Long-Term Care Costs in Texas

Texas's long-term care costs are well below national averages across all care settings — assisted living averages $5,666 per month, approximately 9% below the national average, while nursing home care averages $5,627 per month, roughly 41% below the national average of $9,581. Home care averages $5,720 per month, about 14% below the national rate. Texas Medicaid is administered by the Texas Health and Human Services Commission (HHSC), with most long-term care delivered through Managed Care Organizations (MCOs). The primary programs are STAR+PLUS (serving the elderly and disabled) and STAR+PLUS HCBS (Home and Community Based Services). The income limit for Nursing Home Medicaid and HCBS is $2,982 per month, with applicants able to use Qualified Income Trusts (Miller Trusts) to become eligible if over the limit. Texas uses the maximum MMMNA ($4,066.50) as the standard — no minimum floor or shelter allowance calculation is required. Texas did not expand Medicaid under the ACA. This guide covers what care costs in Texas, how to qualify for Medicaid, and what options exist for veterans and family caregivers in Houston, Dallas, San Antonio, Austin, and across the Lone Star State.

Texas's Aging Population: The Numbers Behind the Need

Texas has approximately 4.1 million residents aged 65 or older — roughly 13% of the state's total population, one of the fastest-growing senior demographics in the country. The senior population is concentrated in the Houston metropolitan area (Harris, Fort Bend, and Montgomery Counties), the Dallas–Fort Worth Metroplex (Dallas, Tarrant, Collin, and Denton Counties), San Antonio (Bexar County), and Austin (Travis and Williamson Counties). Large senior communities also exist in El Paso, the Rio Grande Valley (McAllen, Brownsville, Harlingen), Corpus Christi, Lubbock, and Amarillo.

Texas's vast geography — from the urban centers of Houston and Dallas to the expansive rural regions of West Texas and the Panhandle — creates significant challenges for long-term care delivery. Many rural counties have few or no facility options, making home and community-based services essential for keeping seniors near their families and support networks.

Unpaid Caregivers in Texas: Scale and Impact

An estimated 3.4 million unpaid family caregivers in Texas provide care to aging relatives and adults with disabilities — the largest caregiver population of any state. According to AARP research, family caregivers nationwide spend an average of $7,242 per year in out-of-pocket costs related to caregiving.

Texas offers several programs that support family caregivers. The Community First Choice (CFC) program and Primary Home Care (PHC) program both allow self-direction — participants can hire caregivers of their choosing, including some relatives such as adult children. The STAR+PLUS HCBS waiver provides respite care, adult day services, and personal care visits to help families sustain caregiving over time.

What Long-Term Care Costs in Texas

Texas's care costs vary by type of care:

• Assisted Living: $5,666 per month — approximately 9% below the national average of $6,200
• Nursing Home (semi-private room): $5,627 per month — approximately 41% below the national average of $9,581
• Home Care (home health aide): $5,720 per month — approximately 14% below the national average of $6,673
• Adult Day Care: $1,950 per month — approximately 5% below the national average of $2,058

At these rates, a three-year nursing home stay in Texas costs approximately $203,000 — significantly less than the national average of $345,000. Home care totals roughly $206,000 over the same period. Assisted living, at $5,666/month, represents approximately $204,000 over three years. For a detailed breakdown of care costs by type and how Texas compares to other states, visit our Texas Care Costs page.

How to Qualify for Medicaid in Texas: Eligibility Rules for 2026

Texas Medicaid is administered by the Texas Health and Human Services Commission (HHSC). Most Medicaid plans are provided by Managed Care Organizations (MCOs): STAR+PLUS serves the elderly and disabled, while STAR+PLUS HCBS delivers Home and Community Based Services. Texas Medicaid provides long-term care coverage through nursing homes, assisted living, and adult foster care, along with non-medical support services to help seniors remain at home. Texas did not expand Medicaid under the Affordable Care Act. Consulting with a Texas elder law attorney or Certified Medicaid Planner early can help families avoid costly mistakes. Eligibility rules vary by program type:

• Nursing Home Medicaid (Institutional): Income limit of $2,982/month. All of a beneficiary's monthly income, with the exception of a $75/month Personal Needs Allowance, Medicare premiums, and possibly a Needs Allowance for a non-applicant spouse, must go towards nursing home costs (Patient Liability). Asset limit of $2,000 (single) or $3,000 (married couple, both applying). When only one spouse applies, the non-applicant spouse may retain up to $162,660 in assets. This is an entitlement — anyone who qualifies receives benefits.
• Medicaid Waivers / HCBS (STAR+PLUS HCBS): Income limit of $2,982/month. Asset limit of $2,000 (single). STAR+PLUS HCBS covers assisted living services, adult foster care, and many in-home supports. This is not an entitlement — enrollment is limited and interest lists may exist.
• Regular Medicaid / Medicaid for the Elderly and People with Disabilities (MEPD): Income limit of $994/month (single) or $1,491/month (couple); asset limit of $2,000 (single) or $3,000 (couple). To be eligible, a senior must receive SSI — SSI eligibility leads to automatic Texas Medicaid approval. This is an entitlement.

