How Medicaid Can Help Pay for Long-Term Care in Texas

Q: How long is the STAR+PLUS HCBS waiver waitlist in Texas?

It varies significantly by region — typically 6 to 18 months. Rural areas tend to be shorter (3-8 months), while major metros like Dallas and Austin can run 8-16 months. Getting on the interest list early matters more than almost anything else in the process.

Q: Is there a Texas Medicaid long-term care option with no waitlist?

Yes — Community First Choice (CFC) is an entitlement program covering personal care assistance and in-home support, with no waitlist, unlike the STAR+PLUS HCBS waiver.

Q: What is a Qualified Income Trust in Texas?

Texas is an income-cap state with no income spend-down option — if your income exceeds the $2,982/month limit, a Qualified Income Trust (informally called a Miller Trust) must be set up to redirect the excess before Medicaid approves your application. Texas was among the first states to use this structure.

Published August 28, 2026 How we keep this accurate

This page is Texas-specific. Medicaid long-term care rules vary significantly by state. See our national Medicaid Waivers Explained guide if you're elsewhere.

Two very different paths to in-home support

Texas delivers long-term care Medicaid through STAR+PLUS, its managed care program for seniors 65+ and adults with disabilities. But there are two distinct ways to get home-based help, and they work completely differently:

	STAR+PLUS HCBS Waiver	Community First Choice (CFC)
Guaranteed if eligible?	No — interest list, real wait times	Yes — an entitlement, no waitlist
Typical wait	6-18 months, varies by region	None
What it covers	Broader: assisted living services, adult foster care, home modifications, adaptive aids	Personal care assistance, meal prep, medical alert, light housework

Source: Texas Health and Human Services Commission (HHSC); figures effective 2026.

If you need help now, ask about CFC first. Because it's an entitlement with no waitlist, it can provide real in-home support immediately while you're on the STAR+PLUS interest list for the broader waiver.

How long is the actual wait?

The STAR+PLUS HCBS interest list runs 6 to 18 months depending on your region — rural areas tend to move faster (3-8 months), while major metros like Dallas and Austin can take 8-16 months. Getting on the interest list as early as possible, even before care is urgently needed, is the single most important step in this entire process.

The 2026 financial numbers

Income limit: $2,982/month (300% of the Federal Benefit Rate), regardless of marital status for the applicant.

Asset limit: $2,000 for a single applicant. Your home is exempt up to $752,000 in equity (2026) — above that, Texas can deny both nursing facility Medicaid and HCBS waiver services.

Spousal protection: the non-applicant spouse can keep up to $162,660 in assets, plus a Minimum Monthly Maintenance Needs Allowance up to $3,948/month if housing and utility costs are high.

Texas is an income-cap state — no income spend-down

Unlike states that let you "spend down" excess income on medical bills, Texas doesn't offer that option. If your income exceeds $2,982/month, you'll need a Qualified Income Trust (QIT) — informally called a Miller Trust — to redirect the excess before Medicaid approves your application. Texas was among the first states to use this structure and follows a "name on the check" rule, meaning income is attributed to whoever's name is on the payment. This needs to be set up correctly by someone who knows the rule, not assembled yourself.

How to actually start

Apply for Texas Medicaid and ask specifically about the STAR+PLUS HCBS interest list — get on it immediately given the real wait times, regardless of whether you need care yet.

Ask about Community First Choice in the same conversation — it can start covering real support without the wait.

If your income is close to or above $2,982/month, ask about setting up a Qualified Income Trust before you're denied for exceeding the limit — see Questions to Ask an Elder Law Attorney for how to find someone who handles this correctly.

Common Questions

How long is the STAR+PLUS HCBS waiver waitlist in Texas?

6 to 18 months depending on region — shorter in rural areas, longer in major metros like Dallas and Austin.

Is there a Texas Medicaid long-term care option with no waitlist?

Yes — Community First Choice (CFC) is an entitlement with no waitlist, covering personal care and in-home support.

What is a Qualified Income Trust in Texas?

A required legal structure if your income exceeds $2,982/month — Texas doesn't allow income spend-down, so this redirects excess income before Medicaid approval.