Texas Nursing Home Medicaid pays for a nursing home once Medicare’s short rehabilitation benefit runs out — but only after the family clears an income test, an asset test and a level-of-care assessment. This Texas nursing home medicaid guide gives the 2026 figures, what the spouse at home is allowed to keep, how the five-year look-back works, and where in Texas the application actually goes.
Every dollar figure below comes from the state Medicaid agency, CMS or the statute cited, and each resets on its own calendar. Where Texas has not published a current figure we say so instead of guessing.
In This Texas Nursing Home Medicaid Guide:
Texas Nursing Home Medicaid at a Glance (2026)
| Program | Texas does not use a marketing brand for nursing home coverage. The Texas Health and Human Services Commission (HHSC) provides it through Medicaid for the Elderly and People with Disabilities, usually shortened to MEPD, and the nursing-home category itself appears in HHSC handbooks and notices as “ME – Nursing Facility,” also written as Medicaid for institutional care or nursing facility Medicaid. If you hear a caseworker say MEPD, ME-Nursing Facility, or institutional care, they are all describing the same coverage your family is seeking. |
| 2026 income limit (single applicant) | $2,982 |
| 2026 asset limit (single applicant) | $2,000 |
| Spouse at home may keep (assets) | $32,532 to $162,660 |
| Spouse at home income floor | $2,705 to $4,066.50 per month |
| Look-back period | 60 months |
| Penalty divisor | not published here yet — confirm with HHSC takes the long-term-care Medicaid application and assigns it to an MEPD eligibility specialist; the nursing facility does not decide financial eligibility. Families can apply online through the state’s YourTexasBenefits.com portal, or request and file the paper application by calling 2-1-1 (choose the option for benefit programs) or 1-877-541-7905. Completed paper applications are mailed to HHSC, P.O. Box 149024, Austin, TX 78714-9024, or faxed to 1-877-447-2839. The nursing home’s business office usually helps assemble the paperwork. |
| Home equity limit (no spouse at home) | $752,000 (confirm with HHSC takes the long-term-care Medicaid application and assigns it to an MEPD eligibility specialist; the nursing facility does not decide financial eligibility. Families can apply online through the state’s YourTexasBenefits.com portal, or request and file the paper application by calling 2-1-1 (choose the option for benefit programs) or 1-877-541-7905. Completed paper applications are mailed to HHSC, P.O. Box 149024, Austin, TX 78714-9024, or faxed to 1-877-447-2839. The nursing home’s business office usually helps assemble the paperwork.) |
| Over the income limit? | A qualified income trust (Miller trust) is required |
Texas Nursing Home Medicaid Income and Asset Limits
Two tests, both applied to the person entering the facility. The income test looks at gross monthly income from every source — Social Security, pensions, IRA withdrawals, annuities, rent. The asset test counts what can be turned into cash: bank accounts, investments, retirement accounts in most states, and any property other than the home.
Texas is an income-cap state. If the applicant’s gross monthly income is over the Texas nursing home medicaid limit by even a dollar, the application is denied unless a qualified income trust (a Miller trust) is set up first and funded every month.
Texas does not count everything a family owns. The homestead that is the applicant’s or the spouse’s principal residence is generally excluded, as is one automobile regardless of its value.
Household goods and personal effects are excluded, along with burial plots and an irrevocable prepaid funeral or burial plan; certain designated burial funds and some life insurance are also set aside, though those exclusions carry limits this file does not state. Everything else the applicant owns outright is generally counted as an available resource.
Texas is an income-cap state, so it does not offer a medically needy spend-down for nursing facility Medicaid. Applicants whose gross monthly income sits above the state limit instead use a Qualified Income Trust, abbreviated QIT and widely called a Miller Trust, described in Appendix XXXVI of the MEPD handbook.
The trust must be irrevocable, established with its own separate bank account, and funded each month with the person’s Social Security, pension, or other income; savings and other resources may never be deposited into it.
