Texas — Nursing Home Medicaid Eligibility Guide

Texas is home to over 1,200 Medicaid-certified nursing facilities, and the state's long-term care Medicaid program serves more than 60,000 nursing home residents annually. Understanding the rules can mean the difference between financial devastation and sustainable care for Texas families.

Income Eligibility

Texas is an income cap state:

2024 income limit: $2,829/month (gross)

Like Florida, Texas does not offer a spend-down pathway for income. If your monthly gross income — from all sources including Social Security, pensions, retirement accounts, and annuities — exceeds $2,829, you do not qualify through the standard route.

The workaround is a Qualified Income Trust (QIT) or Miller Trust. This legal arrangement places excess income into a dedicated trust account monthly. Those funds are then applied toward the cost of care, restoring Medicaid eligibility. A qualified elder law attorney must draft and administer the trust.

Personal needs allowance in Texas: $60/month

After the personal needs allowance and any deductions for community spouse support, all remaining income goes toward nursing home costs. Texas Medicaid covers the balance up to the Medicaid-approved rate.

Asset Limits

Individual applicant: $2,000 in countable assets

Married couple (one spouse applying):

• Applicant: $2,000
• Community spouse: up to $154,140 (2024 CSRA maximum)

Common exempt assets:

• Primary residence (up to $713,000 equity; may be unlimited if a spouse or dependent lives there)
• One automobile (no limit on value if used for transportation)
• Household goods and personal property
• Irrevocable pre-paid funeral or burial plan (up to $15,000)
• Term life insurance (no cash value limit)
• Whole life insurance with cash value ≤$10,000 per person

The 5-Year Lookback Period

Texas Medicaid reviews all asset transfers made within 60 months (5 years) of the application date. Transfers of assets for less than fair market value — including gifts to children, transfers to irrevocable trusts, or property transfers — may trigger a penalty period.

The penalty is calculated by dividing the transferred amount by the average monthly private-pay nursing home rate in Texas (approximately $6,500/month as of 2024). The result is the number of months of Medicaid ineligibility.

Penalty-free transfer exceptions:

• Transfers to a spouse
• Transfers to a blind or totally disabled child
• Transfers of the home to an adult child caregiver who lived with the applicant for two or more years
• Transfers to a sibling with equity interest who lived in the home for at least one year before nursing home placement

Application Process

Texas Medicaid long-term care is administered by the Texas Health and Human Services Commission (HHSC). Applications are submitted through:

• Your STAR+PLUS managed care organization (MCO) — most nursing home Medicaid in Texas flows through STAR+PLUS
• A local HHSC eligibility office
• Online through Your Texas Benefits (yourtexasbenefits.com)

The facility's social worker is often the best first contact — they process Medicaid applications routinely and are familiar with required documentation.

Required documents generally include:

• Proof of identity and citizenship
• Social Security card and Medicare information
• Income verification (all sources)
• Bank statements (five years for lookback review)
• Property and vehicle records
• Life insurance policies
• Any trust documents

STAR+PLUS HCBS Waiver

Texas's STAR+PLUS Home and Community Based Services (HCBS) program offers nursing-home-level care at home for eligible seniors. Services may include:

• Personal care assistance
• Adult day services
• Nursing and therapy services at home
• Home modifications for accessibility
• Caregiver training and respite
• Assisted living support

To access the STAR+PLUS HCBS waiver, contact your local HHSC office or call 2-1-1 for a referral. There is often a waiting list; applying before a nursing home crisis is strongly advised.

Texas also has the Community Living Assistance and Support Services (CLASS) waiver for individuals with related conditions, and the DBMD waiver for individuals who are deaf-blind.

Cost Context: What Nursing Home Care Costs in Texas

Texas generally has lower nursing home costs than coastal states:

Costs vary across Texas regions. The Dallas-Fort Worth metroplex and Houston tend to be higher; rural Texas can be notably more affordable. Even at Texas's lower rates, $6,200/month means $74,400/year in nursing home expenses — illustrating why Medicaid planning matters even in more affordable markets.

Next Steps for Texas Families

1. Verify income against the $2,829 cap — if above, an elder law attorney can establish a Miller Trust to preserve eligibility
2. Audit the last five years of financial records — document any large gifts, property transfers, or asset changes
3. Contact HHSC or a STAR+PLUS MCO — begin the needs assessment process; HCBS waiver waiting lists can be months long
4. Ask the facility's social worker — they are the most direct resource for initiating the application process