Does Medicaid Cover Memory Care in Texas? STAR+PLUS Waiver and Costs

Texas Medicaid can pay for memory care, but with an important split. It will cover personal care, nursing, therapies, and supervision for a person with dementia living in a licensed memory care community, but it generally will not pay the room-and-board portion of that facility. The one place Medicaid pays for everything, room and board included, is a nursing home. Which program applies to your family depends on the setting, the license the facility holds, and whether your relative meets both the financial and medical rules.¹²

Nursing Home Memory Care vs. Assisted Living Memory Care

Most standalone memory care communities in Texas are licensed as assisted living facilities, not nursing homes. That single fact drives everything about how Medicaid pays.

In a nursing home, Medicaid covers the full package for residents who qualify: room and board, skilled nursing, personal care, physician visits, prescription medications, and mental health counseling. Many Texas nursing homes run secure units for dementia residents, and the state’s nursing facility directory flags them with a “Cert AlzhCapacity” designation.³ Nursing home Medicaid is an entitlement, so anyone who qualifies is guaranteed coverage; the practical limit is finding a Medicaid-participating facility with a bed. Medicaid typically pays only for a shared room, and beneficiaries must turn over nearly all monthly income to the facility, keeping just a $75 personal needs allowance.²

In an assisted living memory care community, Medicaid works differently. The state uses the STAR+PLUS Home and Community-Based Services waiver to fund the care your relative needs, while the family remains responsible for room and board.

What the STAR+PLUS Waiver Pays For

Through STAR+PLUS HCBS, Medicaid pays for personal care assistance, nursing services, occupational, physical, and speech therapy, medical supplies, adaptive aids, emergency response systems, and respite care for someone who needs a nursing-home level of care but chooses to live in assisted living.⁴¹ The facility must provide 24-hour supervision, three daily meals, transportation to medical appointments, and planned social activities.

Room and board is the piece the program cannot cover. STAR+PLUS members pay their own room and board, calculated as the federal SSI benefit rate minus an $85 personal needs allowance. In 2026 that works out to roughly $909 per month.⁵ A member who refuses to pay can be evicted and lose their services. A copayment based on income may also apply.¹

The Facility Has to Hold the Right License

STAR+PLUS only covers assisted living in a facility that holds a Type B license and contracts with the member’s managed care organization. Texas licenses assisted living as Type A or Type B: Type A requires residents to evacuate independently, while Type B allows residents who need staff help to evacuate, may be unable to follow directions in an emergency, and may need nighttime supervision.⁶ Because people with Alzheimer’s or related disorders typically cannot evacuate safely on their own, any true memory care community must be Type B and must carry specific Alzheimer’s certification.⁷ Not every memory care community participates with every managed care plan, so confirm both the license and the contract before assuming coverage. Members also cannot be permanently bedridden and remain in the program.

The Interest List

Unlike nursing home Medicaid, the STAR+PLUS HCBS waiver is not an entitlement. Enrollment slots are limited, and when they fill, applicants go on an interest list. Waits range from months to years.⁸⁹¹⁰ You do not need to prove eligibility to join the list; the state reviews eligibility only when a name reaches the top. Add your relative’s name as soon as a memory care need is on the horizon.

To join, apply online at YourTexasBenefits.com or call 1-877-438-5658.⁹

Financial Eligibility in 2026

The income and asset limits for nursing home Medicaid and the STAR+PLUS waiver are the same.¹¹

Single applicant: monthly income at or below $2,982, countable assets at or below $2,000.
Married couple, both applying: combined monthly income at or below $5,964, assets at or below $3,000.
Married couple, one applying: applicant income at or below $2,982 and $2,000 in assets. The non-applicant spouse may keep up to $162,660 under the Community Spouse Resource Allowance.

The primary home is generally exempt if a spouse, a child under 21, or a disabled child lives there. Otherwise it stays exempt as long as the applicant intends to return and the equity does not exceed $752,000. One vehicle is excluded regardless of value, and up to $1,500 per person can be set aside in burial funds.¹²

If Income or Assets Are Too High

Being over the limits does not automatically disqualify anyone. Two tools come up constantly in Texas Medicaid planning.

