depth: Our STAR+PLUS waiver guide covers the program's eligibility, services, and MCOs in detail
- See all Texas Medicaid programs: Our overview of Texas Medicaid programs for seniors compares STAR+PLUS, CAS, HCBS waivers, and PACE
- Understand what's covered: Our guide to Texas Medicaid covered services explains what base STAR+PLUS covers vs. waiver services
- Apply for Medicaid: Start with our step-by-step application guide
- Get personalized help: Find home health care near you at brevy.com
The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Medicaid rules vary by state and change frequently. Always verify eligibility and benefits with your state Medicaid agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.