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Revision 25-2; Effective June 6, 2025
An individual is eligible to be assessed for the STAR+PLUS Home and Community Based Services (HCBS) program when their name reaches the top of the STAR+PLUS HCBS program interest list. An individual is placed on the interest list by contacting the Texas Health and Human Services Commission (HHSC) Interest List Management (ILM) unit or their managed care organization (MCO) if he or she is already enrolled in STAR+PLUS. For medical assistance only (MAO) individuals, once their name reaches the top of the interest list, select an MCO who begins the STAR+PLUS HCBS program eligibility determination process. For individuals currently receiving Medicaid and who are already enrolled with an MCO, they may be able to bypass the interest list through the upgrade process. An individual living in a nursing facility (NF) may become eligible for the STAR+PLUS HCBS program by pursuing the Money Follows the Person (MFP) process.
An interest list release individual becomes an applicant when he or she is released from the interest list, confirm interest in the STAR+PLUS HCBS program, and have submitted Form H1200, Application for Assistance – Your Texas Benefits. A non-STAR+PLUS individual pursuing the MFP process becomes an applicant when PSU staff submit a referral to the MCO to begin initial assessment activities. A STAR+PLUS individual pursuing the MFP or upgrade process becomes an applicant when the MCO submits a notice that an assessment has been conducted.
The STAR+PLUS HCBS program is provided by authority granted to the state of Texas. It allows delivery of long-term services and supports (LTSS) that help members live in the community in lieu of a nursing facility (NF). To be eligible for services under the STAR+PLUS HCBS program, the applicant or member must meet the following criteria:
- be 21 years or older;
- have full Medicaid financial eligibility;
- be a U.S. citizen;
- be a resident of Texas;
- have an approved medical necessity (MN) for an NF level of care (LOC);
- have an individual service plan (ISP) with services under the established cost limit;
- have an unmet need for at least one STAR+PLUS HCBS program service; and
- be living in an appropriate living situation.
Title 1 Texas Administrative Code (TAC) Chapter 353.1153(a)(1)(F) states STAR+PLUS HCBS program members cannot be enrolled in more than one Medicaid waiver program at the same time. Refer to Appendix XVIII, Mutually Exclusive Services, to determine if two services may be received simultaneously by an applicant or member.
1210 Age
Revision 19-13; Effective November 5, 2019
Title 1 Texas Administrative Code (TAC) Part 15, Chapter 353, Subchapter M, §353.1153(a)(1)(A), STAR+PLUS Home and Community Based Services (HCBS) Program, states an applicant or member must be age 21 or older to be eligible for the STAR+PLUS HCBS program. Program Support Unit (PSU) staff verify the applicant’s age in the Texas Integrated Eligibility Redesign System (TIERS) upon initial entry into the STAR+PLUS HCBS program.
1220 Medicaid Financial Eligibility
Revision 25-2; Effective June 6, 2025
Title 1 Texas Administrative Code (TAC) Chapter 353.1153(a)(1)(G) states an applicant or member must be determined financially eligible for Medicaid to be eligible for the STAR+PLUS Home and Community Based Services (HCBS) program. Program Support Unit (PSU) staff must determine if an applicant or member is eligible for Medicaid by checking the Texas Integrated Eligibility Redesign System (TIERS).
For individuals who do not have Medicaid eligibility, PSU staff must mail Form H1200, Application for Assistance – Your Texas Benefits, to the individual. PSU staff must fax Form H1200 and Form H1746-A, MEPD Referral Cover Sheet, to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist for a Medicaid eligibility determination once Form H1200 is received back from the applicant.
An individual who does not have Medicaid eligibility may have Form H1200 on file with the Texas Health and Human Services Commission (HHSC). These individuals may not need to complete a new Form H1200 if Form H1200 was received by HHSC within 60 days for an initial application or 90 days for an interest list release (ILR) reopen. PSU staff must encourage the individual to submit a new Form H1200 if there have been changes in the individual’s financial situation since the last submission of Form H1200. PSU staff must verify if the individual has a current Form H1200 on file if the individual claims that they do by checking the Health and Human Services (HHS) Benefits Portal.
For individuals who have Medicaid eligibility, PSU staff must refer to Appendix V, MEPD Referral Crosswalk, to determine if:
- Form H1200 must be mailed to the individual;
- Form H1746-A must be faxed to the MEPD specialist; or
- no action is required.
PSU staff must wait for the individual to complete and send Form H1200 back to PSU staff if Form H1200 is required. PSU staff must fax Form H1746-A and Form H1200 to the MEPD specialist once PSU staff receive Form H1200.
