Paying for assisted living in Texas is rarely one check from one place. Most families start with the resident's income and savings, then add long-term care insurance, veterans benefits or Medicaid when those fit. CareScout's latest Texas cost release publishes statewide median costs that sit below the national assisted living median, and prices still vary by metro area and care needs1.
This Texas guide explains how those pieces fit together, what STAR+PLUS Home and Community-Based Services (HCBS) can cover in a licensed assisted living facility, how that differs from nursing-facility Medicaid, and how to build a written payment plan. For the national overview, see how to pay for assisted living. For every care type, see paying for senior living.
What assisted living costs in Texas
CareScout's 2025 Cost of Care Survey publishes statewide median costs for Texas assisted living based on a private one-bedroom over twelve months. Texas's assisted living median sits below the national median in that release, and CareScout notes that actual prices vary by metro area, services and the level of help needed1.
Treat any survey median as a planning number, not a quote. Ask each community for a written monthly price that separates the base rate from care-level charges, medicine management, incontinence care and one-time move-in costs. Our assisted living costs guide explains common pricing models.
Private funds: the first layer
In Texas, private money is almost always the starting point. Federal home- and community-based rules generally bar Medicaid from paying room and board, and STAR+PLUS HCBS members must pay room and board themselves, so families need a private-pay bridge even when Medicaid is part of the longer plan23.
- Income. Social Security, pensions and retirement-account withdrawals are the steadiest monthly base.
- Savings and investments. Bank accounts, IRAs and brokerage accounts often fund the gap between income and the monthly bill. Plan withdrawals with a tax adviser when retirement accounts are involved.
- Family contributions. Adult children sometimes share costs. Put the agreement in writing: who pays what, and what happens if the bill rises.
- Annuities and life insurance. Some families convert a life policy or use an annuity to create steadier monthly income. Get independent advice before you change a policy.
Most assisted living nationwide is paid privately4. Add up monthly income and assets, then divide by the all-in prices you collected. The month when funds would run thin is the month you want the STAR+PLUS HCBS interest list already started.
Using the family home
- Selling. A sale often funds the move. Some or all of the gain may be excluded from income if IRS ownership and use tests are met7.
- Renting. Rental income can help cover the monthly bill while keeping the home.
- Bridge loans and reverse mortgages. Some families use short-term loans while a house sells. Reverse mortgages are generally designed for people who stay in the home, so get independent advice before borrowing4.
If a sale is part of the plan, our downsizing tips can help with the move itself. Keep Medicaid transfer rules in mind before you gift sale proceeds to relatives. If a nursing home may come later, see Texas Medicaid nursing home eligibility.
Long-term care insurance
If your parent bought a long-term care policy years ago, dig out the paperwork even if you are unsure it is still active. Confirm three things: the daily or monthly benefit, the elimination period (the days you pay out of pocket before benefits start), and whether assisted living is a covered setting. Some older policies cover only nursing-home care89.
File the claim as soon as care begins, and ask the insurer exactly what starts the elimination-period clock. For a fuller walkthrough, see long-term care insurance. Texas SHIP counselors can also help with Medicare and insurance questions10.
Read moreLong-Term Care Insurance: What It Covers and How It Works
VA Aid and Attendance
Wartime veterans and surviving spouses who qualify for a VA pension may receive that pension at the higher Aid and Attendance rate when they need help with daily activities such as bathing, dressing or feeding1112. The cash benefit can go toward assisted living. VA does not pay assisted living rent directly as a facility payment, though VA health care may cover some related medical services13.
Aid and Attendance is not a second check stacked on the basic pension. It is a higher maximum annual pension rate. The VA pays the difference between countable income and that maximum, so a veteran with countable income receives less than the full ceiling11.
State veterans programs. The Texas Veterans Land Board operates Texas State Veterans Homes for qualified veterans, spouses and Gold Star parents. These homes provide nursing-home-level care rather than assisted living, so they fit families whose parent needs more care than an assisted living community provides15. For Texas-specific veterans resources, see our Texas VA benefits page.
Our deeper guide is VA Aid and Attendance. Applications can take months, so start early if military service is part of your family's story.
