Texas Medicaid Long-Term Care

Last updated: August 21, 2026 Jurisdiction: Texas

Texas long-term care Medicaid runs through STAR+PLUS

Texas Health and Human Services Commission oversees Medicaid long-term services and supports, which are delivered principally through STAR+PLUS for people age 65 or older and people with disabilities. STAR+PLUS combines acute care and long-term services and supports through managed care organizations, with service coordination as its core case-management feature (HHSC STAR+PLUS handbook).

STAR+PLUS does not itself change Medicaid eligibility or the services available; it changes how those services are delivered. The former Department of Aging and Disability Services was abolished in 2017 and its functions moved into HHSC, so older materials that name DADS as the current agency are outdated (Texas Sunset Advisory Commission).

The financial gate is an income cap, not an income spend-down

For 2026, HHSC lists a $2,982 monthly special income limit for one person and $5,964 for a couple in nursing-facility and HCBS-waiver settings. Texas is a special-income-limit state, so income over the applicable limit is not handled through an institutional income spend-down (HHSC Appendix XII; HHSC Appendix XXXVI).

Texas's practical dividing line: an applicant whose countable income exceeds the special income limit may need an irrevocable Qualified Income Trust. A QIT addresses income only; it does not raise the separate resource limit (HHSC QIT policy).

Care at home and care in a facility use related but different paths

STAR+PLUS HCBS operates under Section 1115 waiver authority as an alternative to nursing-facility placement. The program requires, among other conditions, full Medicaid financial eligibility, a nursing-facility level-of-care determination, an unmet need, and an individual service plan within the program cost limit (HHSC STAR+PLUS HCBS eligibility policy).

For nursing-facility coverage, HHSC's published criteria include age 65 or older or a qualifying disability, medical necessity, Texas residence and citizenship or qualified-alien status, and residence in a Medicaid-contracted long-term-care facility for at least 30 consecutive days (HHSC Appendix XII).

Start with the Texas program, then test the facts

Planning requires separate attention to eligibility, income, resources, transfers, the care setting, and a spouse at home. Texas differs from Florida's long-term-care Medicaid page in administration, while Texas uses an income-cap model and QIT mechanism (HHSC Appendix XXXVI).

See Medicaid (Baseline) for the broader funding framework. Verify QIT administration before filing (HHSC QIT policy).

Not mutually exclusive. Most families combine two or three funding pillars — this one rarely stands alone. The Journey Assessment ranks all ten pillars against your specific situation and recommends the top three.

Unlock the Full Texas Breakdown

Enter your name and email to unlock the in-depth Texas-specific detail on this page. This tells us you're requesting Texas information specifically — other state pages ask again so we know exactly which state to follow up on.

Want to know how this fits your family's plan?

Twelve questions. About four minutes. A shortlist of funding strategies ranked for your situation — not a generic list.

Take the Journey Assessment Talk to Someone

Texas long-term care Medicaid runs through STAR+PLUS

Unlock the Full Texas Breakdown

Want to know how this fits your family's plan?

Go deeper with The Dependency Series