Medicaid is a joint federal-state program that funds healthcare for people with limited income and assets. Medicare is a federal insurance program for people 65 and older (and some younger individuals with disabilities) that is not income-based. Medicare covers short-term skilled nursing care after hospitalization; Medicaid covers long-term nursing home care when Medicare has ended and the patient has limited financial resources.

Yes. Texas Medicaid (through the STAR+PLUS program for most regions) covers long-term skilled nursing facility care for eligible individuals. Medicaid pays the nursing home directly; the resident contributes their monthly income (less a personal needs allowance of $60 per month) and Medicaid covers the remainder. Not all nursing homes in Texas accept Medicaid — availability varies by facility.

To qualify, an individual must meet both financial and medical criteria. Financial: limited income and assets (in 2026, generally less than $2,000 in countable assets for an individual; income rules depend on whether the person is a waiver participant). Medical: the individual must require nursing home level of care — significant functional limitations requiring skilled nursing oversight. Both criteria must be met simultaneously.

Countable assets include bank accounts, stocks, bonds, and non-primary real estate. Exempt assets include: the primary home (if the applicant intends to return or a spouse remains there), one vehicle, personal belongings and household goods, term life insurance, and prepaid burial arrangements up to certain limits. The rules are detailed and situation-specific — an elder law attorney can evaluate your specific asset picture.

Spend-down refers to reducing countable assets to below the Medicaid eligibility threshold by paying for legitimate care-related expenses. This can include paying nursing home costs privately until assets reach the limit, purchasing exempt assets, or paying off debts. Improper transfers of assets (giving money away to qualify faster) trigger penalty periods during which Medicaid coverage is delayed. An elder law attorney is essential for navigating spend-down planning legally.

Texas Medicaid reviews all asset transfers made within the 60 months (5 years) before the Medicaid application. Transfers made for less than fair market value during this period — gifts, transfers to children, asset sales at below-market prices — are counted and result in a penalty period during which Medicaid will not pay for nursing home care. The length of the penalty period corresponds to the value of the improper transfer.

Yes. Texas has spousal protection rules under the Medicaid Spousal Impoverishment provisions. The community spouse (the one remaining at home) can retain the primary residence, one vehicle, household goods, and a Community Spouse Resource Allowance (approximately $154,140 in 2026). The community spouse also has a Minimum Monthly Maintenance Needs Allowance from the nursing home spouse’s income. An elder law attorney can help maximize spousal protections.

The application process typically takes 45 to 90 days from submission to approval, though it can take longer if additional documentation is requested. The nursing home must be Medicaid-certified and complete a Preadmission Screening and Resident Review (PASRR). Applications are submitted through Texas HHSC. Many families work with an elder law attorney or Medicaid specialist to complete the application accurately and avoid delays.

While the Medicaid application is pending, the nursing home typically continues providing care and bills the patient’s monthly income. Some nursing homes require a private pay deposit or agreement to private pay during the pending period. Once Medicaid is approved, it typically covers retroactively from the date of application or the date of eligibility, whichever is later. Confirm retro coverage policy with both the nursing home and HHSC.

Texas Medicaid does not broadly cover assisted living. The STAR+PLUS waiver program can cover some home and community-based services for Medicaid-eligible individuals who would otherwise need nursing home care, but these programs have limited capacity and waitlists. Most assisted living facilities in Texas are private pay only. If Medicaid long-term care coverage is anticipated, planning for nursing home care is more straightforward than assisted living.

Use Medicare’s Care Compare tool to search for Medicare and Medicaid certified nursing facilities by zip code. You can also contact the Texas HHSC or your local Area Agency on Aging. Not all nursing homes in Texas accept Medicaid, and some that do have limited Medicaid beds. A placement agent who works with Medicaid cases can identify which facilities in your area have available Medicaid-certified beds.

Yes, strongly. Medicaid rules are complex, change frequently, and the stakes are high — mistakes can result in denial, penalty periods, or unnecessary depletion of assets. An elder law attorney can develop a legal asset protection strategy, complete the application accurately, represent you if denied, and coordinate with the nursing home on billing. Many families find that attorney fees are far smaller than the assets preserved through proper planning.