The MEPD specialist may respond using the MEPD Communication Tool to inform PSU staff if the individual is eligible for Medicaid. PSU staff can monitor TIERS for updates to Medicaid eligibility.
1230 U.S. Citizenship
Revision 19-13; Effective November 5, 2019
As part of Public Law 109-171, Deficit Reduction Act of 2005, each U.S. citizen eligible for Medicaid is required to provide proof of U.S. citizenship and identity. This requirement affects all long-term services and supports (LTSS) members whose financial eligibility is based on a determination from a Medicaid for the Elderly and People with Disabilities (MEPD) specialist.
Verification of citizenship and identity for eligibility purposes is a one-time activity conducted by an MEPD specialist, as documented in the MEPD Handbook, Chapter D-5000, Citizenship and Identity. Once verification of citizenship is established and documented by an MEPD specialist, verification is no longer required even after a break in eligibility. Therefore, applicants who are active Medicaid, Medicare or Supplemental Security Income (SSI) recipients do not require citizenship verification since verification occurred upon entry in those programs.
1240 Texas Residency
Revision 25-2; Effective June 6, 2025
Title 1 Texas Administrative Code (TAC) Chapter 353.1153(a)(1)(B), STAR+PLUS Home and Community Based Services (HCBS) Program, states the applicant or member must be a Texas resident to be eligible for the STAR+PLUS HCBS program. Upon initial entry into the STAR+PLUS HCBS program, the Medicaid for the Elderly and People with Disabilities (MEPD) specialist verify Texas residency. Upon annual assessment, the managed care organization (MCO) verifies ongoing Texas residency.
1250 Medical Necessity Determination
Revision 25-2; Effective June 6, 2025
Title 1 Texas Administrative Code (TAC) Chapter 353.1153(a)(1)(C), STAR+PLUS Home and Community Based Services (HCBS) Program, states the applicant or member must have a valid medical necessity (MN) determination for a nursing facility (NF) level of care (LOC) to be eligible for the STAR+PLUS HCBS program.
The MCO must submit the Medical Necessity and Level of Care (MN/LOC) Assessment through the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) for those transitioning to adult programs, interest list releases (ILRs), upgrades and reassessments. The MCO may use the nursing facility (NF) Minimum Data Set (MDS) or submit a MN/LOC Assessment in the TMHP LTCOP for Money Follows the Person (MFP) cases.
The MCO must get a physician signature before submitting the MN/LOC Assessment for applicants not living in a NF. The MCO is not required to get a physician signature for:
- STAR+PLUS HCBS program applicants currently living in an NF; and
- STAR+PLUS HCBS program member reassessments.
TMHP staff will review the MN/LOC Assessment to determine if the applicant or member has an MN for an NF LOC. PSU staff must monitor TMHP LTCOP to determine the MN/LOC Assessment approval status. A MN/LOC Assessment with a BC1 code does not have all the information necessary for TMHP staff to calculate the ISP cost limit accurately for the applicant or member. The MCO must correct a MN/LOC Assessment record resulting in a BC1 code by inactivating the record and resubmitting a new MN/LOC Assessment record, with correct information, in the TMHP LTCOP.
Medical Necessity, Level of Service, and Diagnosis records will automatically be transferred to the Service Authorization System Online (SASO) when the MN/LOC Assessment is submitted electronically in the TMHP LTCOP.
The MCO must submit the ISP in the TMHP LTCOP for interest list release, upgrade, and reassessment cases. The MCO must upload the ISP to the MCOHub for MFP cases and for those transitioning to the STAR+PLUS HCBS program because they have aged out of a children’s program. PSU staff must manually enter authorizing agent, enrollment, service plan, and service authorization records in SASO when the MCO uploads the ISP to the MCOHub.
PSU staff must fax Form H1746-A, MEPD Referral Cover Sheet, to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist when a medical assistance only (MAO) applicant meets MN and an ISP was received. PSU staff must indicate the start of care (SOC) for the STAR+PLUS HCBS program on Form H1746-A.
1260 Individual Service Plan Cost Limit
Revision Notice 25-5; Effective Dec. 17, 2025
The cost of STAR+PLUS HCBS program services on the individual service plan (ISP) should not exceed 202 percent of the cost of care Texas Health and Human Services Commission (HHSC) would pay if the individual was served in a nursing facility (NF). This is per Title 1 Texas Administrative Code (TAC) Chapter 353.1153(c)(1)(H), STAR+PLUS Home and Community Based Services (HCBS) Program.
