Texas's STAR+PLUS HCBS waiver can cover personal care and support services for qualifying seniors in San Antonio. Here's how Bexar County families apply, what to expect, and common mistakes to avoid.
By Rosa Martínez, CSA · April 28, 2026
The STAR+PLUS Home and Community-Based Services (HCBS) waiver is Texas Medicaid's primary long-term care program for seniors and adults with disabilities who meet a nursing-facility level of care. It pays for personal attendant services, adult day care, assisted living services, skilled nursing visits, home modifications, and other supports — but not room and board (rent and meals) in an ALF setting.
STAR+PLUS is managed through Texas Medicaid MCOs: Molina Healthcare, UnitedHealth Community Plan, Superior Health Plan (Centene), and others depending on the Bexar County service area. Enrollment is voluntary but required to receive waiver services; families choose their MCO at the time of Medicaid enrollment.
Eligibility requires full Texas Medicaid (not just CHIP or limited Medicaid), a nursing-facility level of care established through a HHSC functional assessment, and income and asset limits under Texas Medicaid rules. Bexar County seniors can start with a HHSC benefits counselor or contact AACOG at (210) 362-5200 — AACOG is the Area Agency on Aging for the San Antonio region and can screen for STAR+PLUS eligibility at no cost.
Texas Medicaid has no general asset limit for the STAR+PLUS waiver (unlike some other states), but income limits apply. The rules are nuanced and an elder-law attorney familiar with Texas Medicaid can help structure an application correctly.
Families often apply only after a crisis, missing the window to get on waiting lists or navigate MCO enrollment while under pressure. Others don't realize that not every San Antonio ALF accepts STAR+PLUS — many do not, because reimbursement rates are lower than private pay.
A free advisor can identify which Bexar County ALFs have active STAR+PLUS contracts, help families time the application, and coordinate with the hospital discharge planner at Methodist, Baptist, or UT Health to line up a placement before a discharge deadline hits.
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