Full Definition

Applying for Texas Medicaid long-term care coverage — whether for nursing facility or community-based services — is a multi-step process administered by the Texas Health and Human Services Commission (HHSC). Understanding the process helps families prepare and avoid common mistakes that cause delays.

Key steps in the Texas Medicaid long-term care application process: (1) Gather all required documentation — typically 5 years of bank statements, tax returns, proof of all assets and income, Social Security award letters, insurance policies, property records, and the prior 60 months of financial transactions (look-back period review); (2) Submit the application to HHSC — applications for nursing facility Medicaid can be initiated while the person is hospitalized or in a nursing facility; (3) HHSC conducts a medical and functional assessment to confirm the person meets nursing facility level of care; (4) HHSC reviews the financial documentation to determine countable assets and income; (5) HHSC issues an eligibility determination.

The process typically takes 45–90 days from application submission to eligibility determination, though delays are common. During the pending period, the nursing facility typically continues care with the understanding that Medicaid will be the payer if the application is approved.

Most families benefit significantly from working with an elder law attorney who handles Texas Medicaid applications. Errors, omissions, or incomplete documentation can result in denials or significant delays — and missing the look-back period implications of past financial transactions can create unexpected penalty periods.