What the Spouse at Home Keeps Under Texas Nursing Home Medicaid
Federal spousal impoverishment rules stop Texas nursing home medicaid from bankrupting the husband or wife who stays home. The at-home spouse keeps a protected share of the couple’s assets — between $32,532 and $162,660 in 2026 — and is guaranteed a monthly income floor of at least $2,705, rising to $4,066.50 when housing costs are high. The house is fully exempt while the spouse lives in it.
Texas applies the federal spousal impoverishment protections, set out in Chapter J of the state’s MEPD handbook, and does not add unusual state-only twists. The couple’s countable resources are added up as of the date continuous institutionalization began, and the spouse who remains at home keeps a protected share, called the protected resource amount or spousal protected resource amount.
A couple may request a resource assessment from HHSC before ever filing an application. The at-home spouse may also keep a monthly needs allowance from the resident’s income.
The asset snapshot is taken on the first day of the continuous stay, not the application date. Families who spend down before asking for a resource assessment often spend money the spouse was entitled to keep.
The Look-Back Rule and Transfer Penalties
Texas reviews every transfer made in the 60 months before the application. Money or property given away, or sold for less than it was worth, is added up and divided by the state’s penalty divisor — its average private-pay nursing home cost — to produce a period during which Texas nursing home medicaid will not pay.
The divisor in Texas is not published here yet — confirm with HHSC takes the long-term-care Medicaid application and assigns it to an MEPD eligibility specialist; the nursing facility does not decide financial eligibility. Families can apply online through the state’s YourTexasBenefits.com portal, or request and file the paper application by calling 2-1-1 (choose the option for benefit programs) or 1-877-541-7905. Completed paper applications are mailed to HHSC, P.O. Box 149024, Austin, TX 78714-9024, or faxed to 1-877-447-2839.
The nursing home’s business office usually helps assemble the paperwork..
60 months, federal standard. The IRS annual gift exclusion has no bearing here: a gift that is tax-free can still trigger a Medicaid penalty. Transfers to a spouse, to a disabled child, or of the home to a child who lived there and provided care for two years are the main exceptions.
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How to Apply for Texas Nursing Home Medicaid
Where: HHSC takes the long-term-care Medicaid application and assigns it to an MEPD eligibility specialist; the nursing facility does not decide financial eligibility. Families can apply online through the state’s YourTexasBenefits.com portal, or request and file the paper application by calling 2-1-1 (choose the option for benefit programs) or 1-877-541-7905. Completed paper applications are mailed to HHSC, P.O. Box 149024, Austin, TX 78714-9024, or faxed to 1-877-447-2839. The nursing home’s business office usually helps assemble the paperwork. — start the application.
Texas calls this the medical necessity determination, and it is separate from the financial review. The nursing facility’s registered nurse completes the federally required MDS assessment and submits it, along with Form 3618 (the admission notice) and the Long Term Care Medicaid Information section, through the TMHP Long Term Care Online Portal.
Nurses at Texas Medicaid & Healthcare Partnership, the state’s claims administrator, then decide whether the person’s medical and nursing needs exceed what an untrained caregiver could provide and require licensed nursing supervision available only in an institution.
Bring five years of bank statements, deeds, vehicle titles, insurance policies, the Medicare and Social Security cards, and any trust or power of attorney documents. Missing paperwork is the most common reason a Texas nursing home medicaid decision is delayed.
While the Application Is Pending
A Texas nursing home will commonly admit a resident as “Medicaid pending” and bill the state once eligibility is approved, but the family should confirm that in writing with the facility’s business office first. While the case is pending, the resident is expected to turn over income toward the cost of care, which Texas calls applied income or the co-payment, keeping only a small personal needs allowance.
The eligibility specialist also reviews coverage for months before the application month. Typical decision time: UNVERIFIED.
After approval, nearly all of the resident’s income goes to the facility each month as the patient share, minus a small personal needs allowance, health insurance premiums and the spouse’s allowance.
