Texas Long-Term Care Medicaid at Home: Being Single or Married Makes a Difference

The STAR+PLUS Managed Care Medicaid waiver program pays for care provided in the home as an alternative to care provided in a nursing home. The waiver program has the same financial and functional restrictions as Texas Long-Term Care Medicaid for nursing home residents, such as requiring applicants to be aged 65 or older or disabled and meeting “medical necessity” and the income and asset restrictions.

Traditional health care and long-term care support are combined under STAR+PLUS. The program provides services including (though not limited to) a licensed skilled nurse who will provide medical care in accordance with the level of need (perhaps 20-40 hours per week), adult day care, delivered meals, home care, assistance with activities of daily living, hospital bills, doctor bills, prescriptions, and respite care. With these services in place, the person’s spouse or other caregiver is able to continue working in the community or simply enjoy some personal time.

Medical necessity is a prerequisite for participation. The applicant must demonstrate a medical condition that is of such seriousness that their needs exceed the routine care provided by an untrained person. As a result, they require supervision, assessment, planning, and intervention by licensed nurses—services typically available only in an institution. The individual must require medical or nursing services that are ordered by a physician, dependent upon the individual’s documented medical conditions, require the skills of a registered or licensed vocational nurse, are provided either directly by or under the supervision of a licensed nurse in an institution, and are required on a regular basis.

The evaluation for medical necessity is conducted by the Managed Care Organization serving the applicant. The professional sent to the home must examine the applicant’s functional needs, medical history, and living situation and evaluate whether the applicant can receive long-term services at their home rather than a nursing home. If the person is married, it is not uncommon for the healthy spouse to underestimate the care they provide to their spouse, potentially skewing the evaluator’s assessment.

There are differences between allowances for single individuals and for spouses qualifying for STAR+PLUS waiver. While an individual may own a total of $2,000 in assets, excluding a homestead, vehicle, irrevocable prepaid funeral plan, burial plots, among other exclusions, a married applicant (as long as the spouse is not also applying for Medicaid) may own significantly more. As of January 1, 2026, the single or married applicant may have up to $2,982 in monthly direct gross income ($2,901 in 2025). A married applicant is able to keep considerably more of their income under Star+Plus Waiver, as opposed to potentially paying a co-payment to a nursing home, allowing the healthy spouse to continue paying their bills.

Although this program provides valuable assistance so that the Medicaid beneficiary is able to remain at home as long as possible, challenges exist. Star+Plus Waiver has limited funding, restricted enrollment, and a waiting list. When a potential applicant’s name comes to the top of the list, they must meet the eligibility criteria very shortly thereafter. If they do not meet the criteria when they are called, they will lose their opportunity to receive care under the program. When the person is married, this tight timeline is complicated further by when the couple’s assets are evaluated, often requiring the couple to spend down excess assets within a very short period of time.

An elder law attorney can advise you about what other assistance is available while waiting for Star+Plus Waiver services. You should never assume that you have too much to qualify for Medicaid until you have consulted with an experienced elder law attorney. Certified Elder Law Attorneys (CELAs) have years of accumulated knowledge covering a broad range of legal issues affecting elders and persons with disabilities.

You may visit our website at www.wrightabshire.com. Nothing contained in this publication should be considered as the rendering of legal advice to any person’s specific case but should be considered general information.