You have been quoted a number for assisted living and it is not survivable. Somebody has told you that Medicaid will cover it, and that sentence has been holding your family together for about a week now. I need to take some of the weight off it, gently, before you make a decision that rests on it.

Texas Medicaid does not pay the rent. It can pay for the care your parent receives inside an assisted living facility, which is a real and substantial thing, but the room and board is a separate bill and it stays yours. That distinction is rarely the headline anywhere a family encounters it early, and it is the single most common reason people plan around a number that was never going to appear.

So this page separates the two bills and puts real figures against both: what a Texas assisted living community charges, what your parent is expected to contribute, and the gap in the middle that your family funds. It walks the program that actually does the paying, and it is honest about the part that causes the most heartbreak: the waiting list nobody mentions in the tour. None of this is a reason to give up on assisted living. It is what you need to know to plan for it rather than hope at it.

Estimated reading time: 17 min read

Overview

Texas Medicaid does not cover room and board in an assisted living facility. It can cover the care services delivered there, through the STAR+PLUS Home and Community Based Services waiver. Texas HHS sets the room and board charge at the SSI Federal Benefit Rate minus a Personal Needs Allowance of potentially $85 a month, which for 2026 puts the resident’s contribution at roughly $909. The median assisted living rate in Texas was potentially around $63,000 a year, roughly $5,250 a month, in the 2024 Cost of Care Survey published by Genworth and CareScout, so the gap a family funds is potentially around $4,341 a month at the median. For 2026 a single applicant faces a gross monthly income limit of potentially around $2,982 and a countable asset limit of roughly $2,000. The waiver is not an entitlement and operates with interest lists that can run for years. Every figure here should be confirmed with Texas HHS before it is relied on, and none of it is advice about your parent’s money.

What this guide covers

• There are two bills, and Medicaid only looks at one of them
• The number nobody puts next to the other number
• Who qualifies, financially and medically
• If your parent is married, protections apply here too
• When your parent has dementia, two clocks are running in opposite directions
• The interest list, which is the part that actually decides your timeline
• Not every facility takes the waiver, and that changes the shortlist
• What this looks like when a family has the numbers early
• Protect Your Family’s Financial Future

There are two bills, and Medicaid only looks at one of them

An assisted living invoice bundles two entirely different things into one number, and the bundling is where families get hurt. There is the rent: the apartment, the meals, the utilities, the housekeeping. And there is the care: help with bathing and dressing, medication management, supervision, the personal attendant hours that are the actual reason your parent cannot live alone anymore.

Texas Medicaid, through the STAR+PLUS waiver, can pay for the second one. It does not pay the first. Not partially, not eventually. Room and board in an assisted living facility sits outside what the waiver covers, and the family remains responsible for it. Texas HHS states this plainly in its own STAR+PLUS handbook, in a section a family would have to already know existed in order to find. That is the shape of this whole system: the answer is public, and it is filed where only the people who already understand it will look. It is complicated on purpose, and the complication is paid for by families who never get to the bottom of it.

Once you see the invoice as two bills you can plan. While you see it as one number that Medicaid might cover, you are making decisions on a figure that does not exist, and I have watched families commit to a facility on exactly that misunderstanding. You are not being slow about this. You were handed a brochure that said ‘we accept Medicaid’ and you read it the way any reasonable person would.

One deliberate limit before we go further. Everything on this page describes how the rules are written and what families in general run into. None of it tells you what to do with your parent’s assets, because Medicaid planning is legal work, and describing a system is a different job from advising you inside it. The description is the useful part anyway: almost nobody gets it.

The number nobody puts next to the other number

Here is the arithmetic, both halves of it, because half of a subtraction is worse than none.

First, what your parent contributes. Texas HHS sets the room and board charge for a STAR+PLUS waiver resident in an assisted living facility at the SSI Federal Benefit Rate minus a Personal Needs Allowance of potentially $85 a month. The allowance is theirs, for clothing, a haircut, a phone. For 2026 the federal benefit rate is potentially $994 a month, so the room and board charge lands at roughly $909. If your parent’s income is below that, they contribute less; the charge is a ceiling calculated from the benefit rate, not a flat fee. The facility cannot waive it, although Texas HHS does permit a facility to accept a resident for less if it chooses to.

