STAR+PLUS HCBS Medicaid Waiver Eligibility in San Antonio (2026 Guide)

By San Antonio Senior Advisor Care Team · July 4, 2026

Who Qualifies for the STAR+PLUS HCBS Medicaid Waiver in San Antonio

If you are researching STAR+PLUS HCBS Medicaid waiver eligibility in San Antonio, you are looking at the single most important program for Texas seniors who need long-term care but cannot pay $4,500 or more per month out of pocket. STAR+PLUS is the Texas Medicaid managed care program for adults who are age 65 or older or who have a disability, and the HCBS (Home and Community-Based Services) waiver is the part of STAR+PLUS that pays for care outside a nursing home - including personal attendant services at home, adult day activity programs, and assisted living in a contracted facility. In Bexar County, the program is administered not by the state directly but through managed care organizations (MCOs) that hold contracts with Texas Health and Human Services. Every eligible San Antonio resident picks one of these health plans, and that plan coordinates all waiver services through a service coordinator assigned to the member.

Eligibility has two halves, and families in San Antonio routinely misunderstand both. First is functional eligibility: the applicant must meet what Texas calls medical necessity, meaning they require the level of care that would otherwise be provided in a licensed nursing facility under Chapter 242. A nurse completes an assessment covering mobility, bathing, dressing, toileting, medication management, and cognitive status. Second is financial eligibility: in 2026 an individual applicant generally must have countable monthly income at or below the special income limit (roughly three times the federal SSI benefit, about $2,901 per month, adjusted annually) and countable assets of no more than $2,000. A home you live in, one vehicle, and prepaid burial arrangements are typically not counted. Meeting one half without the other gets you nothing - both must be established before the waiver pays for care.

The Interest List: Why San Antonio Families Must Sign Up Early

Here is the detail that catches almost every family off guard: the STAR+PLUS HCBS waiver has an interest list, and in most of Texas the wait can run months or even years. Unlike nursing home Medicaid, which is an entitlement available to everyone who qualifies, the waiver has a limited number of funded slots allocated by the Texas Legislature. When you call 211 (option 2) or Texas Health and Human Services to add a parent to the interest list, their name goes in line based on the date of the call - not the date their health declines. That is why my standing advice to San Antonio families is to place a parent on the interest list the day you first suspect they may need help within the next few years. There is no cost, no obligation, and no financial screening to join the list; you can always decline services if your situation improves.

There are pathways that move faster. Seniors already receiving Medicaid in a nursing facility can often transition to the waiver with priority under Money Follows the Person, which lets a Bexar County resident leave a nursing home and take their Medicaid funding into an assisted living facility or back home with attendant care. Adults who already have full Medicaid and meet medical necessity may also be assessed directly by their STAR+PLUS health plan for an upgrade to waiver services without waiting on the general interest list. A benefits counselor at AACOG, the Alamo Area Council of Governments at (210) 362-5200, can look at your specific situation and tell you which door is fastest - this free counseling service, called the Aging and Disability Resource Center, is one of the most underused resources in San Antonio.

2026 Income and Asset Rules, Miller Trusts, and Spousal Protections

The financial rules deserve a closer look because they are where most Bexar County applications stumble. Countable income includes Social Security, pensions, VA compensation (with some exclusions), annuity payments, and withdrawals that count as income. If your parent's gross monthly income exceeds the special income limit, they are not automatically disqualified - Texas allows a Qualified Income Trust, commonly called a Miller Trust. Income above the limit is deposited into the trust each month, and the state becomes the remainder beneficiary. Setting one up requires precise language, so most San Antonio families work with an elder law attorney; expect to pay several hundred to a couple thousand dollars, which is trivial compared to the cost of care the waiver unlocks.

Married couples get significant protections. When one spouse applies for the waiver and the other remains in the community, spousal impoverishment rules let the community spouse keep a substantial share of the couple's combined assets - in 2026 the protected resource amount can reach approximately $157,920 - plus a minimum monthly income allowance. The couple's home is exempt while the community spouse lives in it. Texas also applies a five-year lookback on gifts and transfers: money given away within 60 months of applying can trigger a penalty period during which the waiver will not pay. Families in neighborhoods from Stone Oak to the South Side sometimes transfer a house to an adult child thinking it protects the asset, and that single move can delay eligibility by months or years. Talk to a benefits counselor or elder law attorney before moving any asset.

Choosing a STAR+PLUS Health Plan in Bexar County

Once eligibility is established, every San Antonio member must enroll with a managed care organization serving the Bexar service area. The plans historically serving this region include Molina Healthcare of Texas, Superior HealthPlan (a Centene company), Amerigroup, and UnitedHealthcare Community Plan - confirm the current lineup when you enroll, because state contract awards change the roster periodically. On paper the plans cover the same waiver benefits; in practice they differ in provider networks, which matters enormously if you want a specific assisted living community. An assisted living facility can only accept waiver residents if it holds a contract with your specific MCO, so the smart sequence is to shortlist facilities first, ask each one which STAR+PLUS plans it contracts with, and then pick your health plan to match.

