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Texas Medicaid home care: STAR+PLUS, HCBS and Consumer Directed Services

Texas pays for long-term care at home mainly through STAR+PLUS and STAR+PLUS HCBS, run by Texas Health and Human Services. Consumer Directed Services (CDS) lets members hire and manage their own attendant.

Carevo editorial team Updated October 27, 2026 Source checked by Carevo editorial team, October 27, 2026

Texas pays for long-term care at home mainly through STAR+PLUS and its home and community based services waiver, STAR+PLUS HCBS. Texas Health and Human Services (HHSC) runs both. Members who qualify can use the Consumer Directed Services (CDS) option to hire and manage their own attendant.

How care at home is paid for here

HHSC's STAR+PLUS handbook describes STAR+PLUS as a managed care system that combines acute care with long-term services and supports (LTSS). LTSS in the handbook's list includes help in the member's home with activities of daily living, home modifications, respite and personal assistance services. The services come from providers contracted with managed care organizations (MCOs), and service coordination is available to all members who need or request it.

STAR+PLUS HCBS is a program approved for the managed care system and designed for people who qualify for nursing facility care to receive LTSS and live in the community. Medicaid.gov lists HHSC as the Texas Medicaid agency.

Who qualifies for STAR+PLUS HCBS

HHSC's procedures handbook lists these requirements. The applicant or member must:

  • be 21 or older;
  • have full Medicaid financial eligibility;
  • be a U.S. citizen;
  • be a Texas resident;
  • have an approved medical necessity determination for a nursing facility level of care;
  • have an individual service plan with services under the established cost limit;
  • have an unmet need for at least one STAR+PLUS HCBS service; and
  • be living in an appropriate living situation.

The same handbook says members cannot be enrolled in more than one Medicaid waiver program at the same time. People who receive Supplemental Security Income are Medicaid eligible and can get STAR+PLUS HCBS services without further financial screening, according to the STAR+PLUS handbook.

The interest list

The procedures handbook, revision 25-2, says a person is eligible to be assessed for STAR+PLUS HCBS when their name reaches the top of the program's interest list. You are placed on the list by contacting the HHSC Interest List Management unit, or your MCO if you are already enrolled in STAR+PLUS. When your name reaches the top, you choose an MCO, which begins the eligibility process. You become an applicant after you are released from the list, confirm interest and submit Form H1200, Application for Assistance, Your Texas Benefits.

Two shortcuts exist. People who already receive Medicaid and are already with an MCO may be able to bypass the list through the upgrade process, and people living in a nursing facility can become eligible through the Money Follows the Person process.

Self-directed care: Consumer Directed Services

HHSC's CDS page says CDS lets people who receive services from Texas Medicaid hire and manage the people who provide their services. HHSC lists CDS as available in a number of programs, including STAR+PLUS and STAR+PLUS HCBS, STAR Kids, STAR Health, Primary Home Care and Community Attendant Services, Community Living Assistance and Support Services, Consumer Managed Personal Attendant Services, Home and Community-based Services, Texas Home Living, the Medically Dependent Children Program, and Deaf-Blind with Multiple Disabilities.

In STAR+PLUS, the handbook says the services that can be self-directed are personal assistance services and Community First Choice personal assistance or habilitation. In STAR+PLUS HCBS they also include in-home respite, skilled nursing, employment assistance, supported employment and several therapies. CDS is available to members living in their own homes or the homes of family members. It is not available to members in adult foster care homes or assisted living facilities.

Under CDS you select a financial management services agency (FMSA) that handles payroll and taxes. For the full picture, see Consumer Directed Services in Texas.

Who can be the paid caregiver

HHSC's CDS FAQ, revised February 6, 2026, says that when you hire your own providers you can often find family, neighbors or friends to work for you, with limits on which relatives depending on your program. Our paid family caregiver page for Texas lists who cannot be hired.