Texas Medicaid & Healthcare Partnership (TMHP) calculates the applicant's or member’s ISP cost limit. It is based on information the managed care organization (MCO) service coordinator gathered through the Medical Necessity and Level of Care (MN/LOC) Assessment. The ISP cost limit is represented as a three-digit Patient-Driven Payment Model (PDPM) for Long-Term Care (LTC) level. A PDPM LTC is a measure of NF staffing intensity. It is used in 1915(c) Medicaid waiver programs to categorize needs for applicants or members.
The MCO service coordinator must develop an ISP that includes STAR+PLUS HCBS program services requested by the applicant or member and the cost of those services. The cost should be developed at or below 202 percent of the cost to provide services to the applicant or member, based on the PDPM LTC level in an NF.
The MCO must notify the Office of the Medical Director (OMD), Utilization Review (UR) unit staff, and Program Support Unit (PSU) staff when the cost of an ISP exceeds the cost limit. The OMD and UR staff must review the ISP and determine if eligibility can be provided through the Medically Fragile group or general revenue (GR) funds process if the cost exceeds the cost limit. UR Unit staff provide a determination to PSU program managers (PMs) if an applicant or member meets the criteria for the Medically Fragile group or GR funds process.
Applicants or members exceeding the cost limit who are not approved for the Medically Fragile group or GR funds process cannot choose to receive reduced services for the STAR+PLUS HCBS program if Medicaid state plan services and STAR+PLUS HCBS program services would pose a risk to the individual’s health, safety or welfare.
Refer to 5000, Medically Fragile Group and General Revenue Funds Process, for more information on processing cases submitted for Medically Fragile group and GR funds process consideration.
1270 Unmet Need for at Least One STAR+PLUS HCBS Program Service
Revision 25-2; Effective June 6, 2025
Title 42 Code of Federal Regulations (CFR) Section 441.302(c) and Title 1 Texas Administrative Code (TAC) Chapter 353.1153(a)(1)(D) states individuals must have a need for at least one STAR+PLUS Home and Community Based Services (HCBS) program service to be eligible for the STAR+PLUS HCBS program. For initial and continued eligibility for the STAR+PLUS HCBS program, a member must have an unmet need for support in the community, and therefore use at least one STAR+PLUS HCBS program service during the individual service plan (ISP) year. Therefore, a STAR+PLUS HCBS program ISP which has $0.00 as the Total Est. Waiver Cost in the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP) will be rejected by Program Support Unit (PSU) staff. Members who do not use at least one STAR+PLUS HCBS program service per ISP year are subject to disenrollment from the STAR+PLUS HCBS program. For medical assistance only (MAO) Medicaid members, disenrollment from the STAR+PLUS HCBS program may result in a loss of Medicaid eligibility.
MAO Medicaid members receiving Community First Choice (CFC) services through a 1915(c) Medicaid waiver program must meet eligibility requirements stated in Title 42 CFR Section 441.510(d). This CFR rule mandates that individuals who qualify for MAO Medicaid must meet all STAR+PLUS HCBS program requirements and must receive one STAR+PLUS HCBS program service per month. Managed care organization (MCO) service coordinators are responsible for tracking monthly services and notifying PSU staff if an MAO member with CFC services is not receiving the minimum requirement of one service per month.
1280 Appropriate Living Arrangement
Revision 26-1; Effective Feb. 20, 2026
Members receiving STAR+PLUS Home and Community Based Services (HCBS) program services may live alone, with family members or others at locations of their choice. The location can be in the community, including adult foster care (AFC) homes or licensed assisted living facilities (ALFs).
Title 42 Code of Federal Regulations (CFR) Section 441.301(b)(1)(ii) states applicants or members enrolled in the STAR+PLUS Home and Community Based (HCBS) program must not be an inpatient of a hospital, nursing facility (NF) or intermediate care facility for individuals with an intellectual disability or related condition (ICF/IID). Non-state group homes are ICF/IID.
Applicants or members who are incarcerated may or may not be able to maintain STAR+PLUS Home and Community Based Services (HCBS) program enrollment. Program Support Unit (PSU) staff must not deny an applicant or member due to incarceration. PSU staff must wait until the applicant or member loses Medicaid eligibility and deny them due to loss of Medicaid eligibility. PSU staff may fax Form H1746-A, MEPD Referral Cover Sheet, to the Medicaid for the Elderly and People with Disabilities (MEPD) specialist advising of the incarceration status.