aging in place, Medicaid waiver, image of senior couple

Aging in Place: A Medicaid Waiver Can Be the Missing Piece

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aging in place, Medicaid waiver, image of senior coupleMost seniors want to remain in their own homes as long as possible. Familiar surroundings, supportive neighbors, and independence all make aging in place attractive.

The challenge is that long-term care often becomes necessary, and paying for it can overwhelm even comfortable retirement savings. Medicare does not pay for custodial care, so many families turn to Medicaid for help.

In Texas, a Medicaid waiver can potentially provide the missing piece that makes aging in place a real option. Let’s look at the facts so you understand the lay of the land.

Why Medicaid Waivers Matter

Medicaid covers nursing home care, but many seniors prefer to stay home. A Medicaid waiver changes the playing field for these folks.

Instead of requiring you to enter a facility, the waiver program directs benefits to in-home services. With the right plan, you may qualify for personal attendants, home health aides, or adult day health care. These benefits support your independence while reducing family stress.

Texas participates in several Medicaid waiver programs. The most relevant for seniors is the STAR+PLUS Home and Community-Based Services waiver. This program provides long-term services outside of an institution if you meet medical and financial eligibility requirements.

Understanding the Medicare Gap

It’s natural to assume that Medicare will pay for senior long-term care, but there is a distinction based on the type of care in question.

Medicare pays for hospital stays, short-term rehabilitation, and doctor visits, but it excludes ongoing custodial care. This form of care includes assistance with dressing, bathing, meal preparation, and other activities of daily living.

That gap creates a financial burden, and Medicaid fills that gap through the full program that pays for nursing home care, or a waiver to cover in-home care.

Financial Eligibility Rules

In 2025, an individual applicant must have less than $2,000 in countable assets to qualify in Texas. Some property isn’t counted, including one vehicle, personal effects, household items, wedding and engagement rings, and unlimited term life insurance.

Your home is not counted, with an equity limit of $730,000 in Texas in 2025. However, if you receive benefits as a homeowner, the program must seek reimbursement from your estate after your passing. At that time, a lien could be placed on the property.

Protecting a Healthy Spouse

When a married person needs long-term care while their spouse does not, the healthy spouse is entitled to a couple of allowances.

The Community Spouse Resource Allowance permits the healthy spouse to keep up to $157,920 in countable assets, subject to a minimum of $31,584.

A healthy spouse may also retain a monthly income allowance, maxing out at $3,948. These rules prevent the healthy spouse from becoming impoverished while the other spouse receives waiver benefits.

Medical Necessity Requirements

Financial eligibility is only part of the equation. You must also demonstrate medical need. For waiver benefits, Texas requires that you meet the same level of care standard used for nursing home placement.

That means you need regular assistance with activities of daily living such as bathing, mobility, or eating. A physician assessment helps confirm eligibility.

Once approved, the waiver directs services to your home rather than requiring institutional placement. This structure gives you the support you need without losing your independence.

Services Covered Under the Waiver

The STAR+PLUS waiver covers a broad range of services. You may receive personal attendant care, meal delivery, home modifications, and respite services for family caregivers.

Some plans also cover medical equipment and supplies. These benefits allow you to remain in your home longer, even as your care needs increase.

You may also use adult day health care centers or in-home nursing visits. These services reduce the burden on family members while keeping you in the community. The flexibility of the waiver program adapts to your unique situation.

Planning Ahead Makes a Difference

Medicaid planning requires foresight. Transfers of assets within five years of applying create a penalty period. During that time, Medicaid will not pay for your care.

If you want to preserve property for children or grandchildren, you need to act before a crisis. An elder law attorney can design a trust that protects assets while meeting Medicaid rules.

Planning ahead also avoids rushed decisions. When you prepare early, you create a structure that allows for home care as long as possible, with nursing home care available as a last resort. The waiver becomes part of a comprehensive plan that covers all of your bases.

Irrevocable Income-Only Trust

One tool often used in Fort Worth, Texas Medicaid planning is the irrevocable income-only trust. By transferring assets into this trust, you remove them from your countable resources.

The trustee you name manages the property, and you may receive income generated by trust assets. After five years, the principal is no longer considered for Medicaid eligibility. This strategy can preserve your property while still allowing you to qualify later on.

These trusts require precise drafting and long-term commitment. You cannot create one after a crisis and expect immediate protection. That is why proactive planning is necessary.

Supporting Family Caregivers

Medicaid waivers also support family caregivers. Many programs provide respite care or training, giving loved ones a break from daily duties.

This support helps avoid burnout and strengthens your ability to remain at home. Including caregiver support in your planning ensures that family members have resources as they step into demanding roles.

Professional Guidance Is Key

The Medicaid system is complex, with rules that are subject to change. Mistakes in timing, trust drafting, or income structuring can cost you eligibility.

An elder law attorney can guide you through the process. Your plan should reflect Texas law, federal guidelines, and your family’s financial goals.

Working with an attorney gives you confidence that your documents will stand up to review. It also gives your family clear direction when care decisions must be made. Without guidance, you risk unnecessary expense and uncertainty.

Let’s Get Started!

When you take the right steps in advance, you can be ready to weather the storm if long-term care is needed at some point. To set the wheels in motion, call our Southlake, TX estate planning office at 817-899-3286 or send us a message through our contact page.

Brandon McGee
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