What Is Nursing-Facility Level of Care?

Nursing-facility level of care is one of the most important — and most confusing — parts of STAR+PLUS HCBS eligibility.

What it means

Nursing-facility level of care describes a level of need that would qualify a person for care in a nursing facility. STAR+PLUS HCBS is designed for people who meet this level of need but can be safely served in the community, such as in an assisted living facility, instead of a nursing home.

How it is assessed

An assessment — typically a nurse evaluation — reviews the person's medical conditions and their ability to perform daily activities. This determines whether the medical-necessity requirement is met.

Why it matters

Without approved medical necessity for this level of care, HCBS assisted-living services are not available, even if the person is financially eligible for Medicaid. It is a required piece of the eligibility checklist.

Frequently asked questions

What is nursing-facility level of care?

It is a level of need that would qualify someone for nursing-facility care. STAR+PLUS HCBS serves people who meet this level but can be safely cared for in the community.

Who decides if someone meets it?

An assessment, typically a nurse evaluation coordinated through HHSC and the MCO, determines whether the medical-necessity requirement is met.