How do I get on the STAR+PLUS HCBS interest list in Houston?

Contact the Texas Health and Human Services Commission's Interest List Management unit to have your name added. If the person needing care is already enrolled in a STAR+PLUS managed care plan, contact that plan's service coordinator instead — HHSC's handbook notes that some already-enrolled Medicaid members can bypass the interest list through the upgrade process. There is no cost and no obligation to accept services when your name comes up.

Does Texas Medicaid pay for assisted living in Houston?

STAR+PLUS HCBS can pay for the care services a person receives while living in an assisted living facility, but it does not pay for room and board in that facility. Families typically cover rent and meals from the person's Social Security, pension or other income. Not every Greater Houston community participates in the waiver, so ask each facility directly whether it accepts STAR+PLUS HCBS members and what its separate room-and-board charge is.

What counties does the Harris STAR+PLUS service area cover?

HHSC defines the Harris service area as nine counties: Austin, Brazoria, Fort Bend, Galveston, Harris, Matagorda, Montgomery, Waller and Wharton. Greater Houston families in Harris, Fort Bend, Montgomery, Brazoria and Galveston counties all fall inside it.

Who qualifies for STAR+PLUS HCBS in Texas?

Under 1 Texas Administrative Code §353.1153 an applicant must be 21 or older, have full Medicaid financial eligibility, be a U.S. citizen and Texas resident, have an approved medical necessity determination for a nursing facility level of care, have an individual service plan under the cost limit, have an unmet need for at least one waiver service, and be in an appropriate living arrangement. Meeting all eight still does not start the process — the name has to reach the top of the interest list first.

How long is the STAR+PLUS interest list wait in Houston?

HHSC does not publish a reliable Houston-specific wait time, and the figures circulating online do not trace back to a primary source, so we won't quote one. The wait is measured in months and moves independently of how urgent a family's situation is. The practical takeaway is to join the list well before care is needed, and to plan a bridge — in-home care, adult day services, or private pay — for the interim.

The STAR+PLUS Interest List: How Houston Families Actually Get Medicaid Help With Assisted Living

Texas Medicaid can help pay for care in an assisted living community through the STAR+PLUS HCBS waiver. But there's a waiting line most Houston families don't hear about until they need care next month — and knowing it exists a year early is worth more than anything else in this guide.

Almost every Houston family that calls us about paying for assisted living asks some version of the same question: "Doesn't Medicaid cover this?" The honest answer is layered, and the layer that trips people up isn't eligibility — it's the interest list. Texas runs its main long-term-care benefit for community living, STAR+PLUS HCBS, as a waiver with a waiting line. If you don't know that line exists, you can lose a year before you ever start.

This guide walks through how the interest list actually works for families in Harris, Fort Bend, Montgomery, Brazoria and Galveston counties, what the program will and won't pay for in an assisted living community, and the one step worth taking this week even if your parent doesn't need care yet.

First: what STAR+PLUS HCBS actually is

STAR+PLUS is Texas Medicaid's managed-care program for adults who are 65 or older or who have a disability. Inside it sits a waiver commonly called STAR+PLUS HCBS (Home and Community Based Services). Its purpose is narrow and specific: to pay for long-term services and supports for people who medically qualify for a nursing facility but would rather stay in the community — at home, in an adult foster care home, or in an assisted living facility.

That framing matters. The waiver is not a general "help with senior housing" benefit. Texas is only willing to fund it because the alternative — a nursing facility placement — costs the state more. Everything about the eligibility rules follows from that logic.

The eight eligibility criteria

Under Title 1 Texas Administrative Code §353.1153, an applicant must:

Be 21 years or older
Have full Medicaid financial eligibility
Be a U.S. citizen
Be a resident of Texas
Have an approved medical necessity determination for a nursing facility level of care
Have an individual service plan (ISP) that comes in under the established cost limit
Have an unmet need for at least one STAR+PLUS HCBS service
Be living in an appropriate living situation (not an inpatient of a hospital, nursing facility, or ICF/IID)

The cost-limit rule is worth understanding because it quietly decides some cases. As of HHSC's February 2025 revision, the ISP cost is not supposed to exceed 202 percent of what the state would pay for that same person in a nursing facility. Your managed care organization's service coordinator builds the plan; the Texas Medicaid & Healthcare Partnership calculates the ceiling from the Medical Necessity and Level of Care assessment. If a plan runs over, it goes to HHSC's Office of the Medical Director for a Medically Fragile or general-revenue review rather than being flatly denied.

The part nobody warns you about: the interest list

Here is the mechanic that costs Houston families the most time. Per HHSC's own operational handbook, a person becomes eligible to be assessed for STAR+PLUS HCBS only when their name reaches the top of the interest list. You do not apply, get evaluated, and get approved. You get in line first, and the evaluation happens at the front of the line.