Second, what the room actually costs. The 2024 Cost of Care Survey published by Genworth and CareScout put the median assisted living rate in Texas at potentially around $63,000 a year, roughly $5,250 a month, against a national median of potentially $70,800 a year. In the 2025 survey the national assisted living median rose to potentially $6,200 a month, an increase of about five percent, so treat the Texas figure as a floor that has since moved rather than a ceiling. Austin and the Dallas-Fort Worth metro sit above the state median. These are medians, not quotes: the number on your parent’s contract is the only one that governs.

Now the subtraction. Roughly $5,250 a month at the Texas median, minus a resident contribution of roughly $909, leaves potentially around $4,341 a month that your family finds from somewhere else. That is potentially around $52,000 a year, every year, for as long as your parent lives there, on top of a Medicaid approval that took months to get.

I am not telling you that to frighten you. I am telling you because that figure is knowable today, before you tour, before you sign, before you fall in love with a dining room. Families who learn it in month one make a different set of choices from families who learn it in month fourteen, and the difference between those two groups is not intelligence or effort. It is only ever who told them in time.

The table below is the same two bills laid out side by side, because this is the split the brochure never draws for you.

Who qualifies, financially and medically

The waiver applies the same financial gates as the rest of Texas long-term care Medicaid. For 2026 a single applicant faces a gross monthly income limit of potentially around $2,982 and a countable asset limit of roughly $2,000, with the primary home, one vehicle and several other categories typically exempt. Those exemptions are real and they are almost never mentioned in the same breath as the $2,000, which is the figure that does all the frightening. The Texas nursing home Medicaid eligibility rules use the same architecture, so a family that has already been through that process will recognize most of this.

The word gross matters as much here as anywhere. Texas measures income before the Medicare Part B premium comes out, so the amount landing in the account each month is not the amount being tested, and families who check the wrong one conclude they are ineligible when they are not. That is not a rounding error. That is a family walking away from a program their parent could have been on. For applicants over the income limit, a Qualified Income Trust is the mechanism Texas provides, and how it is set up is attorney work rather than something to improvise.

There is also a medical gate. The waiver requires a determination that your parent needs a nursing facility level of care, even though the whole point of the program is to deliver that care somewhere less restrictive. Clearing the money tests does not clear this one, and being told so after months of financial work is a blow that is worth seeing coming.

Two related pieces sit underneath all of this and are worth reading before anything moves: how Texas treats countable assets and spend-down, and what the sixty-month look-back period actually catches. Both describe rules that are already in force whether or not a family knows about them, which is precisely the problem with rules that are this hard to find.

If your parent is married, protections apply here too

The spousal protections built for nursing home Medicaid apply to the waiver as well, and they are larger than most families assume.

The Community Spouse Resource Allowance protects a share of the couple’s countable assets for the spouse remaining at home, potentially up to $162,660 in 2026. The Monthly Maintenance Needs Allowance permits potentially up to roughly $4,066.50 a month to be directed to that spouse where their own income falls short.

Couples regularly liquidate assets that were protected from the first day, and there is no mechanism for getting that money back afterward. The protection existed the whole time. Nobody put it on the page next to the $2,000. That is the pattern this article keeps returning to, and it is why knowing the numbers before anything moves is worth more than any single decision made after.

When your parent has dementia, two clocks are running in opposite directions

This is the part of the question that gets answered badly everywhere else, usually because the person answering knows Medicaid or knows dementia but not both. Jessica Cannon is a CPA with 28 years of financial experience and a Certified Dementia Practitioner, and she cared for her own mother through frontotemporal dementia and four misdiagnoses, so this page can hold both halves at once.

Here is the collision. The STAR+PLUS waiver runs on an interest list that can take years to clear. Dementia does not wait for a list. Those are two clocks running in opposite directions, and the second one governs a set of doors that close quietly.

The doors are legal capacity. A Medicaid application, a Qualified Income Trust, a power of attorney, a facility contract: each of them requires a signature, and a signature requires that the person signing understands what they are signing. Dementia moves that threshold. In her published work Jessica describes the window after a diagnosis as roughly the first twelve months, because that is typically when a family still has the option of documents being signed by the person they concern rather than by a court. When capacity falls below the legal threshold and no power of attorney exists, the route that remains is guardianship, which is a court process with a lawyer, a filing and a timeline of its own. It does not close the door. It makes the door expensive and slow, at the exact moment a family has neither money nor time.

