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.

$3998

Texas

$4500

The United States

$4498

New Mexico

$3855

Oklahoma

$3748

Louisiana

$3760

Arkansas

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.    

$2770

Texarkana

$2800

Waco

$5600

Victoria

$5345

Austin

$4195

Dallas

$4245

Houston

$3750

El Paso

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.  

$3998

Assisted Living

$4576

Home Care

$4576

Home Health Care

$769

Adult Day Health Care

$5125

Nursing Home Care (semiprivate)

$7092

Nursing Home Care (private room)

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

Income Limits* 

Asset Limits

Single Applicant

$30,276

$2,000

Two-Person Household

(Only One Person Applying)

$30,276

$2,000 for the applicant 

$137,400 for non-applicants

Two-Person Household
(Both People Applying)

$60,552

$3,000

*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.   

Program

Contact

Services Provided

(800) 925-9126

Trained advisers assist over the telephone with Medicaid applications between 7 am and 7 pm on weekdays 

(800) 252-3439

Staff members assist with understanding health benefits and comparing health insurance policies

(855) 937-2372

Professional advisers offer diverse advice, including benefit entitlements and application assistance

Online

The website contains in-depth information about all benefits, including Medicaid, and individuals can easily check eligibility with the prescreening tool

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.

How to Apply

How It Works

Aid and Attendance

Learn more and apply online at va.gov.

Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for Assisted Living.

Reverse Mortgages

Learn more about your options and how to apply at ftc.gov

If you own a home, you may be able to use a reverse mortgage to help pay for Assisted Living. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan.

Long-Term Care (LTC) Insurance

Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov.

Seniors who already have long-term care insurance may be able to use it to pay for Assisted Living. Most policies cover at least a portion of the cost, but it depends on the specific policy terms. Note that older adults who are already in need of Assisted Living will not typically be eligible to sign up for a LTC insurance policy.

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.    

Resource

Contact

Services

(855) 937-2372

Aging and Disability Resource Centers can be found across the state. Knowledgeable staff provides up-to-date information related to all areas of aging and living with a disability, signpost to relevant assistance organizations and facilitate access to diverse localized, statewide and nationwide services.

(800) 252-9240

Texas has 28 local Area Agencies on Aging (AAA) to offer information and support to individuals aged 60 and above. Areas include benefits, elder law and rights, housing, wellness and nutrition. Agencies typically run diverse support programs, including those for family members, and advise on community projects for seniors.

(512) 463-6564

Senior men and women who served in the U.S. Armed Forces can obtain support and information from VA Centers across the state. Advisors help people to understand the availability of and eligibility for various veterans’ benefits and assist with claims and appeals. Resources include those related to mental health, grants and education, and centers that offer health care advocacy.

(877) 323-6466

The Office of the Independent Ombudsman for State Supported Living Centers safeguards the rights of long-term care residents across Texas. As well as being a valuable source of information on long-term care options and regulations, the office monitors compliance, investigates complaints and advocates for seniors.

(512) 477-6000

Low-income citizens, including seniors with limited means, can obtain free legal advice from Texas Legal Services Center. Areas of law include elder, consumer, pensions and benefits.

211

Available 24 hours a day, seven days a week, 2-1-1 Texas operates a free hotline and website to easily connect Texans, including seniors, with a range of services and provide accurate information from local and statewide health and human services departments and programs.

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

Rules for Texas Communities

Can I visit my relative in person if he/she wants emotional support from me?

Yes (Conditions Apply)

Can I visit my relative in person for end-of-life compassion care?

Yes

Will my loved one be required to self-quarantine after I visit him or her?

No

Do I need to wear PPE and/or a cloth mask if I do visit my relative in person?

Yes

Are Hairdressers and other non-medical contractors still allowed in senior living facilities?

Yes

Does the state recommend or require that senior living facilities assist families with setting up virtual visit alternatives?

Yes

Are visitors being screened for elevated temperatures?

Yes

Are visitors being asked questions about health, travel, and potential virus contact?

Yes

Outings & Social Activities

Rules for Texas Communities

Are residents allowed to leave the facility for non-medical reasons?

Yes

Are residents of senior living facilities who leave and return required to self-quarantine?

No (Conditions Apply)

Are senior living facilities required to cancel all group outings?

No

Are residents still eating together in the dining hall?

Yes (Conditions Apply)

Are facilities still allowed to host group activities within the community?

Yes (Conditions Apply)

COVID-19 Safety Measures for Staff and Residents

Rules for Texas Communities

Are staff members and contractors being screened for elevated temperatures?

