Assisted Living in Texas

Famous for long hot summers, ranching and diverse attractions, Texas is a popular destination for retirees. With around 12.9% of the 29 million-plus population over the age of 65, Texas is home to more than 3.5 million seniors. The number of seniors is continually increasing, with estimates that will exceed a 20% increase by 2030. Texas boasts several high-performing hospitals for geriatric care, including UT Southwestern Medical Center in Dallas and Houston Methodist Hospital.  

In our 2022 Senior Living Report, Texas ranks 45th in the country. The overall score is likely negatively impacted by relatively low scores in the health care and community involvement categories. However, transportation is good and there’s no state income tax, which may help seniors stretch retirement funds further. On average, assisted living care costs $3,998 per month. At more than $500 per month lower than the national average, Texas is an appealing retirement destination for low-income seniors.    

This guide on assisted living in Texas includes costs of residential care and various funding options that may help seniors cover their care costs. The guide provides information about regulations for assisted living communities as well as details about local agencies that offer information, advice, advocacy and support for older citizens.        

The Cost of Assisted Living in Texas

Per Genworth’s 2021 Cost of Care Survey, the average monthly cost for assisted living in Texas is $3,998. While more than $500 per month cheaper than the national average of $4,500, assisted living in Texas is pricier than in neighboring states of Louisiana, Arkansas and Oklahoma, where median monthly costs are $3,748, $3,760 and $3,855 respectively. New Mexico, however, has higher costs for assisted living, with a monthly average of $4,498.

Costs for assisted living care vary significantly across Texas. Some of the cheapest areas include Texarkana and Waco, with respective average rates of $2,770 and $2,800. Conversely, Victoria has some of the state’s highest average costs of $5,600. Median costs are relatively high in the state capital of Austin, where assisted living care costs around $5,345 each month. Seniors in Houston, Dallas and El Paso pay lower than the national average, with costs of $4,245, $4,195 and $3,750 respectively.    

There are several care choices available to Texas’s senior residents. These include at-home and residential options, which can be budget breakers because of the level of care needed and personal preferences. Adult day health care is the cheapest option, costing $769 on average per month. Senior residents who want to remain in their own homes may arrange home care or home health care, both of which cost around $4,576. Care in an assisted living community is generally more affordable, with a median monthly price of $3,998. Older adults who require more in-depth care and medical services may need nursing home arrangements. Nursing homes are the costliest option for senior care in Texas, with monthly rates of around $5,125 for semiprivate rooms and $7,092 for private rooms.  

Does Medicaid Cover Assisted Living in Texas?

While Medicaid does not directly cover assisted living care in Texas, seniors who are eligible for Medicaid may obtain assistance via the STAR+PLUS waiver. Services are provided by managed care organizations (MCO) and allows Medicaid support through an individually chosen health plan. This waiver replaced the previous Community Based Alternatives (CBA) waiver. The STAR+PLUS waiver covers a variety of long-term services, both medical and non-medical, for seniors who are classified as needing nursing home level care. The waiver allows for services to be provided in a person’s home, in adult foster care or within a residential facility, such as an assisted living community.

What Assisted Living Services Are Covered by Medicaid in Texas?

While the STAR+PLUS waiver does not cover the costs of room or board, it may allow seniors to offset costs through the provision of other services for qualifying people who reside in assisted living communities. The managed care program can include assistance with activities of daily living and instrumental activities of daily living, health care and assistance with medication.

Assisted Living Waiver Programs in Texas

STAR+PLUS waiver

The STAR+PLUS waiver replaced the Community Based Alternatives (CBA) waiver in 2014. The program has managed health care plans provided by managed care organizations (MCOs). Seniors can choose their plan provider from specific MCOs in each county. Some eligible individuals may be put on a waiting list to receive services.

All providers must offer basic services, with coverage dependent on specific needs. Different plans also offer a range of extra enhanced services and coverage.

Core services include:

• Assisted living services
• Speech, physical, occupational and cognitive rehabilitation therapies
• Personal assistance services
• Skilled, specialized or intermittent nursing
• Medication management
• Dental services
• Medical supplies
• Adaptive aids
• Transition assistance
• Emergency response systems

For people to be eligible for the STAR+PLUS waiver, they must be either over the age of 65 or be an adult with a disability. They must also meet financial criteria and satisfy medical requirements, in that they would otherwise require nursing home level care in the absence of assistance. An assessment is necessary to determine medical needs.

To enroll in the program, seniors must first sign up for Medicaid. This can be done online through Your Texas Benefits. Alternatively, seniors can print or request a form to complete and return or apply over the telephone. A further application pack will be posted to people who are eligible to apply for the STAR+PLUS waiver. Applicants should choose their preferred health care provider within 15 days. If no choice is made, a provider will be automatically selected. After enrollment in the STAR+PLUS program, a coordinator will visit the applicant and create a tailored service plan.