You are added to the list by contacting HHSC's Interest List Management unit — or, if your parent is already enrolled in STAR+PLUS, by contacting their managed care organization directly.

Quick answer: To join the Texas STAR+PLUS HCBS interest list, call HHSC Interest List Management. If your parent is already in a STAR+PLUS plan, call that plan's service coordinator instead — some already-enrolled Medicaid members can bypass the list entirely through the upgrade process.

That last point is genuinely important and under-publicized: HHSC's handbook notes that individuals already receiving Medicaid and enrolled with an MCO may be able to bypass the interest list through the upgrade process. If your parent is already a STAR+PLUS member, do not assume you're starting at the back. Ask the service coordinator specifically about an upgrade.

How long is the wait?

We won't publish a Houston-specific number, because HHSC does not publish a reliable per-metro figure and the estimates circulating online trace back to no primary source. What we can tell you is that the list is real, it is measured in months rather than weeks, and it moves independently of how urgent your family's situation feels. Treat any specific wait-time figure you see online — including from a placement agency — as unverified unless HHSC published it.

The practical consequence is the same regardless of the exact number: get on the list before you need it. There is no penalty for being on the interest list and declining services when your name comes up. There is a substantial penalty for starting the clock the week after a hospital discharge.

What the waiver pays for in an assisted living community — and what it doesn't

This is the second place Houston families get surprised. STAR+PLUS HCBS can fund care delivered in an assisted living facility. It does not fund room and board in one.

So the personal attendant care, the nursing oversight, the therapies, the emergency response system, the care coordination — those can be covered. The rent, the meals, and the basic hotel cost of living there are the family's responsibility, typically paid from your parent's Social Security, pension, or other income.

For a Houston-area family this usually means the waiver converts an unaffordable number into a merely difficult one, rather than eliminating the bill. It's still often the difference between a community placement and a nursing home. But go in with the right expectation, and ask any facility you tour two blunt questions: do you accept STAR+PLUS HCBS members at all, and what is your monthly room-and-board charge separate from care? Many Greater Houston communities do not participate in the waiver, and the ones that do often hold a limited number of waiver beds.

Which health plan serves the Houston area

Texas splits STAR+PLUS into service areas. Greater Houston falls in the Harris service area, which HHSC defines as nine counties: Austin, Brazoria, Fort Bend, Galveston, Harris, Matagorda, Montgomery, Waller and Wharton.

Several managed care organizations operate in the Harris service area, including Community Health Choice, UnitedHealthcare Community Plan, Wellpoint, Molina and Superior. The lineup is set by HHSC and does change between procurement cycles — so rather than trusting any list (including this one) as permanent, confirm the current options through the state's enrollment broker at 1-800-964-2777 or on HHSC's published "STAR+PLUS Health Plans by Service Areas" chart.

The plan you choose matters more than families expect. Your MCO's service coordinator is the person who conducts the assessment, builds the individual service plan, and decides what goes in it. That relationship is the program, in practice.

A realistic sequence for a Houston family

Call HHSC Interest List Management now, even if care is 18 months away. If your parent already has STAR+PLUS, call the plan and ask about the upgrade process instead.
Get the financial picture straight in parallel. Full Medicaid financial eligibility is its own determination, made by a Medicaid for the Elderly and People with Disabilities specialist on Form H1200. Income and asset limits change annually and the rules around spousal impoverishment, exempt assets and transfers are genuinely complicated — this is the point to talk to an elder law attorney rather than a website.
Line up the medical documentation. The nursing-facility level-of-care finding comes from the MN/LOC assessment, which for community applicants requires a physician's signature. Make sure your parent's Houston-area physician knows this is coming.
Tour with the right question. While you wait, tour communities and ask directly about waiver participation and room-and-board pricing. A facility that says "we take Medicaid" may mean its skilled nursing wing, not assisted living.
Have a bridge plan. Because the list takes time, most families need an interim answer — in-home care a few hours a day, adult day services, or private-pay assisted living for a period. Plan for the gap rather than being caught by it.

If the situation is urgent right now

If your parent is being discharged from a Houston hospital this week, the interest list is not your answer — it's too slow. In that scenario the realistic paths are Medicare-covered short-term rehab (if they qualify after a hospital stay), a nursing facility placement where Medicaid works differently and does cover room and board, or private-pay care while the waiver process runs in the background. Get on the interest list anyway, the same day. It costs nothing and the clock only starts once.

Our advisors do this at no cost to Houston families, and we're not paid by the state — we'll tell you plainly when a waiver isn't the right tool for your timeline. Call (346) 385-3815 and we'll walk your specific situation through.

Last updated August 18, 2026. This guide is general information for Greater Houston families, not medical, legal, or financial advice.