Texas caregiver benefits guide
Last checked: May 18, 2026
Texas Medicaid home and community-based services can help some people get long-term care at home or in the community instead of in a nursing facility, hospital, or other institution. These programs have strict rules, and many have interest lists.
This guide explains the main Texas routes, where to start, what to ask for, and what to do if the first answer is no.
Quick answer
In Texas, Medicaid HCBS help is usually tied to a program route. For many adults age 21 or older who need nursing-facility-level care, the main route is STAR+PLUS HCBS. For children and young adults who are medically dependent, the route may be MDCP through STAR Kids or STAR Health.
For people with intellectual or developmental disabilities, the main routes may be HCS, TxHmL, CLASS, or DBMD. Many Texas waiver programs use interest lists, so ask to be added even if the person is not ready for services today.
Start here: the first 3 actions
- Call the Texas Aging and Disability Resource Center at 855-937-2372. Ask for help finding long-term services and supports for an older adult, a person with a disability, or a caregiver.
- Apply for Medicaid or update the case through Your Texas Benefits. You can also call 2-1-1 or 877-541-7905. After you pick a language, choose option 2 for HHSC benefits help.
- Ask about the right waiver interest list. For HCS or TxHmL, ask your Local Intellectual and Developmental Disability Authority, called a LIDDA. For many other waiver interest-list questions, Texas HHS lists 877-438-5658 as the interest-list number.
If the person is already in STAR+PLUS, STAR Kids, or STAR Health, also call the managed care plan and ask for the service coordinator. Ask for a long-term services and supports screening.
Texas rules can change
Texas program names, contractors, managed care plans, county service offices, and waiver rules can change. Different offices may use different names for the same service. Confirm details with Texas Health and Human Services, Your Texas Benefits, the managed care plan, the ADRC, or the LIDDA before making money or care decisions.
Main Texas programs and where to start
| Program or route | Who it may help | Where to start |
|---|---|---|
| STAR+PLUS HCBS | Adults age 21 or older who have Medicaid, need long-term services and supports, and meet nursing-facility-level need and financial rules. | Call the ADRC at 855-937-2372, apply through Your Texas Benefits, and ask the STAR+PLUS managed care plan for a service coordinator. |
| Community First Choice, also called CFC | Some Medicaid members who need help with daily living tasks and meet an institutional level of care. CFC is a Medicaid state plan service, not a waiver, but it often matters for home care. | Ask HHSC, the managed care plan, or the service coordinator for a CFC screening. |
| MDCP | Children and young adults age 20 or younger who are medically dependent and meet program rules. | Ask the STAR Kids or STAR Health managed care plan. You can also ask HHSC about the MDCP interest list. |
| HCS | People with an intellectual disability or related condition who need individualized services in a family home, their own home, a small group home, or another community setting. | Call the local LIDDA and ask to be placed on the HCS interest list. |
| TxHmL | People with intellectual or developmental disabilities who live in their own home or family home and need selected supports. | Call the local LIDDA and ask about TxHmL. |
| CLASS | People with a related condition that began before age 22 and affects daily life, as an alternative to an intermediate care facility for people with intellectual disability or related conditions. | Ask HHSC or Your Texas Benefits about the CLASS interest list and screening. |
| DBMD | People who are deaf-blind with multiple disabilities and need home and community-based support. | Ask HHSC about DBMD and the interest-list process. |
| Area Agency on Aging services | People age 60 or older, family members, and caregivers who need local help, respite options, counseling, training, or service referrals. | Call the nearest AAA or call 800-252-9240 to find the AAA for your area. |
What an HCBS waiver is
HCBS means home and community-based services.
In plain English, it means Medicaid may pay for certain long-term care services outside an institution. The goal is to help a person live at home, with family, or in another community setting when that is safe and allowed by the program.
A waiver is not the same as regular Medicaid health coverage. A waiver can have special rules, a target group, a service plan, and a limited number of slots. A person may need to meet an institutional level of care. That means the state decides the person needs a level of help similar to care in a nursing facility, hospital, or intermediate care facility, depending on the waiver.