After enrollment, the health plan assigns a service coordinator who becomes your family's main contact. The coordinator conducts an in-person assessment, writes the individual service plan, and authorizes hours of attendant care, day activity and health services, respite for family caregivers, home-delivered meals, emergency response systems, minor home modifications, and - for those who need residential care - assisted living services in a contracted Type A or Type B licensed facility. Do not be shy about pushing back on an authorization you think is too low; members have appeal rights through the MCO and a fair hearing process through the state. Rosa's rule for San Antonio families: get every authorization decision in writing, and keep a dated log of every call with the service coordinator.

Using the Waiver for Assisted Living in San Antonio: What It Pays and What It Does Not

This is the point that surprises families most: the STAR+PLUS HCBS waiver pays for the care component of assisted living, not the room and board. In a contracted facility, the waiver covers personal care, medication supervision, and nursing oversight, while the resident still owes room and board out of their own income - typically capped near the SSI-related level, in the neighborhood of $800 to $900 per month, with the member keeping a small personal needs allowance. Compare that with the private-pay market in San Antonio, where assisted living runs roughly $4,000 to $5,500 per month in areas like Stone Oak, Alamo Heights, and the Medical Center corridor, and the value of the waiver becomes obvious. The catch is supply: only a subset of the roughly 150-plus licensed assisted living facilities in Bexar County contract with STAR+PLUS plans, and waiver beds fill quickly.

When you tour facilities, verify two things independently. First, confirm the facility's license type and inspection history on the Texas HHSC public disclosure site at apps.hhs.texas.gov/HSPubDisclosure - a memory care unit must hold a Type B license under Chapter 247, and the inspection record will show any recent deficiencies. Second, ask the admissions director point-blank which MCOs they contract with and how many waiver residents they currently serve. For families in San Antonio's predominantly Spanish-speaking neighborhoods on the West Side and South Side, also ask whether bilingual caregivers are on every shift, not just in the front office - en espanol cuando lo necesite is a fair and reasonable request, and several San Antonio communities staff accordingly. If a hospital discharge is forcing your timeline - from Methodist Hospital, Baptist Medical Center, or University Hospital - tell the discharge planner explicitly that you are pursuing STAR+PLUS waiver placement so they document medical necessity in the record.

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Common questions

What is the income limit for STAR+PLUS HCBS Medicaid waiver eligibility in San Antonio in 2026?

For 2026, an individual applicant in San Antonio generally must have countable gross monthly income at or below the special income limit, which Texas sets at 300 percent of the federal SSI individual benefit - approximately $2,901 per month, adjusted each January. Countable assets must not exceed $2,000 for an individual, though the home you live in, one vehicle, household goods, and irrevocable prepaid burial plans are excluded. If income is over the limit, a Qualified Income Trust (Miller Trust) can restore eligibility by channeling the excess income through the trust each month. Married couples benefit from spousal impoverishment protections that let the spouse at home keep a much larger share of assets. Because these numbers adjust annually and individual situations vary, verify current figures with Texas Health and Human Services at hhs.texas.gov or get free counseling from AACOG's Aging and Disability Resource Center at (210) 362-5200.

How long is the STAR+PLUS waiver interest list in Bexar County?

Wait times on the STAR+PLUS HCBS interest list vary with legislative funding and turnover, and Texas HHS does not publish a running countdown for Bexar County specifically - families have reported waits ranging from several months to a few years. The list is first-come, first-served by the date you call, which is why the single best move is to call 211 and select option 2, or contact Texas Health and Human Services, the moment you think a parent might need long-term services within the next few years. Joining costs nothing and requires no financial disclosure. Faster pathways exist: a senior already on Medicaid in a nursing facility can transition out under Money Follows the Person with priority access, and adults who already have full Medicaid coverage and meet nursing-facility medical necessity can sometimes be upgraded to waiver services directly through their STAR+PLUS health plan without the general wait.

Does the STAR+PLUS waiver pay for assisted living room and board in Texas?

No - and this is the most common misunderstanding I encounter with San Antonio families. Federal Medicaid rules prohibit waiver programs from paying room and board in assisted living. The STAR+PLUS HCBS waiver pays for the services delivered in the facility: personal care assistance, medication supervision, nursing oversight, and related supports. The resident pays room and board from their own income, and in waiver-contracted facilities that charge is capped at a state-set level tied to SSI - generally in the $800 to $900 per month range - with the resident keeping a small personal needs allowance. Compare that to $4,000 to $5,500 per month private-pay rates common across San Antonio and the waiver still transforms affordability. Confirm any facility you tour actually contracts with your chosen MCO, because a facility without a contract with your specific health plan cannot bill the waiver for your care.

Which health plans offer STAR+PLUS in San Antonio, and does it matter which one I pick?

The Bexar service area has historically been served by Molina Healthcare of Texas, Superior HealthPlan (Centene), Amerigroup, and UnitedHealthcare Community Plan; confirm the current roster when you enroll because state contract awards periodically change which MCOs serve the region. The benefit package is standardized, but the choice still matters for one big reason: provider networks. An assisted living facility, home care agency, or adult day program can only serve you under the waiver if it contracts with your specific plan. The practical strategy is to work backwards - identify the facilities or agencies you actually want, ask each which STAR+PLUS plans it accepts, then choose the plan that matches. You can switch plans if needed, but switches take effect on a following month and can disrupt care authorizations mid-stream. Your plan's service coordinator controls assessments and authorized hours, so document every interaction and use the appeal process if an authorization seems too low.