What You Need to Know About the Medicaid Waiver Program in Texas

Long-term care costs can be overwhelming, especially for aging individuals who require nursing home care or in-home assistance. If you or a loved one needs Medicaid benefits but want to avoid moving into a nursing home, the Medicaid waiver program in Texas may provide an alternative. These programs allow eligible individuals to receive long-term care services at home or in the community instead of an institutional setting.

While many people associate Medicaid waivers with aging, these programs also support individuals with disabilities or chronic conditions, regardless of age. Whether you’re approaching retirement, planning for a loved one, or considering your own future care needs, exploring your options now can provide peace of mind.

Here’s an overview of what you need to know about how these programs work, who qualifies, and how proper Medicaid planning can protect your assets.

How Do Medicaid Waiver Programs Work in Texas?

A Medicaid waiver allows individuals who meet specific medical and financial criteria to receive home and community-based services (HCBS) instead of institutional care. While some waivers focus on long-term care for seniors, others support individuals of all ages with disabilities or complex medical needs regarding:

• Personal care assistance (help with daily activities like bathing and dressing)
• Skilled nursing care
• Physical and occupational therapy
• Respite care for family caregivers
• Home modifications (such as wheelchair ramps and safety installations)

Since traditional Medicaid does not cover extensive home and community-based services, families may have to pay out of pocket for in-home care, which can be costly. Medicaid waivers help bridge this gap by covering essential services that allow individuals to remain at home.

Medicaid Waiver Programs Available in Texas

Texas offers several Medicaid waiver programs, each designed to serve different populations with specific care needs. Some of the programs available in Texas include:

• STAR+PLUS HCBS Program – This is the primary Medicaid waiver for seniors and adults with disabilities who require long-term care. It operates within the STAR+PLUS managed care system and provides home and community-based services for individuals who qualify for a nursing home level of care. Covered services may include home health care, assisted living, personal care, and respite care. However, not all STAR+PLUS enrollees receive HCBS waiver services—additional medical and financial criteria must be met.
• Community Living Assistance and Support Services (CLASS) – Designed for individuals with developmental disabilities who need long-term support. This waiver is not typically used for aging individuals.
• Home and Community-Based Services (HCS) – Supports individuals with intellectual disabilities, offering residential assistance, therapy, and behavioral support. This program is not intended for seniors and differs from the STAR+PLUS HCBS waiver, even though both fall under the general HCBS category.
• Deaf Blind with Multiple Disabilities (DBMD) – Provides specialized care for individuals who are both deaf and blind, regardless of age.

Each program has unique eligibility criteria, and applicants must demonstrate both financial need and medical necessity. Due to high demand, some waiver programs, including STAR+PLUS HCBS, have long waitlists.  Below, we’ll discuss the eligibility requirements for STAR+PLUS HCBS in more detail.

Eligibility for the STAR+PLUS HCBS Waiver Program in Texas

To qualify for the STAR+PLUS HCBS program, applicants must meet the following criteria:​

• Age: Be 21 years or older.
• Residency: Be a resident of Texas.
• Citizenship: Be a U.S. citizen or have an acceptable immigration status.
• Medicaid Eligibility: Have full Medicaid financial eligibility, which includes meeting income and asset limits.
• Medical Necessity: Have an approved medical necessity for a nursing facility level of care, as determined by a comprehensive assessment.
• Individual Service Plan (ISP): Have an ISP with services that do not exceed the established cost limit.
• Unmet Service Need: Have an unmet need for at least one STAR+PLUS HCBS program service.
• Living Arrangement: Reside in an appropriate living situation that supports community-based services.

Applicants must not be enrolled in another Medicaid HCBS waiver program approved by the Centers for Medicare & Medicaid Services.

Given the complexity of the eligibility requirements and the potential for waiting lists, it’s advisable to begin planning early. Consulting Medicaid planning attorneys can provide guidance on navigating the application process and structuring assets to maintain eligibility.

Protecting Assets While Qualifying for Medicaid

Many families worry about how to protect assets while still qualifying for long-term care under Texas Medicaid. Without proper Medicaid planning, individuals may be required to spend down their savings before they can access Medicaid benefits.

Strategies to Preserve Eligibility:

• Miller Trust (Qualified Income Trust) – In Texas, a Miller Trust is required for individuals whose income exceeds Medicaid’s limit. This legally designated trust allows excess income to be managed in a way that preserves Medicaid eligibility while ensuring funds are used for approved expenses, such as medical care.
• Irrevocable Trust – This type of trust protects assets by transferring ownership out of the applicant’s name, preventing them from being counted toward Medicaid eligibility. However, assets placed in an irrevocable trust may still be subject to Medicaid’s 5-year look-back period, which means transfers must be planned well in advance of applying for benefits.
• Comprehensive Estate Planning – Medicaid eligibility rules are complex, and improper asset management can lead to penalties or disqualification. Working with a Houston Medicaid planning lawyer can help individuals legally structure their assets, preserve wealth, and maintain eligibility for long-term care benefits when needed.

Without proper Medicaid planning, you may face delays, unexpected penalties, or be forced to spend down your assets before qualifying for benefits. Taking proactive steps now can help protect your financial security while securing the care you need.

Get the Right Legal Strategy for Medicaid Waivers and Long-Term Care

Securing Medicaid benefits isn’t just about meeting financial limits—it’s about knowing your options. Whether you’re applying for a Medicaid waiver to receive care at home, seeking nursing home benefits, or protecting assets for the future, having a legal strategy can make all the difference.

At Your Legacy Legal Care®, our elder law attorneys help Houston families apply for Medicaid waivers, navigate long-term care planning, and preserve eligibility while protecting family assets. If you’re unsure whether you qualify for STAR+PLUS HCBS or other Medicaid waiver programs, we can assess your situation and guide you toward the best solution.

Your online search for a “Medicaid planning lawyer near me” and “lawyer for elderly” brought you to this blog. Take the next step toward securing your future. Call us today at (281) 218-0880(281) 218-0880 or fill out our confidential online form to schedule your strategy session with a Houston Medicaid planning attorney.

While you wait for your strategy session, we invite you to check out our podcast, “Life Happens!”, with estate planning and elder law attorney Kim Hegwood.

We help families plan for the future, protect their loved ones, and guide them through the unexpected.

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The information in this blog post (“post”) is provided for general informational purposes only and may not reflect the current law in your jurisdiction. No information in this post should be construed as legal advice from the individual author or the law firm, nor is it intended to be a substitute for legal counsel on any subject matter. No reader of this post should act or refrain from acting based on any information included in or accessible through this post without seeking the appropriate legal or other professional advice on the particular facts and circumstances at issue from a lawyer licensed in the recipient’s state, country, or other appropriate licensing jurisdiction.

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