What STAR+PLUS is
STAR+PLUS is Texas Medicaid's managed care program for adults who are 65 or older or who have a disability. Members get medical care and long-term services and supports through a health plan, also called a managed care organization or MCO. A key part of STAR+PLUS is service coordination: a person at the health plan who helps members who need or ask for extra help organize their services.
Some STAR+PLUS members also qualify for home and community-based services (HCBS), which are meant to help people live safely at home instead of in a nursing facility. Minor home modifications are one of those services.
What the handbook allows
The Texas HHS STAR+PLUS Handbook, section 6600, describes minor home modifications. A few points stand out for bathroom projects:
- Lifetime limit: $7,500 per member, with $300 per year allowed for repairs, replacement or additional modifications after that limit is reached.
- Bathroom changes are a recognized category. Related HHS handbook language lists modification of bathroom facilities, ramps and doorway widening among allowable work.
- Exclusions: the handbook rules out items that are general repairs, such as roofs, gutters or a leaky faucet, and some larger items such as elevators. Additions that create new square footage are not allowed.
- Above the limit: the handbook describes situations where a plan may exceed the cost limit when the member's service plan documents the need. That is the plan's decision.
Handbooks are revised. Before relying on any number here, ask your service coordinator for the current rule and read the linked section.
Who decides
You do not apply to us, and you do not apply directly to the state. The member's health plan decides whether a modification is part of the service plan, usually after an assessment of needs at home. An occupational therapist or nurse may be involved. The plan typically arranges or approves the contractor and may ask for bids.
How to start
- Call the member services number on the STAR+PLUS ID card and ask for your service coordinator.
- Describe the problem, not the product: "I can't step over the tub wall safely" or "my caregiver can't help me bathe in this space."
- Ask about an assessment and what documentation the plan needs.
- Ask what kinds of changes the plan has approved before. A grab bar and a hand shower, a curbless shower, or a tub replacement may be treated differently.
- Get approval in writing before any work begins.
Is a walk-in tub the right request?
With a $7,500 lifetime limit, it is worth thinking about the whole picture. A plan may prefer lower-cost changes first, such as grab bars, a transfer bench and a handheld shower, or a shower conversion that also helps a caregiver. If a walk-in tub is the right fit, an itemized quote helps the plan review it. We can provide one; whether the plan pays is up to the plan.
Not on STAR+PLUS?
Texas has other Medicaid waiver programs with their own rules, and many people are not on Medicaid at all. The 28 Area Agencies on Aging and the Aging and Disability Resource Centers (1-855-937-2372) can explain options. TDHCA's Amy Young Barrier Removal Program is another route for households with a person with a disability and limited income. See all Texas funding routes.
Tips for a smoother request
- Keep a short diary for a week of what goes wrong at bath time. Concrete examples help an assessor.
- Ask the doctor to note fall history, balance problems or a recent surgery in the medical record.
- Ask whether the plan uses its own contractors or accepts outside bids, and how many.
- If a request is denied, ask for the reason in writing and how to appeal.
Common questions
What is the STAR+PLUS limit for minor home modifications?
The STAR+PLUS Handbook sets a lifetime limit of $7,500 per member, with $300 per year for repairs or additional modifications after the limit is reached. Check the current handbook with your service coordinator.
Who approves a STAR+PLUS home modification?
The member's health plan (MCO), usually through a service coordinator after a needs assessment.
Can STAR+PLUS pay for a walk-in tub?
Bathroom modifications are a recognized category, but each request is decided by the health plan based on the member's needs and the program rules. Ask before any work begins.
Sources
- STAR+PLUS Handbook 6600, Minor Home Modifications
- Texas HHS STAR+PLUS Handbook 3200, Eligibility
- Texas HHS: Aging and Disability Resource Centers
- Texas HHS: Area Agencies on Aging directory
- Texas Dept. of Housing and Community Affairs, AYBR program
Agencies update their rules and amounts. Confirm with the linked source before you rely on a figure.