How long the Texas STAR+PLUS HCBS waiver interest list really runs, why it doesn't apply to every DFW family, and what to use while you wait.
By Dallas Senior Advisor Care Team · August 14, 2026
If you have called Texas Health and Human Services about long-term care for a parent in Dallas, you have probably heard the phrase "interest list" and wondered how long the Texas STAR+PLUS HCBS waiver waiting list actually runs. The honest answer is uncomfortable: HHSC does not publish a guaranteed timeline, and the interest list is not a queue with a posted finish line. Families across the Dallas-Fort Worth metro are routinely told to plan for a wait measured in years rather than months, and to make the request long before the need becomes urgent. What matters more than any number is understanding what the list is. Adding your parent's name is free, takes one phone call to HHSC, and commits you to nothing. It is not an application, not an eligibility determination, and not a care plan - it is a timestamp. The timestamp is the whole asset. Every month a Lakewood or Plano family waits to make that call is a month added to the back end of a wait they cannot shorten later.
It also helps to separate two things Texas names almost identically. STAR+PLUS is the state's Medicaid managed care program for adults who are 65 or older or who have a disability; if your parent already has full Medicaid in the DFW service area, they are generally already in STAR+PLUS and already have a health plan and a service coordinator. The STAR+PLUS Home and Community Based Services (HCBS) waiver is the add-on that funds attendant care, personal assistance, respite, adaptive aids and home modifications so someone can stay in the community instead of entering a nursing facility. Only the waiver piece carries the interest list. That distinction matters because a family in Oak Cliff or Garland can sometimes get real help through plain STAR+PLUS and other Medicaid programs while the waiver request sits.
The interest list is kept by the state, ordered by the date your request was recorded, not by county. That single fact answers a question DFW families ask constantly: no, moving a parent from Mesquite to be closer to an adult child in Frisco or Flower Mound does not reset the clock, and no, living in a faster-growing county does not move anyone up. The timestamp travels with the person. What does change when you cross a county line in this metro is everything downstream of the waiver - which managed care organization options exist at that address, which agencies serve that ZIP code, and which assisted living communities have an actual contract in place. The DFW-area STAR+PLUS plans include Molina Healthcare, UnitedHealthcare Community Plan, Superior HealthPlan and Aetna Better Health; confirm which are offered at your parent's specific address at enrollment rather than assuming the plan a neighbor uses is available.
The harder local reality is supply. Dallas County, Collin County, Denton County and Tarrant County together hold hundreds of licensed assisted living facilities, but the subset that accepts the STAR+PLUS HCBS waiver is far smaller - and the waiver never pays room and board regardless. Newer, higher-priced inventory in Frisco, Legacy West and North Dallas is the least likely to participate; older buildings in Garland, Mesquite, Irving and parts of Oak Cliff are more likely candidates. Verify participation two ways: check the license and inspection record through the HHSC Long-Term Care Provider Search, then ask the administrator directly whether they currently hold a waiver contract and have an open waiver slot. A marketing director saying they "work with Medicaid" is not the same answer.
There is one exception that reshapes the whole calculation, and most DFW families learn about it too late to use it. Texas allows people who have lived in a Medicaid-certified nursing facility for a qualifying continuous period - commonly cited as at least 30 consecutive days - to move to STAR+PLUS HCBS waiver services in the community without waiting on the interest list, under the Money Follows the Person provision. In other words, the door that opens fastest is the one nobody wants to walk through. If a parent is already in a nursing home on Medicaid and the family's goal is to bring them home or into a participating assisted living community, that transition is a different process than the interest list, and it should be raised with the facility's social worker and the STAR+PLUS health plan's service coordinator before any discharge plan is finalized.
This shows up constantly in the DFW hospital-discharge pipeline. A fall in Preston Hollow, a stroke, or a hip fracture leads to admission at Baylor University Medical Center, UT Southwestern Medical Center, Texas Health Presbyterian Dallas, Methodist Dallas Medical Center, Medical City Plano or Texas Health Arlington Memorial. Rehab follows in a skilled nursing facility under Medicare Part A, and when those covered days end the family is given a few days to decide. That is precisely the moment to ask about Medicaid nursing facility eligibility and the Money Follows the Person path, rather than paying privately for months and discovering the option afterward. Eligibility still requires an HHSC medical necessity and level-of-care assessment plus a financial test, and the specific day-count and program rules should be confirmed with HHSC or the health plan for your parent's situation.
A multi-year wait is only survivable if something fills the gap, and Texas has non-waiver options that do not carry the same interest list. Community Attendant Services, the state's non-waiver attendant care program, is worth asking about specifically - it is more limited in scope than the waiver but is a separate track. Beyond Medicaid, the area agencies on aging are the practical front door: the Dallas Area Agency on Aging, operated by The Senior Source, covers Dallas County; the Area Agency on Aging of North Central Texas at NCTCOG covers Collin, Denton and Rockwall counties; and the Area Agency on Aging of Tarrant County covers Arlington and the rest of Tarrant. They handle benefits counseling, care coordination, caregiver respite and home-delivered meals, all subject to their own funding limits. Texas 2-1-1 and the HHSC Aging and Disability Resource Center route you to the right one.
Money-wise, the bridge is usually a blend. Wartime veterans and surviving spouses should be screened for VA Aid and Attendance through VA North Texas Health Care System and the Dallas VA Medical Center, with the VA Caregiver Support Line at 1-855-260-3274 as a starting point. Adult day programs across the metro typically run about $50 to $85 per day in 2026 and solve two problems at once in a metro this spread out - supervision plus transportation - which matters enormously once a parent stops driving and a Denton County or far-north-Dallas address turns into functional isolation. Private-pay in-home care in DFW generally runs about $26 to $34 per hour, so a few structured days a week is often cheaper than the round-the-clock coverage families default to. Assisted living in the metro runs roughly $3,800 to $5,800 per month, with Park Cities, North Dallas and Frisco skewing high.
When HHSC finally reaches your parent's name, the contact attempt is real and time-limited, and the most common way DFW families lose a slot is administrative. A disconnected landline in Lake Highlands, an unforwarded address after a move to Stonebridge Ranch in McKinney, or an unanswered call from an unfamiliar number is enough. Keep the phone number and mailing address on file current every time anything changes, open state mail the day it arrives, and if a spouse or adult child manages the parent's affairs, make sure that person is the listed contact. Note the date you were added and check in periodically rather than assuming silence means progress.
Then get the eligibility file ready in advance, because two separate tests follow: an HHSC medical necessity and level-of-care assessment, and a financial eligibility review submitted through YourTexasBenefits.com. Pull together several years of bank statements, the deed on the home, life insurance policies with cash value, annuity contracts, and documentation of every income source. Texas applies a look-back period to asset transfers, which is why the single most damaging thing a family can do is quietly deed a Highland Park or Preston Hollow house to a child to "qualify" - that move can create a penalty period at the exact moment care is needed. Talk to a Texas-licensed elder law attorney before moving any asset. This guide is general information about how the process works in Texas, not legal, financial or benefits advice, and program rules change; confirm current requirements with HHSC or your STAR+PLUS health plan.
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