Read moreVA Aid and Attendance: Who Qualifies and How to Apply
Texas Medicaid: STAR+PLUS and assisted living
Medicare does not pay for assisted living rent or personal care16. Texas Medicaid is different. For adults who need nursing-facility-level care but want to live in the community, the key path is STAR+PLUS Home and Community-Based Services (HCBS), sometimes called the STAR+PLUS waiver. STAR+PLUS itself is Texas's Medicaid managed care program for many adults age 65 or older or with disabilities17.
STAR+PLUS HCBS is an alternative to nursing facility placement. Covered HCBS services include assisted living in a personal care facility licensed by HHSC and contracted with the member's managed care organization (MCO). The facility provides 24-hour supervision, meals, housekeeping help, personal care and related supports identified on the individual service plan317.
Under federal HCBS rules, Medicaid generally cannot pay room and board. STAR+PLUS HCBS members must pay room and board to the facility. SSI recipients are not required to pay a separate copayment; members whose financial eligibility was determined under special institutional criteria may owe a copayment. Room and board cannot be waived under HHSC policy, though a facility may choose to accept a lower amount23.
- Who can be assessed. To be eligible for STAR+PLUS HCBS, a person generally must be age 21 or older, have full Medicaid financial eligibility, be a Texas resident, have an approved medical necessity determination for a nursing-facility level of care, have an individual service plan within the program cost limit, have an unmet need for at least one HCBS service, and live in an appropriate setting18.
- Interest list. Most people are assessed only after their name reaches the top of the STAR+PLUS HCBS interest list. Ask to be placed on the list by calling the HHSC Interest List Management / CSIL hotline at 1-877-438-5658, or through your MCO if you are already in STAR+PLUS1819.
- Facility must contract. The assisted living facility must be licensed and contracted with the member's MCO to deliver STAR+PLUS HCBS assisted living3.
- Ways around a long wait. People already in STAR+PLUS may sometimes move into HCBS through an upgrade process. Someone in a nursing facility may pursue Money Follows the Person to transition to HCBS. Ask HHSC or the MCO which path fits18.
Nursing-facility Medicaid pays for care in a nursing home when someone meets institutional rules. That is not the same as STAR+PLUS HCBS assisted living, which is designed to keep people in community settings instead of a nursing facility1718. For how Medicaid waivers work across states, see Does Medicaid pay for assisted living?.
Read moreDoes Medicaid Pay for Assisted Living? How Waivers Work
Community First Choice is not AL rent
You may also hear about Community First Choice (CFC). On STAR+PLUS, CFC can support personal assistance and related services that help people live in the community17. It is not a program that pays assisted living room and board. If your parent needs residential assisted living under Medicaid, the relevant HCBS benefit is STAR+PLUS HCBS assisted living, with the member still paying room and board3.
While waiting on the interest list, Area Agencies on Aging (1-800-252-9240) and Aging and Disability Resource Centers (1-855-937-2372) can point families to other community supports20.
What Medicare does and does not cover
Medicare does not pay assisted living rent or ongoing personal care such as help with bathing and dressing164. It still covers doctor visits, hospital care, skilled nursing facility stays that meet Medicare rules, home health when criteria are met, hospice and most outpatient prescriptions through Part D.
Do not count on Medicare to close the monthly assisted living gap. Build the payment plan from private funds, insurance, VA benefits and, when eligible, STAR+PLUS HCBS instead.
Build a Texas payment plan
- Get written prices. Ask two or three Texas communities for all-in monthly prices at the care level your parent needs now. Ask whether they contract with STAR+PLUS MCOs for HCBS assisted living and what happens if private funds run out.
- List income, assets and benefits. Include Social Security, pensions, savings, insurance and any VA pension.
- Estimate how long private funds last. Factor in likely price increases and higher care levels over time.
- Call the interest-list line early. Request STAR+PLUS HCBS interest-list placement at 1-877-438-5658 before money is nearly gone1918.
- Start VA or insurance claims early. Both can take months. Use a free VA-accredited representative for VA claims14.
- Get advice on complex finances. An HHSC MEPD specialist, elder law attorney, financial planner or SHIP counselor can help with trusts, look-backs and policy questions1020.
Ready to compare communities? Browse assisted living in Texas, take our care quiz, or use the assisted living tour checklist. Check licenses and inspection history through the Texas Long-term Care Provider Search before you decide21.
