How families actually pay for care
Texas has not expanded Medicaid under the ACA, but that has no bearing on long-term-care Medicaid for seniors, which is a separate, decades-old eligibility pathway. The STAR+PLUS HCBS waiver pays for care services inside a participating assisted living facility or at home -- it does not cover room and board. VA Aid and Attendance and long-term care insurance are the other two most common funding sources families use.
STAR+PLUS HCBS (Medicaid)
Texas's home and community based services waiver, delivered through the STAR+PLUS Medicaid managed care program, pays for personal care assistance, in-home nursing, respite, emergency response systems and placement in a participating assisted living facility or adult foster care home. It does not cover room and board -- that portion remains the resident's responsibility. Apply through Your Texas Benefits or by calling Texas 2-1-1.
Nursing facility Medicaid
For 2026, the special income limit is $2,901/month with a $2,000 asset limit for a single applicant; income above that generally requires a Miller Trust (Qualified Income Trust) to still qualify. The personal needs allowance is $75/month. Community-spouse resource allowances (roughly $32,041 to $160,200 for 2026) protect an at-home spouse when only one spouse needs nursing facility care. Confirm current figures with HHSC or an elder law attorney -- these adjust annually.
VA Aid and Attendance
A federal pension add-on, not state-specific: current maximum annual rates run $29,093 for a single veteran, $34,488 for a veteran with one dependent, and $18,697 for a surviving spouse, effective December 1, 2025. See our full VA Aid and Attendance guide for the net worth limit and how the benefit is calculated.