For a deeper national overview, see Medicaid HCBS waivers explained.
Main waivers in Texas
STAR+PLUS HCBS
STAR+PLUS is Texas Medicaid managed care for adults who have disabilities or are age 65 or older. STAR+PLUS can include long-term services and supports. STAR+PLUS HCBS is the home and community-based route for some adults who would otherwise need nursing facility care.
Ask about STAR+PLUS HCBS if the person is 21 or older and needs hands-on help with bathing, dressing, using the toilet, eating, moving around the home, medication support, or safety supervision.
Community First Choice
Community First Choice is not the same as a waiver, but caregivers should ask about it. Texas says CFC may be available to people in Medicaid, including people in 1915(c) waiver programs and Medicaid managed care.
CFC can include personal assistance and habilitation services. It may be one of the first home-care routes to ask about if a person already has Medicaid.
MDCP for medically dependent children and young adults
The Medically Dependent Children Program, or MDCP, supports families caring for children and young adults age 20 or younger who are medically dependent. Texas says MDCP services are delivered through STAR Kids or STAR Health managed care organizations.
MDCP may include respite, flexible family support, adaptive aids, minor home changes, transition help, employment supports, and financial management services.
HCS and TxHmL
Home and Community-based Services, called HCS, helps people with intellectual disabilities or related conditions live in the community. Texas Home Living, called TxHmL, provides selected essential supports for people with intellectual and developmental disabilities who live in their own home or family home.
The key starting point is the LIDDA. Ask the LIDDA to explain HCS, TxHmL, general revenue services, crisis options, and how to get on the interest lists.
CLASS and DBMD
CLASS helps people with related conditions as an alternative to placement in an intermediate care facility for people with intellectual disability or related conditions. Texas says a related condition is a disability, other than intellectual disability, that began before age 22 and affects daily life.
DBMD is for people who are deaf-blind with multiple disabilities. It can include specialized supports. Ask HHSC or an ADRC how to start the DBMD interest-list and screening process.
Services that may help caregivers
Texas waiver and long-term care services are not all the same. The service must fit the person’s program, assessment, plan, and budget. Still, these are common types of help caregivers should ask about:
- Personal care or personal assistance: help with bathing, dressing, eating, toileting, transfers, and other daily tasks.
- Respite: short-term relief for the regular caregiver. Learn more at respite care for caregivers.
- Adult day or day activity health services: daytime care, health checks, meals, and supervision in a program setting when approved.
- Home changes: minor home modifications, such as changes tied to safety or access, when the program allows them.
- Adaptive aids and medical supplies: items that help the person function more safely.
- Transportation: rides or non-medical transportation when listed in the program rules and service plan.
- Emergency response services: an emergency call device or similar support when approved.
- Nursing or therapy: skilled services when the program and assessment support them.
- Home-delivered meals: meals for some STAR+PLUS HCBS members when approved.
- Caregiver supports through AAAs: information, help applying, training, counseling, support groups, respite, and limited supplemental services for some older adults and caregivers.
Before you call, make a short list of the unsafe parts of the day. For example: falls in the shower, missed medicine, wandering, unsafe cooking, lifting needs, or the caregiver missing work. Use caregiver checklists to get organized.
Can family caregivers be paid through a waiver?
Sometimes, but not by default.
Texas has a Consumer Directed Services option, called CDS. CDS can let a Medicaid member or legally authorized representative hire and manage some of the people who provide approved services. Texas HHS says people may often hire family, friends, or neighbors, but each program has limits on who can be hired.
This is important: Texas HHS lists program-specific exclusions. For STAR+PLUS HCBS, the person’s primary caregiver cannot be the employee. For MDCP, the person’s caregiver cannot be an employee. Some programs also limit whether a person who lives with the individual can provide respite or transportation. These rules can change, so ask the service coordinator or case manager before you count on being paid.
