Texas Medicaid STAR+PLUS for dementia care

What is STAR+PLUS?

STAR+PLUS is Texas Medicaid's managed-care program for people who have disabilities or are age 65 and older. It covers both standard Medicaid benefits (doctor visits, hospital care, prescriptions) and, for people who qualify, long-term services and supports in the community instead of a nursing facility. Those community-based services are often called the STAR+PLUS Home and Community-Based Services (HCBS) waiver.

For families caring for someone with dementia, STAR+PLUS is one of the most important paths to help pay for personal care, adult day care, respite, home modifications, and other support that keeps a person at home longer.

Why STAR+PLUS matters for dementia care

Dementia is progressive. Over time, many people need help with bathing, dressing, meals, medication reminders, and supervision. Medicare does not pay for most long-term custodial care, and private memory care can cost thousands of dollars a month. STAR+PLUS can help eligible Texans cover some of those costs, especially when care is provided at home, in an adult day setting, or through an assisted living facility that participates in the program.

It is not a one-size-fits-all solution. Benefits depend on medical need, income, assets, and which managed care plan you choose. But it is the primary Texas Medicaid pathway families should understand when paying for care becomes a concern.

Who qualifies for STAR+PLUS

Eligibility has two parts: medical and financial. You must meet both. Rules can change, so always verify current limits with Texas Health and Human Services (HHS) or a local benefits counselor.

Medical eligibility

• Be age 65 or older, or have a disability as determined by Social Security or Texas HHS.
• Meet the medical criteria for nursing facility level of care. A state assessment looks at whether you need help with daily activities such as bathing, dressing, eating, toileting, transferring, or taking medications.
• For dementia, the assessment also considers whether the person needs supervision for safety, wandering, or behavioral symptoms.

Financial eligibility

• STAR+PLUS is for people with limited income and assets. Income limits vary by program pathway and whether the person is single or married.
• Texas allows some assets to be exempt, such as a primary home (up to an equity limit), one vehicle, burial plots, and certain small life insurance policies. Countable assets are typically limited to a few thousand dollars for an individual.
• Spousal rules may protect some income and assets for a spouse still living at home. These rules are complex and worth reviewing with an elder-law attorney or benefits counselor.

What services STAR+PLUS covers for dementia

The exact services available depend on the managed care plan and the person's assessed needs. Common services that help families dealing with dementia include:

• Personal attendant care: Help with bathing, dressing, grooming, meals, and light housekeeping.
• Respite care: Short-term relief so a family caregiver can rest, work, or handle other responsibilities.
• Adult day care: Supervised daytime activities and care, which can also give caregivers a break.
• Home modifications: Grab bars, ramps, and other safety changes that let a person stay at home longer.
• Home-delivered meals and nutritional support.
• Primary care, specialty care, and prescription drug coverage through the standard Medicaid benefit package.
• Assisted living / intermediate care facility services in certain participating facilities for people who meet the waiver criteria.

STAR+PLUS does not cover room and board in an assisted living facility. It covers the care services portion. Families still pay the facility's basic rent and board unless another program helps.

STAR+PLUS vs. nursing facility Medicaid

Texas Medicaid also pays for nursing facility care when someone meets the medical and financial criteria. The difference is where the care is provided:

• STAR+PLUS HCBS waiver: Services delivered in the home, community, or certain assisted living settings. The goal is to avoid or delay nursing facility placement.
• Nursing facility Medicaid: Care provided in a licensed nursing home. Medicaid pays for the care portion; the resident contributes most of their income toward the cost.

A person can move from STAR+PLUS community services to nursing facility Medicaid if their needs increase. The same Medicaid eligibility usually applies, though the care setting and paperwork differ.

How to apply for STAR+PLUS

1. Start with Your Texas Benefits: Apply online at YourTexasBenefits.com, by phone, or in person at a local HHS office. You will need ID, citizenship or lawful residency documents, proof of income, and bank or asset statements.
2. Complete the Medicaid eligibility review. Texas HHS will determine if the person qualifies financially and medically.
3. Choose or be assigned a STAR+PLUS managed care plan. If approved, Texas will send information about available plans. Compare provider networks, especially if the person already sees a neurologist, geriatrician, or memory care clinic.
4. Request a long-term services assessment. Ask the plan or HHS for a Medical Necessity and Level of Care assessment to see if the person qualifies for HCBS waiver services.
5. Work with a service coordinator. Once enrolled, a service coordinator helps develop a plan of care and connects the family to approved providers.

Tips for families navigating STAR+PLUS

• Apply early. Assessments and approvals can take weeks or months. Do not wait until a crisis.
• Keep a folder of documents. Income, assets, diagnoses, medication lists, and doctor notes all matter.
• Ask about memory care providers. Not all STAR+PLUS plans or adult day centers serve people with dementia. Ask specifically about dementia experience and staff training.
• Compare managed care plans. Each plan has its own network of doctors, home care agencies, and facilities. Use the annual open enrollment period to switch if needed.
• Get free help. Area Agencies on Aging, 2-1-1 Texas, and elder-law attorneys can help you understand eligibility and avoid mistakes. Be cautious of anyone charging large fees to "guarantee" Medicaid approval.

What to do next

If your family is starting to think about paying for dementia care, review the broader picture in Paying for Care. Then check whether STAR+PLUS is the right next step for your situation. Many families combine Medicaid with Medicare, veteran benefits, long-term care insurance, or private pay to cover the full cost of care.

Educational only. Texas Dementia Care is not affiliated with Texas HHS, Medicaid, or any government agency. Eligibility rules, income limits, and covered services change over time. Always verify current information with YourTexasBenefits.com or a qualified benefits counselor.