Long-Term Care Medicaid in Texas: 2026 Guide

In Texas, Long-Term Care Medicaid is run by Texas Health and Human Services (HHS), through the Health and Human Services Commission (HHSC). Older adults and people with disabilities apply through HHS’s Medicaid for the Elderly and People with Disabilities (MEPD) program. Medicaid can pay for nursing home care and, through STAR+PLUS, for care at home and in assisted living. This guide explains the 2026 rules in plain language.

At a glance: Texas 2026 figures

Item	2026 figure
Income limit (applicant)	$2,982 a month (special income limit). Above this, a Qualified Income Trust is needed
Asset limit (single applicant)	$2,000
Asset limit (couple, both applying)	$3,000
Home equity limit	$752,000
Spouse at home: resource allowance (CSRA)	Minimum $32,532 / maximum $162,660
Spouse at home: monthly income allowance	$4,066.50 (Texas uses the federal maximum)
Personal needs allowance (nursing home)	$75 a month
Look-back period	60 months (5 years)
Penalty divisor	$262.37 a day (from September 1, 2025)

Figures last updated for 2026. Sources are listed at the end of this page.

Figures change periodically. Double-check current amounts with Texas Health and Human Services before relying on them.

What Long-Term Care Medicaid covers in Texas

Nursing home care. Medicaid pays for care in a Medicaid-certified nursing facility. Most people in Texas nursing homes on Medicaid get their health care through a STAR+PLUS health plan.

Care at home and in the community. Texas provides most long-term services for adults through STAR+PLUS, a Medicaid managed care program. Two parts matter most:

STAR+PLUS Home and Community Based Services (HCBS) program: for adults 21 and older who need a nursing-home level of care but want to live at home or in assisted living. Services can include personal attendant care, adult day care, home-delivered meals, nursing, minor home changes, respite and assisted living services.
Personal attendant services for people with full Medicaid who need help with daily tasks (for example, Primary Home Care or Community Attendant Services).

There is an interest list (wait list) for STAR+PLUS HCBS for people who qualify only because of the higher long-term care income limit. People who already have full Medicaid (for example, through SSI) can usually skip it through their health plan. People living in a nursing home may be able to move home through the Money Follows the Person process without waiting.

PACE is available in a few areas of Texas.

Assisted living. STAR+PLUS HCBS can pay for care services in a contracted assisted living facility. Room and board are paid by the resident.

Who qualifies

A person generally must:

be 65 or older, or disabled (21 or older for STAR+PLUS HCBS);
live in Texas and be a U.S. citizen or qualified non-citizen;
have a medical necessity for nursing facility care. For STAR+PLUS HCBS, the health plan does an assessment and builds a service plan within a cost limit;
meet the income and asset rules below.

Income rules

Texas has an income cap. In 2026, an applicant’s gross monthly income must be $2,982 or less.

If income is higher, a Qualified Income Trust (QIT), also called a Miller trust, can be set up. Income above the limit goes into the trust account each month, and the trust pays toward care costs. Texas HHS publishes a sample QIT form on its website.

Once you are on Medicaid in a nursing home, most of your income is paid to the facility each month (your “applied income”). You keep a personal needs allowance of $75 a month. Money can also be set aside for a spouse at home and for health insurance premiums.

Asset rules

In 2026, a single applicant can have $2,000 in countable assets, and a couple who both apply can have $3,000.

Countable assets include cash, bank accounts, CDs, stocks, bonds, mutual funds, retirement accounts that can be cashed in, life insurance cash value above small amounts, and real estate other than the home.

Usually exempt:

Your home (equity up to $752,000) if you live there or intend to return, or a spouse or dependent relative lives there
One vehicle
Household goods and personal belongings
Prepaid funeral contracts, burial plots and limited burial funds
Some income-producing property

Spousal protections

Assets: The spouse at home can keep a Community Spouse Resource Allowance of at least $32,532 and up to $162,660 in 2026, plus the home, one car and belongings.
Income: The spouse at home keeps all income in their own name. Texas lets them receive part of the applicant’s income to bring their total up to $4,066.50 a month, the federal maximum.

Look-back and penalties

When you apply, Texas looks back at the 60 months (5 years) before the application date. This is called the look-back period. The state checks whether you, or your spouse, gave away money or property, or sold something for less than it was worth, during that time.

Common examples of transfers that can cause a problem:

Cash gifts to children or grandchildren, even small yearly gifts. (A gift that is fine for federal gift-tax purposes can still count for Medicaid.)
Adding a child’s name to a house deed or bank account in a way that gives them part ownership.
Selling a house or car to a relative for much less than it is worth.
Paying a family member for care without a written agreement made at the time.

Some transfers are allowed, such as transfers between spouses, or transferring a home to a child who is blind or disabled.

How the penalty works. If the state finds a transfer that is not allowed, it does not deny Medicaid forever. Instead, it sets a penalty period: a stretch of time when Medicaid will not pay for long-term care. The state divides the amount given away by the penalty divisor ($262.37 a day).

Example: Suppose you gave your daughter $50,000 three years before applying. $50,000 divided by $262.37 is about 191 days (a little over 6 months) without Medicaid payment for long-term care.

