Help in Texas

Texas is the youngest of the five pilot states (median age 35.5) and has the smallest 65+ share — a little over 13%. But the absolute numbers are still large: roughly 4 million Texans are 65 or older, and the population is aging faster than the national average. Texas did not expand Medicaid under the Affordable Care Act, which means many adults under 65 with low incomes fall into a coverage gap. For long-term care, the relevant Medicaid programs are STAR+PLUS (the managed-care program for seniors and adults with disabilities) and a set of HCBS waiver programs (CLASS, DBMD, HCS, and others) that pay for in-home and community-based care for specific eligible populations. The waiver programs are notorious for what Texas officially calls "interest lists" — multi-year waiting lists — and the standard advice from Texas elder-law attorneys is to put your parent on the relevant interest list as early as possible, even if they don't currently need services. Texas has 28 Area Agencies on Aging covering all 254 counties. The AAA network is generally functional, but coverage in the more rural parts of West and East Texas is thinner than in the major metros (Houston, Dallas-Fort Worth, San Antonio, Austin). Transportation gaps, in particular, are real outside the urban areas. Adult Protective Services is administered statewide by the Department of Family and Protective Services. Reports can be made 24/7 online or by phone, and anonymous reports are accepted. One practical note: Texas has no state income tax, which makes financial planning for long-term care somewhat simpler than in higher-tax states — but it also means the state's budget for senior services is tighter than national averages.