Texas Medicaid covers nursing home care primarily through the STAR+PLUS program (Medicaid managed care) and the traditional Medicaid fee-for-service program in some counties. The program pays nursing home costs directly to the facility; the resident contributes their monthly income (less a $60 personal needs allowance) and Medicaid covers the remainder. Eligibility requires meeting both financial and medical criteria.

For a single individual in 2026: countable assets must generally be at or below $2,000. The primary home is exempt if the applicant plans to return or a spouse remains. One vehicle, personal belongings, and prepaid burial up to certain limits are also exempt. Income rules vary — Texas uses a Qualified Income Trust (Miller Trust) system for individuals whose income exceeds the Medicaid income standard.

Medically, a person must require nursing home level of care — significant functional limitations requiring skilled nursing or 24-hour supervision that cannot be safely managed in a less intensive setting. Texas uses a standardized assessment tool to determine medical necessity for long-term care Medicaid. A physician or nurse assessor documents the functional limitations that establish the need for institutional care.

Exempt assets include: the primary home (if planning to return, if a spouse or disabled minor child lives there); one vehicle of any value; personal belongings and household goods; term life insurance; prepaid burial arrangements up to the state limit; and certain retirement accounts (rules vary). Assets held in irrevocable trusts established prior to the look-back period may also be exempt, subject to specific rules.

When applying for Medicaid nursing home benefits, Texas reviews all asset transfers made within the 60 months (five years) before the application. Transfers made for less than fair market value — gifts, below-market property sales, transfers to family members — result in a penalty period during which Medicaid will not pay for care. The penalty period length is calculated by dividing the transferred amount by the average daily nursing home cost.

If a person’s monthly income exceeds the Texas Medicaid income standard (approximately $2,742 in 2026), they must establish a Qualified Income Trust (QIT, also called a Miller Trust) to qualify for Medicaid. Excess income is deposited into the trust monthly and used for care costs, with Medicaid covering the balance. An elder law attorney establishes the trust; it must be set up before Medicaid approval.

Federal Medicaid spousal impoverishment protections allow the community spouse (the one remaining at home) to keep: the primary home; one vehicle; household goods; and a Community Spouse Resource Allowance (approximately $154,140 in 2026). The community spouse also retains a Minimum Monthly Maintenance Needs Allowance from the nursing home spouse’s income. An elder law attorney can structure assets to maximize these protections.

The Medicaid application process in Texas typically takes 45 to 90 days from submission to approval. This timeline can be longer if documentation is incomplete or if the application requires clarification. The application must be submitted to Texas HHSC with complete documentation of income, assets, medical need, and residency. Many families work with an elder law attorney or Medicaid specialist to ensure accuracy and avoid delays.

Yes — and it is advisable to start the application as early as possible. If the application is approved, Medicaid coverage is retroactive to the date of application or the date of eligibility (whichever is later). This means that care costs during the application processing period may eventually be covered retroactively. Confirm the specific retroactivity rules with the nursing home and HHSC when applying.

After a Medicaid recipient passes away, Texas Medicaid may seek to recover from the deceased person’s estate the costs paid by Medicaid. This is called estate recovery. The primary home is subject to recovery after the community spouse also passes. Estate recovery does not affect transfers made more than five years before the Medicaid application, and there are hardship exemptions. An elder law attorney can advise on estate recovery implications for specific family situations.

Broadly, no. Texas Medicaid does not fund regular assisted living residence. The STAR+PLUS Home and Community-Based Services waiver covers some services (personal care, day programs, transportation) for Medicaid-eligible individuals who would otherwise need nursing home care. However, these programs have limited capacity and waitlists, and the assisted living room and board costs must still be paid privately.

An elder law attorney provides legal strategies to protect assets while achieving Medicaid eligibility, within the law. They can: evaluate the asset and income picture; develop a legally compliant spend-down strategy; set up Qualified Income Trusts and other planning vehicles; complete the Medicaid application; represent the family in appeals; and advise on estate recovery. Given the financial stakes, most families find attorney fees are far outweighed by assets preserved through proper planning.