The second dementia-specific difference is that the diagnosis can change which setting will take your parent at all. Assisted living communities set their own admission and discharge criteria. A resident whose needs grow past what that community is licensed and staffed to handle can be asked to move, and a dementia diagnosis is one of the common reasons that conversation starts. If the move is to memory care, the rate changes, and so does the arithmetic in the table above. This is also where families discover what Medicare does and does not cover in memory care and assisted living, which is a different answer again and almost never the one they were expecting.

The third difference is the medical determination. The waiver asks whether your parent needs a nursing facility level of care. Dementia can meet that standard through supervision needs rather than through physical needs, which is unfamiliar territory for a family used to thinking about care in terms of mobility and medication. It is worth knowing that the two are assessed differently, because a family who assumes a parent who walks and eats independently cannot qualify may never apply.

I am describing how these pieces interact, not telling you which to do first. Sequencing decisions about capacity, documents and assets is legal work and belongs with an attorney in your own state. What is useful here is simply knowing that the money question and the dementia question are the same question, on the same timeline, and that treating them as two separate errands is how families lose the twelve months.

The interest list, which is the part that actually decides your timeline

Nursing Home Medicaid is an entitlement: meet the criteria and coverage follows. The STAR+PLUS waiver is not. It is a capped program, it operates with interest lists, and those lists can run for years.

This is the hardest thing on this page and I would rather you hear it now than in month fourteen. A family can do everything correctly, clear every financial gate, obtain the medical determination, and still be waiting, while the facility-based route remains available immediately. Nothing about being well prepared moves anyone up the list. That is not a failure of preparation, and I want to say that clearly, because the families who work hardest at this take the wait most personally.

What the wait does change is the planning. If the waiver is years away, the question stops being how Medicaid pays for assisted living and becomes how the next few years get funded, and those are completely different conversations with completely different answers. The interest list also runs from the day a name goes on it rather than from the day a family needs it, which is why the timing of that step matters more than almost anything else in the sequence.

Not every facility takes the waiver, and that changes the shortlist

A facility has to contract with a STAR+PLUS managed care plan to accept waiver residents, and many of the places families tour do not. ‘We accept Medicaid’ on a brochure can mean the community has one such contract, or that it once did, or that it will consider it, and none of those are the same as a bed your parent can move into.

The questions that separate those answers are simple: whether the community accepts STAR+PLUS HCBS residents, and how many it currently has. A facility that takes the waiver in principle but holds no waiver residents is answering a different question from the one asked. So is one that says yes but requires a private-pay period first, which is a common arrangement and entirely legal, and which belongs in the arithmetic before anyone falls in love with the place.

Touring on the assumption that any nice community will work, and then discovering the shortlist is a quarter the size you thought, is a particularly demoralizing way to spend a month you did not have to spare. The information exists. It is just never volunteered.

What this looks like when a family has the numbers early

None of this tells you what to do with your parent’s money, and that is deliberate rather than coy. What a description can do is stop a family touring on assumptions the system has no interest in correcting.

The families who come through this without a second, worse move tend to have the same handful of things in front of them before they walk into a building. They have the gross income figure rather than the deposited one. They have assets sorted into countable and exempt, and if there is a spouse at home, they have the protected allowance in writing. They know the facility’s actual monthly rate and have set it against a resident contribution of potentially around $909, so the gap is a number rather than a feeling. They have asked every community on the list about STAR+PLUS. And they understand that the interest list runs on its own clock, separately from everything else they are doing.

That is a short list and it is worth more than any brochure you will be handed. You cannot make this system simpler than it is. You can walk into it knowing which bill is yours and roughly how big it will be, which is a great deal more than most families get, and it is the difference between a plan and a hope.

One note on geography, because Texas detail on a page like this reads like a boundary. It is not one. Jessica works with families nationwide through virtual coaching, with in-person roots in Austin and Central Texas. The Texas rules here are a worked example of a structure that exists in every state under different names, and the two-bill split is the part that travels.

Frequently asked questions

Q: Does Medicaid pay for assisted living in Texas?

A: Not the room and board. Texas Medicaid can pay for the care services delivered in an assisted living facility through the STAR+PLUS Home and Community Based Services waiver, but the rent, meals and utilities remain the family’s responsibility. Reading the invoice as two separate bills, care and housing, is the single most useful thing a family can do early.

Q: How much will my parent have to pay toward room and board, and what does the family owe?

