How the Texas Medicaid interest list for STAR+PLUS HCBS works in San Antonio, who to call, and what families should do while they wait.
By San Antonio Senior Advisor Care Team · September 07, 2026
Families across San Antonio call us after a hospital discharge or a hard fall and ask the same question: how do we get Mom on Medicaid so it will help pay for assisted living? In Texas, the answer almost always runs through the STAR+PLUS Home and Community-Based Services waiver, and the first step is not an application at all. It is a request to be added to the Texas Medicaid interest list for STAR+PLUS HCBS. The interest list is exactly what the name suggests: a queue of people who have told the Texas Health and Human Services Commission that they want waiver services when a slot becomes available. It is not an application, it is not an eligibility determination, and getting your name on it does not mean anyone has reviewed your parent's finances or medical needs. It only records the date you asked. That date is the single most valuable thing on the list, because Texas releases waiver slots in the order names were added, so a call made this month is worth more than a perfect application filed two years from now.
This distinction trips up a lot of Bexar County families, and it costs them years. We regularly meet adult children who assumed that because their father was not yet ready for assisted living, or because they thought his savings were too high, there was no point in calling. Both assumptions are expensive mistakes. There is no cost to be on the interest list, no obligation to accept services later, and no requirement that you already qualify financially or medically on the day you call. Circumstances change. Savings get spent down on care. A spouse dies and household income drops. A diagnosis progresses. If your name has been sitting on the list the whole time, you are in position when that happens. If it has not, you start the clock from zero at the exact moment you can least afford to wait.
The mechanics are simpler than most families expect. To get on the Texas Medicaid interest list for STAR+PLUS HCBS in San Antonio, call the Texas Health and Human Services interest list line at 1-877-438-5658 and say clearly that you want to be added to the STAR+PLUS HCBS interest list. Have the person's full legal name, date of birth, Social Security number, current address, and phone number ready. If you are calling on a parent's behalf, be prepared to give your own name and relationship as the contact. The call itself is usually short. Ask the representative to confirm the date your request was recorded, write that date down, and keep it somewhere you will still be able to find it in three or four years, because that is realistically how long these lists can run. You can also generate a referral through Your Texas Benefits at yourtexasbenefits.com, and the statewide 2-1-1 Texas line can route you to the same process.
Two San Antonio resources are worth using alongside that phone call. The Alamo Area Council of Governments, which serves as the Area Agency on Aging for Bexar and the surrounding counties, offers free benefits counseling and can walk a family through what the waiver does and does not cover. You can reach AACOG at (210) 362-5200 or at aacog.com. Their benefits counselors are a genuinely useful, no-cost second set of eyes, especially for Spanish-speaking families and for households where the older adult is a veteran with overlapping VA benefits. If you already have a case worker at a hospital such as Methodist Hospital, Baptist Medical Center, or UT Health's University Hospital, tell them you are pursuing STAR+PLUS HCBS and ask whether the discharge plan can be documented in a way that supports the medical necessity review later.
We will not give you a number of years, because anyone who quotes you a precise wait for the Texas STAR+PLUS HCBS interest list is guessing. HHSC publishes interest list data and periodically funds interest list reduction efforts, but the pace depends on legislative appropriations that change every session. What we can tell you honestly is that the wait is long enough that it should be treated as a background process, not a plan. Do not build your family's care strategy around a waiver slot arriving on any particular timeline. Get the name on the list, then plan as though it will not come for a long while, and treat it as a genuine relief if it comes sooner.
There are two important exceptions that let some San Antonio families bypass the interest list entirely, and they are the most under-used facts in this whole area. First, a person who is already living in a Medicaid-certified nursing facility with Medicaid paying for that stay can generally access STAR+PLUS HCBS to move back into the community without waiting on the interest list. This is the pathway that grew out of Texas's Money Follows the Person work, and it is why some families find that a parent who entered a Bexar County nursing home after a hospitalization has more options, not fewer. Second, people who qualify through certain other Medicaid pathways may have different access rules. If either situation might apply to your family, say so explicitly when you call HHSC and ask directly whether the nursing facility transition pathway applies, because the answer materially changes what you should do next.
Understanding what you are waiting for keeps expectations honest. STAR+PLUS HCBS is a services waiver, not a rent voucher. In an assisted living or residential care setting, the waiver can cover the care and service component: personal attendant services, help with bathing, dressing and medication, nursing oversight, and related supports. It does not function as a blanket payment for the full monthly private-pay rate at any San Antonio community, and it does not cover room and board the way many families assume. The resident is generally still responsible for the room and board portion, typically funded from their own income such as Social Security. This is the single biggest source of disappointment we see, and it is far better to understand it now than after a slot finally arrives.
Just as important, not every assisted living community in San Antonio accepts the waiver. Participation is a business decision each operator makes, and many of the newer communities in Stone Oak, Alamo Heights, and the far Northwest side are private-pay only. Facilities that do participate are often, though not always, smaller Type B licensed communities. Type B licensure matters here because Texas licenses assisted living under Chapter 247 and distinguishes Type A, for residents who can evacuate without assistance, from Type B, for residents who need staff assistance to evacuate, which is the category that covers most memory care and most residents with significant mobility limits. You can verify any facility's license type, and review its inspection history, through HHSC's public provider search at apps.hhs.texas.gov/HSPubDisclosure. Do that before you fall in love with a community.
The interest list should be the first thing you do, not the only thing. While you wait, pursue every benefit your parent may already be entitled to. San Antonio has one of the largest veteran and military-retiree populations in the country, and a wartime veteran or surviving spouse who needs help with daily activities may qualify for VA Aid and Attendance, an additional monthly pension amount that is entirely separate from Medicaid and does not require an interest list. The South Texas Veterans Health Care System and Audie L. Murphy VA Medical Center, along with the Texas Veterans Commission at tvc.texas.gov, are the right starting points. Families near Joint Base San Antonio, Lackland, and Fort Sam Houston should treat this as a first-tier option, not an afterthought.
At the same time, use AACOG's non-waiver programs, look hard at whether a long-term care insurance policy is sitting forgotten in a filing cabinet, and get the legal paperwork in order now. A durable power of attorney signed while a parent still has capacity is worth more than almost anything else you can do this year, because without it, a family that finally reaches the top of the interest list can find itself unable to complete the application. Keep your own records too: the date you called, the name of the representative, and any confirmation number. And update HHSC when your address or phone number changes. The most heartbreaking version of this story is the family whose slot came up and whose notice went to an address they moved away from two years earlier. Nada duele más que perder un lugar en la lista por una carta que nunca llegó, so keep your contact information current.
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