Texas Medicaid Nursing Home Eligibility: A Complete Guide

The median annual cost for a semi-private nursing home room in Texas ranges from $65,000 to $75,000. Texas Medicaid (administered by HHSC) can cover the cost for eligible residents — but the application process and eligibility rules require careful navigation.

Who Qualifies

1. Medical necessity — Physician certifies need for nursing facility level of care via Texas Medical Necessity review.
2. Financial eligibility — Income and asset limits.
3. Texas residency — U.S. citizenship or qualifying immigration status.

Income Requirements

• Monthly income limit: $2,829/month (300% of SSI, 2025)

A Qualified Income Trust (Miller Trust) is required when income exceeds the cap. Community spouse income protections apply — Monthly Maintenance Needs Allowance up to approximately $3,715/month.

Asset Requirements

• Individual applicant: $2,000 in countable assets
• Community spouse: Up to $148,620 (2025 CSRA)

Exempt assets: Primary home (with intent to return, or spouse/dependent lives there), one vehicle, personal property and household goods, burial plots and prepaid funeral arrangements.

Look-back period: Texas enforces a 60-month (5-year) look-back period.

Application Process

Apply through Texas Health and Human Services (HHSC):

1. Call 2-1-1 or HHSC Benefits hotline at 1-877-787-8999.
2. Apply online at Your Texas Benefits (yourtexasbenefits.com).
3. Submit: income verification, 60 months of bank statements, asset proof, physician certification.
4. Both financial eligibility and Medical Necessity reviews are required.

What Texas Medicaid Covers

Covered: Semi-private room and board, skilled and custodial nursing care, physical/occupational/speech therapy, physician visits, prescriptions, medical equipment, dietary and social services.

Not covered: Private rooms (unless medically necessary), personal items, non-covered dental and vision.

Home- and Community-Based Programs

• STAR+PLUS Home and Community Based Services (HCBS): Primary waiver for seniors and people with physical disabilities. Includes personal attendant services, home health, adult day health, respite, and therapy.
• Community Attendant Services (CAS): Personal care services for lower-acuity needs.
• Day Activity and Health Services (DAHS): Adult day health programs.

Important: Texas STAR+PLUS HCBS waiver historically has had very long wait times — in some areas, 3–5+ years. Contact your local HHSC to get on the interest list as early as possible.

Frequently Asked Questions

My income is $3,200/month — do I need a Miller Trust?

Yes. An elder law attorney can establish one.

How does the look-back period work?

Assets transferred for less than fair market value within 60 months before applying may trigger a penalty period, calculated by dividing the transfer value by the average monthly nursing home cost in Texas.

Is my home counted as an asset?

No — your primary home is exempt during your lifetime. Texas may pursue estate recovery after death.