How To Know If You’re Eligible for Medicaid in Texas

Texas Health and Human Services (HHS) administers Medicaid throughout the state.

Medicaid eligibility for Texans depends on an individual’s income and assets. Income is based on yearly household income levels before taxes. For single applicants, the maximum annual income is $30,276. For couples, where both people are applying for Medicaid, the maximum household income per annum is $60,552.

Assets include bank savings, trusts, stocks, shares, bonds and additional real estate after a person’s primary home. Individuals have an asset limit of $2,000, and the limit increases to $3,000 for couples where each person claims Medicaid. For couples with only one Medicaid applicant, the non-applicant spouse has an enhanced asset limit of $137,400.   

2022 Medicaid Income Limits for Seniors in Texas

*Per year

In Texas, eligibility for Medicaid for long-term care is also dependent on other factors. Additional criteria include citizenship, age and disability. in Texas is also reliant on other criteria being met. These include age, citizenship and disability status. Texan Medicaid applicants must:

• Be a full-time Texas resident
• Be 65 or older, have a qualifying disability or be legally blind
• Be a U.S. citizen or U.S. national, have permanent residency status or hold legal alien status

How To Apply for Medicaid in Texas

The Your Texas Benefits website provides a quick and convenient way for people to apply for Medicaid in Texas. Available 24 hours a day, seven days a week, the system allows applicants to save partially completed applicants and return later, upload additional documentation and check the ongoing status of existing claims.  

Seniors who prefer to complete a paper application form can either download a form or request a form through the post. This can then be returned via mail or handed in at a Texas Health and Human Services benefits office or community partner. Telephone applications and inquiries are also possible through the toll-free Texas Medicaid & Healthcare Partnership Texas Medicaid hotline on (800) 925-9126.

What Information You Will Need

Applicants must also provide supporting evidence and documents with Medicaid claims in Texas. You’ll need proof of identification, such as an ID card or driver’s license, proof of residency in Texas, such as a rental agreement or recent utility bill, and proof of all incomes, including all pensions and benefits.

Applicants must also provide:

• Social Security number
• Proof of citizenship or residency status
• Up-to-date bank statements for all accounts
• Information about all active insurance plans
• Details of any assets, including shocks, shares and bonds
• Information about housing status, such as proof of homeownership, mortgage agreements or rental agreements
• Details of any loans or gifts
• Papers related to military service (where applicable)
• Proof of recent medical bills and expenses

How To Get Help Applying for Medicaid

Texas seniors who need help filling in Medicaid forms and making claims have various options for assistance.  Texas Medicaid & Healthcare Partnership and Texas Health and Human Services have professional advisors who can offer assistance and information. Seniors can get online information from Your Texas Benefits. Statewide, Area Agencies on Aging (AAA) have trained staff who can provide advice and assistance related to Medicaid, and local senior centers may hold benefits workshops.   

Does Medicare Cover Assisted Living in Texas?

The short answer is that no, Medicare does not cover the cost of assisted living in Texas. Assisted living facilities are considered to be a “residential setting” and not a “clinical setting,” (think nursing homes). While Medicare doesn’t cover the cost of care received in an assisted living community, it does still cover things like approved medications, doctor visits, medical equipment, etc., just like it would if you lived at home.

For more information about when Medicare can be used to pay for senior living in a nursing home, and for Medicare-related resources, see our guide to Nursing Homes in Texas.

Other Financial Assistance Options for Assisted Living in Texas

Seniors who are not eligible (due to location, financial situation, or other factors) for other types of financial assistance, do still have some options. See the table below for an overview of some of the most common ways to make Assisted Living affordable.

Free and Low-Cost Resources for Seniors in Texas

Various free and low-cost services and resources exist to support older adults in Texas. Agencies include government and nonprofit organizations, and service areas include benefits, legal and housing advice, recreational, social and volunteering connections, support groups and education.    

COVID-19 Rules for Assisted Living in Texas

The following information is based on research done on several government websites, including hhs.texas.gov and cms.gov. These rules apply to nursing homes and other types of senior living facilities. We’ve most recently updated this data on 3/4/2022, but since COVID-19 is a rapidly evolving pandemic, contact your local senior living facility or Area Agency on Aging for more specific and up-to-date information.

Visitation Policies

Outings & Social Activities

COVID-19 Safety Measures for Staff and Residents

Assisted Living Laws and Regulations in Texas

Assisted living communities in Texas must adhere to strict regulations and rules set by Texas Health and Human Services Commission (HSSC). These regulations set out minimum requirements regarding staffing, care and amenities to ensure high standards of senior care.