Denials, Appeals and What Comes After
Most Texas denials are paperwork problems rather than true ineligibility: requested bank statements, deed records, insurance policies, or trust documents were not returned to the eligibility specialist in time. Other frequent causes are countable resources still sitting above the limit, an unapproved or delayed medical necessity determination from TMHP, uncompensated asset transfers, and a Qualified Income Trust that was signed but never funded properly each month.
Any denial notice may be appealed by requesting a fair hearing, verbally or in writing, following the instructions printed on the notice.
One more thing families should know before they file: after the resident’s death, the state may seek repayment from the estate. That process — what it can reach and the exemptions — is covered in our guide to Texas Medicaid estate recovery.
A Realistic Texas Nursing Home Medicaid Timeline
Week one: the hospital or family calls the Medicaid office for the level-of-care assessment and starts gathering five years of statements. Weeks two to four: the assessment is done and the financial application is filed, usually with the facility’s admissions office helping. Weeks six to twelve: the caseworker verifies accounts and may ask for more documents; answer within the deadline on each request or the clock resets.
Approval, when it comes, is retroactive to the eligibility date, which is why filing early is the single most valuable thing a family can do.
Where to Get Help Free
Two free doors exist in every state: the Texas SHIP counselor for the Medicare side and the state’s Aging and Disability Resource Center for the Medicaid side. Neither sells anything. For a Texas nursing home medicaid question involving a house, a spouse at home or a recent gift, a local elder law attorney or legal aid office is the next call.
Key Takeaways: Texas Nursing Home Medicaid
- Two tests, not one: Texas nursing home medicaid checks income and assets separately, and passing one does not excuse the other.
- The spouse is protected: the at-home spouse keeps a share of assets and an income floor under Texas nursing home medicaid before anything is spent down.
- The look-back is five years: any gift inside it is divided by the divisor and becomes months without Texas nursing home medicaid coverage.
- The home usually does not count: while a spouse lives there, the house is exempt from the Texas nursing home medicaid asset test.
- Apply as Medicaid pending: most facilities admit while Texas nursing home medicaid is decided and the state pays back to the eligibility date.
- Assessment first: the level-of-care evaluation is what starts the Texas nursing home medicaid clock, so request it on day one.
- Retirement accounts often count: IRAs and 401(k)s are countable in most states under Texas nursing home medicaid unless in payout status.
Official Sources
- Texas does not use a marketing brand for nursing home coverage. The Texas Health and Human Services Commission (HHSC) provides it through Medicaid for the Elderly and People with Disabilities, usually shortened to MEPD, and the nursing-home category itself appears in HHSC handbooks and notices as “ME – Nursing Facility,” also written as Medicaid for institutional care or nursing facility Medicaid. If you hear a caseworker say MEPD, ME-Nursing Facility, or institutional care, they are all describing the same coverage your family is seeking. — Texas Medicaid: https://www.hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-programs-services/programs-children-adults-disabilities/medicaid-elderly-people-disabilities
- HHSC takes the long-term-care Medicaid application and assigns it to an MEPD eligibility specialist; the nursing facility does not decide financial eligibility. Families can apply online through the state’s YourTexasBenefits.com portal, or request and file the paper application by calling 2-1-1 (choose the option for benefit programs) or 1-877-541-7905. Completed paper applications are mailed to HHSC, P.O. Box 149024, Austin, TX 78714-9024, or faxed to 1-877-447-2839. The nursing home’s business office usually helps assemble the paperwork.: https://www.hhs.texas.gov/regulations/forms/1000-1999/form-h1200-application-assistance-your-texas-benefits
- Medicaid.gov spousal impoverishment standards: medicaid.gov
- Medicare.gov Medicare Savings Programs: medicare.gov
This Texas nursing home medicaid guide was checked against the state Medicaid agency, CMS and the statute cited above in September 2026. Figures reset on their own calendars (most on January 1); if a number here disagrees with a notice you received, the notice wins — and please tell us. This page is general information, not legal, financial or medical advice.