The penalty period starts only once you have applied, are otherwise eligible, and are in (or need) long-term care. This is why gifts made while someone is healthy can still matter years later. If a gift is returned in full, the penalty can be removed.

Estate recovery in Texas

The Texas Medicaid Estate Recovery Program (MERP) is run by Texas HHS.

What is recovered: long-term services received at age 55 or older, starting on or after March 1, 2005. This includes nursing facility care, STAR+PLUS long-term services and several waivers. Some related hospital and drug costs may be included. Primary Home Care is not subject to MERP.
When Texas will not file a claim:
a spouse is still alive;
there is a child under 21, or a child of any age who is blind or disabled;
the estate is worth $15,000 or less;
Medicaid costs were $5,000 or less;
an unmarried adult child lived full time in the home for at least one year before the death;
selling the property would cost more than it is worth;
recovery would cause undue hardship for the heirs.
The state never asks for more than it paid. Families can use the MERP online portal to upload documents and apply for a hardship waiver.

How to apply

Online: YourTexasBenefits.com
Paper form: Form H1200, Application for Assistance – Your Texas Benefits, by mail, fax or at a local HHS office
By phone: dial 2-1-1 and choose the HHS option

For STAR+PLUS HCBS, contact HHS to be placed on the interest list, or contact your STAR+PLUS health plan if you already have Medicaid. Nursing home residents can ask about Money Follows the Person.

Gather what you can before you apply. The caseworker may ask for:

Photo ID, Social Security card and Medicare card
Proof of age and of U.S. citizenship or immigration status
Proof that you live in the state (for example, a utility bill or lease)
Proof of all income: Social Security award letter, pension statements, annuity statements
Bank, credit union and investment statements (often for the full 60-month look-back period)
Deeds, property tax bills and the value of any real estate
Life insurance policies (showing cash value) and prepaid funeral or burial contracts
Vehicle titles
Health insurance cards and long-term care insurance policies
Power of attorney or guardianship papers, if someone is applying for you
For a spouse at home: their income and assets too, since both spouses’ assets are counted at the start

If you cannot find a document, apply anyway and tell the caseworker. They can explain what else is accepted.

Free public help in Texas

Texas HHS (2-1-1): Medicaid applications and eligibility questions.
Area Agencies on Aging and Aging and Disability Resource Centers (ADRCs): information on local long-term care services and benefits counseling.
HICAP (Health Information, Counseling and Advocacy Program): Texas’s free Medicare counseling program (SHIP), offered through the Area Agencies on Aging.
Texas Long-Term Care Ombudsman Program: free, independent advocates for residents of nursing homes and assisted living.
HHS Office of the Ombudsman: help with problems or complaints about HHS programs, including MERP.

Recent and upcoming changes

A 2025 federal law (Public Law 119-21) makes two changes that affect Long-Term Care Medicaid in every state, including Texas:

Retroactive coverage gets shorter on January 1, 2027. Today, Medicaid can pay bills from up to 3 months before the month you apply, if you would have qualified then. For applications from January 1, 2027, this window shrinks to 2 months for older adults and people with disabilities. In plain terms: from 2027, it matters more to apply soon after care starts, so that earlier bills are not left unpaid.
Home equity cap on January 1, 2028. States will no longer be able to set a home equity limit above $1,000,000 (except for some farm property). Texas’s 2026 home equity limit, $752,000, is already below the new cap, so this change is not expected to affect Texas’s limit.

The federal amounts that change each year (for example, the allowances for a spouse at home) will be updated on this page for 2027 once they are published.

State programs

Each program below has its own page with who qualifies, services, how to apply and waiting lists:

Frequently asked questions

Is there a wait list for home care in Texas? Often, yes. STAR+PLUS HCBS has an interest list for people who qualify only under the long-term care income limit. People who already have full Medicaid can usually go through their health plan instead.

My income is over $2,982 a month. Can I still qualify? Yes, with a Qualified Income Trust. Texas HHS has information and a sample trust form on its website.

Can my spouse keep our house? Yes. The home is exempt while your spouse lives there. Texas will also not file an estate recovery claim while a spouse is alive.

Does Medicaid pay for assisted living in Texas? STAR+PLUS HCBS can pay for care services in a contracted assisted living facility. The resident pays room and board.

Will Texas recover from a small estate? Not if the estate is worth $15,000 or less, or if Medicaid costs were $5,000 or less.

How long is the penalty for a gift? Divide the gift by $262.37 to get the number of days. A $10,000 gift would mean about 38 days without Medicaid payment for long-term care.

Figures change periodically. Double-check current amounts with Texas Health and Human Services before relying on them.

Sources

Texas HHS, MEPD Handbook Appendix XXXI, Budget Reference Chart
Texas HHS, MEPD Handbook I-5100, Transfer of assets divisor
Texas HHS, STAR+PLUS HCBS Program Eligibility
Texas HHS, Your Guide to the Medicaid Estate Recovery Program
Form H1200, Application for Assistance
Your Texas Benefits
CMS, 2026 SSI and spousal impoverishment standards
Public Law 119-21 (2025)

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.