Use these exact words:
Phone script: “I am caring for my family member at home. I need to know if their Texas Medicaid program allows Consumer Directed Services. Which services can be self-directed? Can any family member be hired? Who is not allowed to be paid? Please send me the rule or form that explains this.”
CDS also means work. The person or representative becomes the employer. They may need to hire workers, set schedules, approve time, keep records, work with a financial management services agency, and make a backup plan.
For more help, read Can I get paid to be a caregiver? and try the caregiver pay quiz. If you are caring for a veteran, also check VA Aid and Attendance. For tax questions, see caregiver tax deductions.
Waitlists and priority
Texas often calls waiver waiting lists “interest lists.” Getting on an interest list is not the same as getting approved. For many programs, the person is screened for full eligibility only when a slot opens or the person’s name comes up.
Texas HHS says people can be on more than one interest list at the same time. This matters. A child or adult may fit more than one route. Ask to be added to every list that may fit the person’s disability and care needs.
For HCS and TxHmL, contact the LIDDA. Texas HHS says HCS and TxHmL interest lists are handled through the LIDDA process. For other waiver programs, Texas HHS points people to the HHSC interest-list number, 877-438-5658, and some requests or updates can be handled through Your Texas Benefits.
Keep the person’s address and phone number current. If HHSC or the LIDDA cannot reach you, the person may miss a step. Save proof of every call, online request, and letter.
Do not wait for a crisis to ask
If the person may need home care in the future, ask about interest lists now. Ask the ADRC, LIDDA, HHSC, or managed care plan what services may be available while waiting.
How to apply
Step 1: Call the right first door
For an older adult or adult with a disability, call the ADRC at 855-937-2372. Say you need help with Texas Medicaid long-term services and supports at home.
For a person with an intellectual or developmental disability, call the local LIDDA. Ask for intake, interest lists, HCS, TxHmL, and any non-waiver supports that may be open now.
For a child or young adult with major medical needs, call the STAR Kids or STAR Health plan and ask for MDCP screening. If the child is not yet in the right managed care route, call HHSC or 2-1-1 for help.
Step 2: Apply for Medicaid if needed
Use Your Texas Benefits to apply, send proof, check status, or get paper forms. If the person is older or disabled, ask whether Form H1200 or another Medicaid for the Elderly and People with Disabilities form is needed. Do not guess which form fits.
If income or resources are over the limit, ask HHSC about Medicaid for long-term care and get advice before moving money. Read Medicaid spend-down and Medicaid look-back period before making transfers.
Step 3: Ask for a functional assessment
Medicaid home care is not based only on diagnosis. The state or plan needs to know what help the person needs each day.
Be specific. Say if the person cannot bathe safely, needs help transferring, cannot prepare meals, has falls, wanders, needs overnight help, or cannot be left alone.
Step 4: Ask about CDS if you want family-directed care
If the person gets approved for services, ask which services can be self-directed through CDS. Ask for the list of people who cannot be hired. Ask for the financial management services agency list.
Documents to gather
- Photo ID and Social Security number, if available.
- Medicaid, Medicare, and health plan cards.
- Proof of income, such as Social Security, pension, wages, or other payments.
- Bank statements and other resource records.
- Insurance policies, if requested.
- Medical bills, pharmacy bills, and care costs. You can estimate care costs with the care cost calculator.
- Doctor notes, hospital discharge papers, nursing facility records, therapy notes, medication list, and diagnoses.
- A short daily care log showing what help the person needs in the morning, afternoon, evening, and overnight.
- Any denial, reduction, termination, or waitlist letters.
- Legal papers, such as guardianship, power of attorney, or authorized representative forms, if you have them.
What to say on the phone
“I am caring for someone in Texas who needs help at home with daily care. I need to ask about Medicaid long-term services and supports, STAR+PLUS HCBS or another waiver, Community First Choice, and any interest list that fits. Can you screen us or tell me the right office?”
Need more scripts? See caregiver phone scripts.
Common problems to avoid
- Only asking for one program. Texas has several routes. Ask which lists or services fit the person’s age, diagnosis, and care needs.
