By Austin Senior Advisor Care Team · August 24, 2026
STAR+PLUS Home and Community Based Services can pay for the help that keeps your parent out of a nursing facility, but the program has a fixed number of slots and a first-come, first-served interest list behind it. Here is what that list actually means and what to do while your parent's name moves up it.
Two Medicaid paths that sound alike and are not
Families researching Medicaid long-term care in Texas usually run into two different doors without anyone explaining that they are different. One is Medicaid coverage for a nursing facility. The other is the STAR+PLUS Home and Community Based Services program, sometimes still called the STAR+PLUS waiver, which pays for personal care, respite, home modifications, and in some cases assisted living services so a person can stay out of a nursing facility.
The distinction that trips people up: nursing facility Medicaid in Texas is an entitlement. If your parent meets the financial and medical criteria, the state has to serve them, full stop, no waiting list. STAR+PLUS HCBS is not an entitlement. The Texas Health and Human Services Commission funds a capped number of slots for the program, and when the slots are full, new applicants who otherwise qualify go onto an interest list instead of getting served right away.
This is not a paperwork problem or an Austin-specific bottleneck. It is a structural feature of how the federal government lets states run these particular waiver programs, and it means a family can do everything right, financially and medically qualify, and still be told to wait.
How the interest list actually works
Texas HHSC runs interest lists for several 1915(c) waiver programs, STAR+PLUS HCBS among them. Per HHSC's own description of the process, applicants are placed on interest lists on a first-come, first-served basis, allocations are based on available funding, and people who have been on the list the longest are enrolled first. When a name reaches the top, the person is contacted by a state office or, for the intellectual and developmental disability waivers, a Local Intellectual or Developmental Disability Authority representative.
One detail worth knowing before you assume the wait is wasted time: being on the interest list does not block a person from receiving other Medicaid or community services they already qualify for in the meantime. If your parent is Medicaid-eligible on the acute-care side, or qualifies for other community programs, those can continue running while STAR+PLUS HCBS enrollment is pending.
To be added to the interest list for STAR+PLUS HCBS, the number to call is 1-877-438-5658. You can also start the process through 211. Neither call requires the Medicaid application itself to be finished first, so it is worth making the call as soon as you know your parent may eventually need this level of support, rather than waiting until the financial paperwork is complete.
What the wait actually looks like
HHSC does not publish a single guaranteed wait time for STAR+PLUS HCBS, and any number you see quoted is an estimate, not a promise. Benefits-planning organizations that track these programs generally describe waits in the range of six months to a year and a half depending on region, with larger metro areas, Austin included, typically running longer than rural counties simply because more people are competing for the same allocation of slots in that service area. Treat any specific month count you read online, including this one, as a planning range rather than a date you can bank on.
What does move the number: legislative funding. The Texas Legislature periodically approves additional interest list reduction funding, which HHSC then uses to release a batch of names off the list into actual enrollment. These releases happen on the state's schedule, not a predictable calendar families can plan around, which is part of why the honest answer to 'how long will this take' is that nobody can tell you precisely in advance.
Where Austin fits inside STAR+PLUS
STAR+PLUS is organized by HHSC into regional service areas, each with a small number of contracted managed care organizations. Travis County sits in the Travis service area alongside Bastrop, Burnet, Caldwell, Fayette, Hays, Lee, and Williamson counties, meaning a family anywhere from Georgetown to Lockhart to Bastrop is drawing from the same regional plan options. As of the most recent HHSC contract cycle, the STAR+PLUS managed care organizations serving the Travis service area are Superior and United Healthcare.
This matters for a very practical reason covered in a separate post on this site about 30-day discharge notices: not every Austin-area assisted living community or in-home provider contracts with every STAR+PLUS health plan. Before your parent's name comes up on the interest list, it is worth finding out which of the two Travis-area MCOs the communities or agencies you are considering actually accept, so you are not choosing a plan in a vacuum during a fast-moving enrollment window.
The financial test that runs alongside the wait
Being on the interest list does not exempt your parent from meeting Medicaid's financial rules once their name is called. For 2026, the STAR+PLUS HCBS income limit follows the same 300 percent of the federal SSI benefit rate standard used across Texas's Medicaid waiver programs, which works out to a monthly income cap in the neighborhood of $2,982 for a single applicant, alongside the standard $2,000 countable asset limit, with the home and one vehicle excluded from that count.
If your parent's income runs slightly over that cap, the same Qualified Income Trust, or Miller Trust, mechanism used for nursing facility Medicaid applies to STAR+PLUS HCBS as well. That is worth knowing now, while your parent's name is still on the list, because setting up a Qualified Income Trust correctly takes time, and you do not want to be starting that process for the first time in the same week HHSC calls to say a slot has opened.
One limit worth flagging clearly: even an approved STAR+PLUS HCBS waiver does not pay for the room-and-board portion of assisted living. It can fund personal care and service coordination inside a qualifying community, but the rent-equivalent charge stays a private-pay or other-benefit responsibility. Families sometimes assume waiver approval solves the entire assisted living bill, and it does not.
What to actually do while your parent's name is on the list
First, call and get on the list before the financial paperwork is finished, not after. The clock on a first-come, first-served list only starts once the name is on it, so delaying the call to first sort out income and assets just adds that delay on top of the program's own wait.
Second, keep a running file of medical documentation that supports the level-of-care determination STAR+PLUS HCBS requires, the same kind of nursing-facility-level need documentation used for the institutional Medicaid pathway. If your parent's condition changes while waiting, updated records make the eventual enrollment review faster, not slower.
Third, treat the interest list period as the time to research Travis-area MCO contracting, start any needed Qualified Income Trust paperwork if your parent's income is close to the cap, and have a private-pay or family-funded bridge plan for care needs that cannot wait. A family that assumes the waiver will simply materialize on a needed timeline is the family most likely to be caught short if a crisis arrives before the state's call does.