Yes

Are staff members and contractors being tested for Coronavirus?

Yes (Conditions Apply)

Are staff members and contractors being asked questions about health, travel, and potential virus contact?

Yes

Are staff members required to regularly screen residents for coronavirus symptoms?

Yes

Are residents relied on to screen themselves and self-report potential coronavirus symptoms?

No

Are staff members required to take residents’ temperatures?

Yes

Are residents being tested for coronavirus?

Yes (Conditions Apply)

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.  

Texas Laws and Regulations

Assisted Living Admission Requirements 

There are two licensing types in Texas for assisted living communities: A and B. The license types are largely based on a resident’s physical and mental ability to evacuate the premises in an emergency situation. Residents must be appropriate for the license type when admitted. If a resident’s situation later changes and is not in accordance with the license, the community is not obliged to retain them. A community cannot admit anyone whose physical and mental needs cannot be met by the facility. A community can, however, secure services through third-party providers to meet resident needs, with written agreement of the resident, their physician or their legal representative.

Assisted Living Facility Requirements 

Assisted living facilities in Texas are not required to offer single rooms. No more than 50 percent of all beds in a facility can be in rooms for two people. Rooms can house up to four residents. One toilet and one sink must be available for every six residents, with one shower or bathtub available for up to 10 residents. In split-level buildings, there must be at least one bathroom and toilet on every floor with sleeping accommodation. Toilet rooms must be available for each gender.

Assisted Living Medicaid Policy 

Texas’s Medicaid program covers assisted living services under the STAR+PLUS waiver. Assisted living facilities must have a contract with a resident’s managed care organization (MCO).

Assisted Living Scope of Care 

Assisted living facilities provide housing, meals and supervision of the physical and mental wellbeing of residents. Facilities should provide either medication administration, personal care, including activities of daily living, or both. Communities must offer at least one activity or social program per week. A facility may offer temporary skilled nursing services for no longer than 30 days.

Assisted Living Service Plan Requirements 

When admitting a new resident, assisted living communities in Texas are required to conduct an in-depth assessment. This should be completed within 14 days of admission, and should be completed by qualified staff. Based on the assessment, the facility must complete a written individualized service plan (ISP) that details an individual’s particular needs, preferences and situation. The service plan must be updated yearly and if there is a significant change in condition.

Background Checks for Assisted Living 

Assisted living facilities in Texas require background checks for prospective employees. A person is ineligible for hire if they have a disqualifying conviction.

Medication Management Regulations 

Only licensed or certified members of staff can administer medication to residents. For residents who can administer their own medications, monthly checks are required to ensure they are still able to self-administer necessary medications. Staff members can supervise self-administration of medication, including providing reminders that medication is due, opening and closing containers, measuring the correct amount of medication according to a prescription, and returning medications to safe storage.

Requirements for Reporting Abuse 

Under Texas law, everybody has a responsibility to report suspected or actual elder abuse or neglect. Reports concerning abuse in assisted living facilities can be made to the Texas Department of State Health Services by calling (800) 458-9858. Alternatively, anyone can telephone the 24/7 Texas Abuse Hotline on (800) 252-5400.

Staff Training Requirements 

All staff members must complete training and continuing education commensurate with their role. Managers of small facilities must have a minimum of a high school diploma or certification of equivalency. Managers of larger communities should have a bachelor’s degree, an associate’s degree in nursing, health care management or a related subject, or a high school diploma (or certification of equivalency), plus at least one years’ experience of working in health care management or general management.

All managers hired post-August 2000 need to complete a 24-hour course on assisted living management within the first year of hire and also complete a minimum of 12 hours of ongoing education in related areas each year. Topics include ethics, laws, resident evaluations and financial management. All staff must receive four hours of orientation training before beginning their role. Full-time attendants must be a minimum of 18 years old or hold a high school diploma, and they must complete 16 hours of hands-on training and supervision. On-going yearly education and training are mandatory.

Staffing Requirements 

In Texas, there are no minimum staff to resident ratios. There should be enough staff members to maintain safety, order and cleanliness, prepare and serve meals, help with laundry, provide basic care and supervision in accordance with residents’ individual service plans, assist with medication and be able to evacuate the property in an emergency situation. Every community must have a designated manager. In Type A facilities, small communities must have night shift staff available in case of an emergency and large communities must have awake and directly accessible night shift staff. All Type B communities need awake and directly available staff at nighttime. Communities must post monthly staffing patterns.

Assisted Living Facilities in Texas (169)