A Qualified Income Trust, often called a Miller Trust, lets an applicant whose income exceeds $2,982 deposit the excess into an irrevocable trust where it no longer counts toward the income test. The trust must name the State of Texas as residuary beneficiary, meaning the state gets repaid from whatever is left after the beneficiary dies. Any income stream directed to the trust must be deposited in full; partial deposits are not allowed.¹³¹⁴

For assets, families can spend down by using excess funds on exempt purchases such as home repairs, paying off debt, or an irrevocable burial trust, as long as those transactions don’t violate the look-back rules.¹¹

Spousal Protections

The healthy spouse is protected from being wiped out. In 2026 the community spouse in Texas may keep up to $162,660 in assets; if their half of the couple’s countable assets is under $32,532, they keep at least that minimum floor. They are also entitled to a Monthly Maintenance Needs Allowance of $4,066.50, and if their own income falls short, income can be transferred from the applying spouse to reach it.¹¹

The Medical Assessment

Money is only half of it. Your relative must also demonstrate a “nursing facility level of care” through a Medical Necessity and Level of Care assessment.¹⁵ An Alzheimer’s diagnosis alone is not enough. The applicant must show a need for help with daily activities such as eating, bathing, dressing, toileting, and mobility, and must require skilled nursing or around-the-clock supervision.¹⁶

Look-Back Period and Estate Recovery

Texas enforces a 60-month look-back for nursing home Medicaid and Medicaid waivers. Assets given away or sold below fair market value in the five years before applying can trigger a penalty period of ineligibility. The IRS annual gift tax exclusion does not shield gifts from Medicaid penalties.¹¹

After the beneficiary dies, Texas can seek reimbursement through the Medicaid Estate Recovery Program for long-term care services received after age 55, including nursing facility care, waiver services, and related hospital and drug costs. The state will not pursue a claim if a surviving spouse is alive, if the deceased leaves a child under 21 or a disabled child of any age, if the estate is worth $10,000 or less, or if total Medicaid costs were under $3,000.¹⁷

Families often protect a home from recovery with a Lady Bird deed, also called an enhanced life estate deed. The owner names a beneficiary to inherit at death but keeps full control while alive, including the right to sell or cancel. The property passes outside probate, and for Medicaid purposes the recipient is treated as not owning it at death, so it is shielded from a MERP claim. Transfer on Death Deeds under Texas Estates Code 114.151 serve a similar function.¹⁸¹⁹

How to Apply and How Long It Takes

Applications go through YourTexasBenefits.com. You can also call 2-1-1 or reach out to a local Aging and Disability Resource Center for help.²⁰ For nursing home Medicaid specifically, the person must have lived in the facility for 30 consecutive days before applying.²¹

Federal rules give the state 45 days to process a Medicaid application. Texas has been missing that mark. As of March 2024, the median processing time for a new Medicaid application was 88 days, and fewer than half were processed within 45 days.²² Start early.

The Cost Gap

Memory care in Texas averages about $5,356 per month, below the national average of roughly $7,505.²³ Even when Medicaid picks up the care side through STAR+PLUS, the family still owes the roughly $909 monthly room-and-board charge, and the facility’s total rate can exceed what Medicaid reimburses for services. Most Texas families start with private funds and shift to Medicaid as savings run down.

Wartime veterans and their surviving spouses have another lever: the VA Aid and Attendance benefit, paid on top of a VA pension. In 2026, the benefit is $2,874 per month for a married veteran, $2,424 for a single veteran, and $1,558 for a surviving spouse.²⁴ It won’t cover memory care by itself, but paired with Social Security and other income it can close much of the gap. Aid and Attendance can be received alongside Medicaid, though the payment counts as income for Medicaid eligibility calculations.

One Note on Medicare

Medicare is not a substitute here. It does not pay for custodial long-term care, assisted living, or memory care facilities. Medicare will cover up to 100 days of skilled nursing after a qualifying hospital stay, along with medically necessary doctor visits, diagnostic assessments, and prescription drugs for someone with dementia.²⁵²⁶ After those 100 days, Medicaid is the program that steps in for ongoing long-term care for people who qualify.²⁷

1
Texas Health and Human Services. STAR+PLUS Handbook – Assisted Living Services
2
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3
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4
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Texas Health and Human Services. Interest List Reduction
10
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11
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12
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13
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14
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15
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16
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17
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18
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19
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20
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21
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22
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24
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25
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26
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