By Austin Senior Advisor Care Team · October 30, 2026
Texas nursing facility residents are asked, by federal rule, whether they want to talk to someone about returning to the community. Saying yes opens a Medicaid route that does not require waiting on the STAR+PLUS interest list.
The question the nursing home is required to ask your parent
Somewhere in the assessment paperwork of every Medicaid-certified nursing facility in Travis County is a question most families never hear about. It is item Q0500B on the federal Minimum Data Set, the standardized assessment every nursing facility completes, and Texas HHSC quotes it this way: “Do you want to talk to someone about the possibility of leaving this facility and returning to live and receive services in the community?”
The CMS assessment manual puts Q0500B on admission, quarterly and annual assessments. HHSC is blunter about who it applies to: all people in Medicaid-certified nursing facilities, regardless of their payment source, must respond to Section Q and have a referral made on their behalf if they answer yes. HHSC also states that nursing facilities are required to make the referral to the local contact agency and to ensure that there was a follow-up response. Both halves of that sentence are the facility’s obligation, not a courtesy.
Answering yes is smaller than it sounds and bigger than families expect. CMS is explicit that answering yes does not commit the resident to leaving at a specific time, and does not ensure they will be able to move back to the community. It is a request for a conversation with an outside organization. That is all it is, which is exactly why there is no reason to be careful about it.
You also do not have to wait for the next quarterly assessment. The CMS manual instructs staff to let the resident know they can change their mind about requesting information at any time, and that they should be referred when they voice that request regardless of the MDS assessment schedule. If your mother said no in August and means yes in November, November is when the referral is owed.
What Money Follows the Person actually is
The program behind that referral has a name that sounds like a slogan and is in fact a procedure with section numbers. HHSC’s STAR+PLUS program support handbook defines it plainly: the Money Follows the Person procedure allows Medicaid-eligible nursing facility residents to receive services in the community by transitioning to long-term services and supports. The eligibility handbook says the same thing from the other direction — an individual living in a nursing facility may become eligible for the STAR+PLUS HCBS program by pursuing the Money Follows the Person process.
To see why that matters you have to know what the normal road looks like. STAR+PLUS Home and Community Based Services is the Texas Medicaid waiver that pays for the care that keeps someone out of a nursing facility, and the handbook’s standard rule is that a person is eligible to be assessed when their name reaches the top of the STAR+PLUS HCBS interest list. We have written separately about what that interest list actually means. For most Austin families it is the single most discouraging fact in the system.
Here is the mechanism that changes it. For a nursing facility resident not already in STAR+PLUS, the handbook instructs state staff to add the individual to the STAR+PLUS HCBS program interest list in the state database and then immediately release and assign the individual from the interest list — within two business days of being told the person chooses STAR+PLUS. For someone already enrolled in STAR+PLUS, a parallel section gives five business days. The name goes on the list and comes straight back off.
We will not oversell the wording. The handbook does not describe this as a bypass; the word bypass appears in the eligibility section only for a different route available to some people already enrolled with a managed care plan. But a wait that is opened and closed inside two business days is not a wait in any sense a family would recognize.
One requirement does all the damage when it is missed. The handbook states that one of the eligibility requirements for Money Follows the Person is that the individual be approved for the STAR+PLUS HCBS program before leaving the nursing facility. Discharge first and the mechanism is gone. Your parent is then an ordinary applicant on an ordinary interest list, which is the most expensive sequencing error available in this corner of Texas Medicaid.
Who starts it, and the form that does
Families assume the facility drives this. It does not have to. The handbook says state program support staff may receive a Money Follows the Person referral from a managed care organization or from regional Community Care Services Eligibility staff, and that anyone can make referrals to those regional staff, including family members, nursing facility staff, relocation specialists and HHSC case managers. You are on that list by name.
HHSC’s Section Q page splits the practical route by whether your parent already has Medicaid. For Medicaid-eligible residents who want a referral, it directs you to the managed care organization service coordinator, Program Support Unit staff, or the Local Intellectual and Developmental Disability Authority service coordinator assigned to the resident; those staff complete Form 1579, Referral for Relocation Services. For residents who are not on Medicaid, it directs you to the Aging and Disability Resource Center for the area.
In the Austin metro that resource center is the Aging and Disability Resource Center of the Capital Area, reachable at 855-937-2372 and located at 6800 Burleson Road, Building 310, Suite 165. It is open 8 a.m. to 5 p.m. Monday through Friday, walk-ins are accepted but appointments are strongly suggested, and it covers the ten-county CAPCOG region — Bastrop, Blanco, Burnet, Caldwell, Fayette, Hays, Lee, Llano, Travis and Williamson.
If your parent is already a STAR+PLUS member, there is a specific piece of paper to ask for. The handbook requires the managed care organization to upload Form H2067-MC to the state’s system to inform Program Support Unit staff of the request to transition to the community. Ask the service coordinator, by name, to upload it, and ask when. That single question converts a sympathetic phone call into a dated record, which is the difference between a request and a file.
The 60 days, and which program it belongs to
There are two overlapping things in Texas called Money Follows the Person, and conflating them is how families get told the wrong thing confidently. The Money Follows the Person procedure is the transition into STAR+PLUS HCBS described above. The Money Follows the Person Demonstration is an additional program layered on top, with its own screening criteria and its own handbook sections.
The 60-day figure everyone repeats belongs to the Demonstration. Its screening criteria require the person to reside continuously in an institutional setting — including days in a Medicare-certified skilled nursing facility stay that follows a stay in a Medicaid-certified nursing facility — for at least 60 days before the STAR+PLUS HCBS eligibility date, to be enrolled in the Demonstration before leaving a Medicaid-certified nursing facility, and to be Medicaid eligible.
