Abstract: Starch, an abundant, renewable, and biodegradable natural polymer, exhibits substantial potential for food preservation packaging. However, pristine starch-based materials suffer from inherent drawbacks, such as poor mechanical properties and inadequate barrier performance, which significantly limit their practical application. This review outlines the fundamental molecular structure and film-forming mechanism of starch. To overcome the limitations of native starch, recent advances in preparing preservation packaging materials by blending starch with polysaccharides, proteins, essential oils, and nanomaterials are summarized. Commonly employed physical and chemical modification strategies are systematically elaborated, and the regulatory mechanisms by which different modification methods influence the structure and properties of starch-based preservation materials are analyzed. Physical modification approaches, including heat-moisture treatment, ultrasound, and irradiation, can alter the crystallinity and molecular chain arrangement of starch in an environmentally friendly manner, whereas chemical modification enables the introduction of new functional groups or covalent bonds. Furthermore, research progress on various types of intelligent responsive starch-based preservation packaging, including pH-responsive, gas-responsive, and light-responsive systems, is introduced. Finally, the challenges facing the future research, development, and application of starch-based preservation materials are summarized, and future directions are discussed to provide a reference for the development of high-performance, multifunctional starch-based preservation packaging materials.