Texas Medicaid Programs

  Medicaid is a jointly funded federal and state program that provides health coverage to certain groups of low-income people.  It provides medical care and supportive services to people who qualify for Medicaid under one of the programs in this chapter. Services include doctor visits, vendor drugs, nursing facility services, and long-term care. While the federal government establishes general guidelines for the program, each state determines Medicaid eligibility. 

 HHSC Medicaid for the Elderly and People with Disabilities (MEPD) staff determine eligibility. 

Below are Texas Medicaid Programs for long term care:

  Long-term nursing care can be a difficult subject to speak of in today’s household. The reality check: 70% of Americans will need some long-term care within their lifetime and the average stay is 3.7 years for women and 2.2 years for men. 

Cost and Coverage:

• You must pay part of the cost by using your qualifying income (e.g. social security and pension), also known as your copay.
• Medicaid covers the remainder up-to 100% indefinitely, as long as you remain eligible.
• Keep in mind, any other health supplemental insurance will be used before Medicaid.

Medicaid for long-term care covers the following:

• Doctor’s visits
• Drugs ordered by a doctor.
• Lab and X-ray charges
• Hospital care
• Vision and hearing care
• Nursing home room and board

How will you pay the $5,000 to $7,000 per month in nursing home costs? Medicare? Private pay? Maybe. The good news: Medicaid is there to help, and there are ways to qualify. 

STAR+PLUS is a Texas Medicaid managed care program that provides long term care services and support at the recipient’s home, postponing the need for institutionalization. Therefore, the program allows disabled adults and elderly Texans, age 65 or older, who require a nursing facility level of care to reside at home, adult foster care, or in assisted living residences and receive care services in those locations. Under this Medicaid waiver, both medical care and non-medical long-term care services are covered. Benefits such as personal care, adult day care, assistance for home modifications, and personal emergency response systems are available.

STAR+PLUS requires an individual be placed on an interest list (known as the waiting list) for the program. The interest list is known for having a significant waiting period (in some cases years). However, some needs may be met through other programs until an applicant's name comes to the top of the list. People can receive Medicaid or other community services while they are on the interest list, if they are eligible. Receiving other services does not impact a person's place on an interest list. 

 However, if admitted into a long-term care nursing facility for thirty consecutive days, and you are approved for “normal” long-term care Medicaid, you may be able to discharge the facility and bypass the interest list.  Thus, immediately start receiving Star + Plus services at home or an assisted living facility quicker than waiting on the interest list.

The application process for STAR+PLUS is different than traditional long-term care Medicaid, however the eligibility criteria is the same.  To be added to the state interest list please call 1-855-937-2372 for the Department of Aging or Call the HHSC Interest List at 1-877-438-5658. 

 You DO NOT need medical or diagnostic info to get on Interest lists. Just name, address, phone, birthday, & social security number. 

UPDATE- Currently the wait time for Star Plus Waiver Medicaid is about 90 days.  *(09/01/2024)