The rule is softer than it reads, and in a useful direction. The handbook says the applicant does not have to have lived in the facility for 60 days at the time they indicate a desire to transition; the criterion is met if it appears likely they will reach 60 days before the discharge date. A family three weeks into a nursing home stay should be asking now rather than waiting out the calendar. The qualifying settings are broader than a nursing home too, covering skilled nursing facilities, intermediate care facilities, state supported living centers and hospitals.
So if someone tells you your parent has not been there long enough, the right question is which of the two programs they are describing. The procedure sections state no minimum stay. And for the Demonstration, the handbook sets an entitlement of 365 days of participation, with time spent in an institutional setting not counting toward it.
The two tests that do not go away
Removing the interest list does not remove eligibility. The handbook’s general STAR+PLUS HCBS requirements still apply in full: be 21 or older, have full Medicaid financial eligibility, be a U.S. citizen and 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 care test is the one being in a nursing home makes easy. The managed care organization performs the functional assessment and service planning, and the handbook allows it to use the facility’s own Minimum Data Set to determine medical necessity instead of conducting a separate Medical Necessity and Level of Care assessment. The evidence that your parent needs nursing-facility-level care is already sitting in the facility’s file. Note the shelf life, though: a medical necessity determination from the assessment expires 120 days after the assessment date, so a stalled application can go stale and need redoing.
The money test is the one that takes work. A resident who is not yet on Medicaid will be mailed Form H1200, the application for assistance, and must return it — the handbook sets a 30-day window from the date it was mailed, after which the request is denied. If your parent is in the middle of spending down assets, read our pieces on how Texas asset spend-down actually works and what STAR+PLUS covers before you start filling in forms.
One Austin-specific caution. Which managed care plans serve the Travis service delivery area has changed since 2024. Confirm the current list on HHSC’s health plans by service area document before your parent picks one, rather than relying on a plan name someone mentioned two years ago.
Where your parent can actually live afterward
Families hear community and picture the house they just emptied. The waiver is broader than that. The handbook states that STAR+PLUS HCBS members may live alone, with family members or others at locations of their choice, and that the location can be in the community, including adult foster care homes or licensed assisted living facilities.
The Demonstration’s list of qualified residences is more specific and worth reading before you plan a move: a home owned or leased by the applicant or the applicant’s family; an apartment with an individual lease that includes living, sleeping, bathing and cooking areas where the applicant or their family has domain; an assisted living apartment; a residential care apartment; or an adult foster care home with no more than four unrelated individuals living in it.
Then the gap that surprises almost everyone. The waiver does not cover room and board in assisted living. Medicaid treats the room, the meals and the utilities as the resident’s own responsibility, paid out of their Social Security or pension income. A move from a Travis County nursing home into an Austin assisted living community is therefore partly funded, not fully funded, and the arithmetic has to be done before the discharge date is set, not after.
Be careful with cost figures here, including ours. There is no published Austin-specific median for any of this. The CareScout survey publishes Texas statewide medians, and the Texas semi-private nursing figure of $185 a day is the lowest in the nation and almost certainly reflects the state’s heavily Medicaid-weighted census rather than what a private-pay room costs in Austin. We lay out what is and is not knowable on our costs page.
The timeline, honestly
This is a months-long process with short, unforgiving windows inside it. On the STAR+PLUS member path, state staff complete their database checks within two business days of receiving Form H2067-MC; the managed care organization must upload the individual service plan and that form within 45 days of the request to transition; the form goes up again within two business days of the discharge date being set; and the final notice is completed within five business days of the state being told the discharge happened.
On the path for a resident not already in STAR+PLUS, the sequence runs on its own clocks: two business days for the initial steps after the referral, a conversation about the process within 14 days, denial if Form H1200 is not returned within 30 days of mailing, automatic assignment to a plan if no selection is made within 30 days of the enrollment packet, and 45 days for the managed care organization to complete its activities after receiving Form H3676.
For the overall shape of it, the handbook offers one honest sentence: a four calendar month time frame is the guideline used in determining pending, or denying, requests for services. Plan on months. And notice that the two deadlines most likely to sink this are the family’s, not the state’s — the 30-day form windows. A packet that sits on a kitchen counter for five weeks ends the application.
The discharge date itself is negotiated rather than announced. The handbook says the managed care organization collaborates with the relocation specialist, the nursing facility, the applicant and state staff to identify a proposed discharge date. Four parties have to agree. If you are the one keeping a shared list of who owes what, you will be the reason it happens on time; nobody else in that group is organized around your parent alone.
What to do this week
Ask the facility a direct question: has Section Q been answered for my parent, what was the answer, and was a referral made to the local contact agency? Then ask for the follow-up response. HHSC requires the facility both to make the referral and to ensure a response came back, so both are fair to ask for in writing.
If your parent is on Medicaid and in a managed care plan, call the service coordinator, use the words Money Follows the Person, and ask for Form H2067-MC to be uploaded. If your parent is not on Medicaid, start with the Aging and Disability Resource Center of the Capital Area at 855-937-2372. Either way, you can also make the referral yourself through regional Community Care Services Eligibility staff — the handbook names family members as people who can.
Do not let a discharge get ahead of the approval. Everything in this article depends on the STAR+PLUS HCBS approval landing before your parent leaves the nursing facility. If a facility is pushing a discharge date for other reasons, that is a separate fight with its own rules and its own notice requirements.
If you hit a wall inside the facility, the long-term care ombudsman for the Austin area is the Area Agency on Aging of the Capital Area, at 512-916-6054 — not the Area Agency on Aging of Central Texas in Belton, which is a different agency covering different counties. For a complaint about a licensed facility, HHSC Complaint and Incident Intake is 1-800-458-9858. Adult Protective Services, at 1-800-252-5400, handles community settings rather than licensed facilities. Using the right line saves a week.