- Using the word “caregiver pay” only. Also ask about CDS, personal assistance, respite, and financial management services.
- Missing mail or calls. Keep contact information current with HHSC, the managed care plan, the ADRC, and the LIDDA.
- Giving away money before applying. Medicaid long-term care can have financial and transfer rules. Get advice first.
- Not saying what happens at home. A diagnosis is not enough. Explain the daily tasks the person cannot do safely.
Resumen en espanol
En Texas, algunos programas de Medicaid pueden pagar servicios en el hogar o en la comunidad para personas que necesitan cuidado a largo plazo. Muchos programas tienen listas de interes.
Empiece llamando al ADRC al 855-937-2372 si necesita ayuda para una persona mayor, una persona con discapacidad, o un cuidador. Para HCS o TxHmL, llame a la autoridad local de discapacidad intelectual y del desarrollo, llamada LIDDA. Tambien puede llamar a 2-1-1 o 877-541-7905 para ayuda con beneficios de HHSC.
FAQ
Is STAR+PLUS the same as STAR+PLUS HCBS?
No. STAR+PLUS is a Texas Medicaid managed care program for many adults with disabilities or adults age 65 or older. STAR+PLUS HCBS is a home and community-based services route for some adults who meet added long-term care rules.
Can I get paid for caring for my parent in Texas?
Maybe, but it depends on the program, the service, and who Texas rules allow the person to hire. Ask about Consumer Directed Services. Also ask whether the primary caregiver, spouse, parent, guardian, or legally authorized representative is allowed to be paid under that specific program.
Can a person be on more than one Texas waiver interest list?
Texas HHS says a person can be on more than one interest list at the same time. Ask to be added to each list that may fit.
Who should I call first for an older adult who needs help at home?
Call the Texas ADRC at 855-937-2372. You can also call 2-1-1 or 877-541-7905 for HHSC benefits help and Your Texas Benefits support.
Who should I call first for HCS or TxHmL?
Call the local LIDDA. Ask for intake, HCS, TxHmL, interest lists, and any services that may be open while waiting.
What if we are told the wait is long?
Ask to be added anyway. Then ask what services are open now. This may include CFC, personal care, AAA caregiver support, respite, managed care services, or local support services.
About this guide
This guide was written for family caregivers who need a clear first step. It focuses on Texas Medicaid HCBS waivers, home care routes, family-directed care, interest lists, and appeal steps. It does not list every Texas Medicaid rule or every service limit.
Disclaimer
This is general information, not legal, tax, medical, or financial advice. For legal or tax questions, talk with a qualified professional in your state. Confirm current rules with Texas Health and Human Services, Your Texas Benefits, the managed care plan, the ADRC, the LIDDA, or another official office before you act.
Official sources used
- Texas Health and Human Services: STAR+PLUS
- Texas HHS: STAR+PLUS HCBS Program Eligibility
- Texas HHS: STAR+PLUS HCBS Program Services
- Texas HHS: Community First Choice
- Texas HHS: Consumer Directed Services
- Texas HHS: How Consumer Directed Services Works
- Texas HHS: Aging and Disability Resource Centers
- Texas HHS: Area Agencies on Aging
- Texas HHS: Caregiver Support and Resources
- Texas HHS: Medically Dependent Children Program
- Texas HHS: Home and Community-based Services
- Texas HHS: Texas Home Living
- Texas HHS: Community Living Assistance and Support Services
- Texas HHS: Deaf Blind with Multiple Disabilities
- Texas HHS: Local Intellectual and Developmental Disability Authority
- Texas HHS: Interest List Reduction
- Texas HHS: HCS and TxHmL Interest Lists
- Your Texas Benefits
- Your Texas Benefits: Get a Paper Form
- Texas HHS: Contact
- Texas HHS: Fair and Fraud Hearings
- Texas HHS: Ombudsman Managed Care Help
- Medicaid.gov: Home and Community-Based Services 1915(c)
