Last reviewed October 2026

Can Texas Medicaid pay for long-term care at home instead of a nursing home?

Short answer: Yes. STAR+PLUS Home and Community Based Services (HCBS) serves Medicaid-eligible adults 21 and older who need a nursing-facility level of care but can be served at home or in the community, with services like personal assistance, home-delivered meals, minor home modifications and respite.

STAR+PLUS HCBS, authorized under Texas’s Section 1115 waiver, is meant as a cost-effective alternative to a nursing facility. Services include personal assistance, adaptive aids, adult foster care, assisted living services, emergency response, home-delivered meals, medical supplies, minor home modifications, nursing, respite, therapies, and transition help for someone leaving a nursing facility.

The financial rules track nursing home Medicaid:

  • For 2026, the special income limit of $2,982 per month and the $2,000 resource limit apply, and a Qualified Income Trust can be used for income over the cap.
  • The 60-month look-back and the home equity limit ($752,000 in 2026) apply to waiver services too.
  • A waiver recipient keeps far more income to live on: HHSC’s chart sets the personal needs allowance for an HCBS waiver recipient far above the $75 per month allowed in a nursing facility.

The person must still meet the medical need for a nursing-facility level of care. HHSC assesses the need for the program when the person applies for Medicaid.

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