How to apply

  1. Medicaid. HHSC's procedures handbook says people without Medicaid submit Form H1200, Application for Assistance, Your Texas Benefits, and a Medicaid for the Elderly and People with Disabilities specialist decides financial eligibility. Medicaid.gov's state agency list gives HHSC's contact details.
  2. Interest list. Contact the HHSC Interest List Management unit, or your MCO if you are enrolled in STAR+PLUS.
  3. Assessment. Your MCO does the assessment, the nursing facility level of care determination and your individual service plan.
  4. Choose a delivery option. Ask the MCO service coordinator about the agency option, the CDS option or the service responsibility option, where the provider employs the attendant and you manage day-to-day work.

Questions to ask when you call

  • Am I already on the STAR+PLUS HCBS interest list, and what is my place on it?
  • If I already have Medicaid and an MCO, can I use the upgrade process?
  • Which delivery option fits me: agency, CDS or the service responsibility option?
  • Which FMSAs serve my area, and who do I call if a paycheck is late?
  • If I want a relative as my attendant, does my program allow that relative?

Terms you will see

  • MCO: managed care organization, the health plan that coordinates and pays for your STAR+PLUS services.
  • Service coordinator: the MCO staff member who works with you on your service plan.
  • ISP: individual service plan, the list of authorized services under STAR+PLUS HCBS.
  • FMSA: financial management services agency, which handles payroll and taxes under CDS.
  • LAR: legally authorized representative, such as a parent of a minor or the guardian of an adult.

What this page does not cover

Texas has other Medicaid programs for children, for people with intellectual and developmental disabilities, and for people who do not qualify for nursing facility level of care. We read the STAR+PLUS HCBS and CDS pages only. For provider directories, see intellectual and developmental disability services in Texas.

Where Carevo fits

Carevo is a connection platform and directory. We do not run any Texas program, decide eligibility or recommend a provider. The care-type links below show providers that serve your area.

Programs in Texas

  • Consumer Directed Services (CDS): Texas Consumer Directed Services (CDS) lets a Medicaid member, or their legal representative, be the employer of their attendants. You hire, train and set schedules, and a financial agency runs payroll.

Find providers in Texas

Looking for care?

Tell us your ZIP code and the type of care, and we will show providers that serve your area.

Common questions

Who runs Medicaid in Texas?

Texas Health and Human Services (HHSC). Medicaid.gov lists HHSC as the state Medicaid agency. HHSC publishes the STAR+PLUS handbooks and the Consumer Directed Services pages this guide uses.

What is STAR+PLUS?

HHSC's handbook says STAR+PLUS is Texas's managed care program that combines acute care with long-term services and supports, such as help in the home with activities of daily living, home modifications, respite and personal assistance. Services come from providers contracted with managed care organizations.

What is STAR+PLUS HCBS?

The STAR+PLUS Home and Community Based Services program is for people who qualify for nursing facility care and want long-term services and supports to live in the community. Adults must be 21 or older, have full Medicaid financial eligibility, be a U.S. citizen, be a Texas resident and have an approved medical necessity determination, among other conditions.

Is there a waiting list?

HHSC's procedures handbook says a person is eligible to be assessed for STAR+PLUS HCBS when their name reaches the top of the interest list. You get on the list by contacting the HHSC Interest List Management unit, or your managed care organization if you are already in STAR+PLUS. Some people already on Medicaid can use an upgrade process, and nursing facility residents can pursue Money Follows the Person.

What is Consumer Directed Services?

CDS lets a member or legally authorized representative be the employer of their service providers: you hire, train and manage them, set wages within state guidelines, and use a financial management services agency (FMSA) for payroll and taxes.

Can I hire a relative under CDS?

Often, but HHSC says it depends on your program. People who cannot be your employee include the CDS employer, the spouse of the person receiving services (except in Consumer Managed Personal Attendant Services), the designated representative or their spouse, and the parent or legally authorized representative of a person under 18.

Does Carevo handle Texas Medicaid applications?

No. Carevo is a connection platform and directory. HHSC, your managed care organization and your local benefits office decide eligibility and services.

Sources

Review status: Carevo checked this page against the primary sources listed above. It has not been professionally reviewed by a registered nurse, licensed social worker, benefits counselor or attorney. See our editorial standards.

This page is general information, not financial, legal or medical advice. Rules and services vary by state and by individual circumstances. Use the official sources and decision-maker named on the page. Carevo is a connection platform, not a care provider.