A: Texas HHS calculates the room and board charge from the SSI Federal Benefit Rate, potentially $994 in 2026, minus a Personal Needs Allowance of potentially $85, so roughly $909 a month. The median assisted living rate in Texas was potentially around $63,000 a year, roughly $5,250 a month, in the 2024 Cost of Care Survey published by Genworth and CareScout. That leaves potentially around $4,341 a month, or around $52,000 a year, for the family to fund. Medians are not quotes, so the facility’s own contract rate is the figure that governs.

Q: What are the income and asset limits for the STAR+PLUS waiver?

A: For 2026, potentially around $2,982 in gross monthly income for a single applicant and roughly $2,000 in countable assets, with the primary home, one vehicle and other categories typically exempt. Texas measures income before deductions such as the Medicare Part B premium, so the figure in the bank statement is not the figure being tested. Confirm current limits with Texas HHS.

Q: How is paying for assisted living different when a parent has dementia?

A: Two things change. Capacity is one: a Medicaid application, a Qualified Income Trust, a power of attorney and a facility contract all require a signature from someone who understands what they are signing, and dementia moves that threshold, after which guardianship through a court is the route that remains. Setting is the other: a community can discharge a resident whose needs outgrow what it is licensed to handle, and a move to memory care changes the monthly rate and therefore the gap the family funds. Sequencing any of this is attorney work rather than something to improvise.

Q: How long is the wait for the STAR+PLUS waiver?

A: It varies and it can run to years, because the waiver is a capped program with interest lists rather than an entitlement. Nursing Home Medicaid, by contrast, is an entitlement and is available once the criteria are met. Meeting every requirement does not move a family up the list, and the list runs from the day a name goes on it rather than from the day the family needs it.

Citations

• Texas Health and Human Services: STAR+PLUS Handbook, Assisted Living Services. The room and board charge, set at the SSI federal benefit rate minus the personal needs allowance, and what the waiver covers in an assisted living facility https://www.hhs.texas.gov/handbooks/starplus-handbook/7200-assisted-living-services
• Texas Health and Human Services: MEPD Handbook H-1500, Personal Needs Allowance. The personal needs allowance retained by a resident https://www.hhs.texas.gov/handbooks/medicaid-elderly-people-disabilities-handbook/h-1500-personal-needs-allowance
• Texas Health and Human Services: STAR+PLUS. Program overview, waiver services and member rights https://www.hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-programs-services/starplus
• Texas HHS: Medicaid for the Elderly and People with Disabilities. Eligibility and long-term care programs https://www.hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-programs-services/programs-children-adults-disabilities/medicaid-elderly-people-disabilities
• Social Security Administration: SSI Federal Benefit Rate. The federal benefit rate used in the room-and-board calculation https://www.ssa.gov/oact/cola/SSI.html
• Medicaid.gov: Home and Community Based Services. How HCBS waivers work and why they are not entitlements https://www.medicaid.gov/medicaid/home-community-based-services
• Genworth and CareScout: Long-Term Care Costs Increase in Texas, Remain Lower Than National Costs. The 2024 Cost of Care Survey Texas medians, including assisted living at potentially around $63,000 a year https://investor.genworth.com/news-events/press-releases/detail/1027/long-term-care-costs-increase-in-texas-remain-lower-than
• CMS: 2026 SSI and Spousal Impoverishment Standards (Informational Bulletin, December 9, 2025). The federal source for the Community Spouse Resource Allowance maximum and the maximum Monthly Maintenance Needs Allowance. https://www.medicaid.gov/federal-policy-guidance/downloads/cib12092025.pdf

Related reading

• Does my parent qualify for nursing home Medicaid in Texas?
• Medicaid spend-down in Texas: what counts and what is exempt
• The Medicaid look-back period explained
• Does Medicare pay for memory care and assisted living?
• How families pay for long-term dementia care
• How reactive caregiving costs families $750K, and what proactive planning saves
• Financial Wellness for Family Caregivers
• The Proactive Caregiver Method

About this article. Jessica Cannon is a CPA and a Certified Dementia Practitioner. She provides financial coaching, not legal or medical services. This article is general information about how these systems work, not advice about your situation, and it is not a substitute for the advice of an attorney. It is not medical advice, and it is not individualized tax or financial advice. For the legal instruments themselves, including wills, powers of attorney and guardianship, you will need a licensed attorney in your own state. Medicaid and long-term care rules also differ by state and change over time, so any Texas detail here is an example rather than a rule that will apply to you.