Texas applies a 60-month (5-year) look-back period for Nursing Home Medicaid and HCBS Waiver applications. Asset transfers during this period — including gifts to family members and transfers by one's spouse — can trigger a penalty period of Medicaid ineligibility. The federal $19,000 Gift Tax exclusion (2026) does NOT apply to Medicaid's look-back rules. There is no look-back period for Regular Medicaid (MEPD). For the full Texas Medicaid eligibility breakdown, see our Texas Medicaid Guide.

Spousal Protections and Community Spouse Resource Allowance

When one spouse applies for Nursing Home Medicaid or STAR+PLUS HCBS in Texas, only the applicant spouse's income is counted. The Community Spouse Resource Allowance (CSRA) allows the non-applicant spouse to retain up to $162,660 in countable assets. The minimum CSRA is $32,532. If the community spouse's half of the couple's assets is under $32,532, up to $32,532 can be retained.

Texas uses the maximum Monthly Maintenance Needs Allowance (MMMNA) of $4,066.50 as the standard — there is no minimum floor or shelter allowance calculation. If the non-applicant spouse already has income of $4,066.50 or more per month, no additional allowance is provided. If their income is below this amount, income can be transferred from the applicant spouse up to this maximum. For Regular Medicaid (MEPD), both spouses' income is counted and there is no MMMNA or CSRA. Spousal protections apply only to Nursing Home Medicaid and Medicaid Waivers.

Texas Medicaid Programs: STAR+PLUS and Community Services

Texas offers several Medicaid-funded long-term care programs:

• STAR+PLUS Waiver (STAR+PLUS HCBS): Limited enrollment managed care program covering assisted living services, adult foster care services, and many in-home supports to help beneficiaries avoid nursing home placement.
• Community First Choice (CFC) Program: Entitlement program providing personal care assistance and in-home support (meal preparation, medical alert services, light housework). Allows self-direction — participants can hire caregivers of their choosing, including some relatives.
• Primary Home Care (PHC): Provides personal care in the home with self-direction option — participants can choose their own caregivers, including adult children.
• Day Activity and Health Services (DAHS): Adult day care program providing daytime supervision and health services at community facilities.
• Texas Community Attendant Services (CAS): Medicaid-funded program providing non-medical personal care assistance, homemaker services, and transportation to/from medical appointments.
• Program of All-Inclusive Care for the Elderly (PACE): Combines Medicaid long-term care services and Medicare benefits into one program. Additional benefits like dental and eye care may be available. Available in select Texas counties.
• Money Follows the Person (MFP): Federal program helping institutionalized Medicaid-eligible individuals transition back home or into the community.

Qualifying When Over the Limits: Miller Trusts and Asset Spend-Down

Texas offers several pathways for applicants who exceed the income or asset limits:

• Qualified Income Trusts (QIT / Miller Trust): For applicants over the $2,982/month income cap. Excess income is deposited into an irrevocable trust (terms cannot be altered or canceled) managed by a designated trustee. Funds can only be used for approved purposes such as unreimbursed medical expenses of the Medicaid enrollee. Income in the trust no longer counts toward Medicaid's income limit.
• Asset Spend-Down: Reduce countable assets by spending on exempt items — home modifications (wheelchair ramps, stair lifts, walk-in showers), prepaying funeral and burial expenses (irrevocable burial trusts), and paying off mortgage, vehicle, or credit card debt. CRITICAL: Never gift assets or sell below fair market value within the 5-year Look-Back Period — always keep receipts.
• Medicaid Planning: Work with a Certified Medicaid Planner or Texas elder law attorney to employ legal strategies for eligibility and protect your home from Estate Recovery.

Asset Rules: What Counts and What Doesn't

Countable assets in Texas include cash, stocks, bonds, investments, cryptocurrency, bank accounts, and non-residential real estate. Non-countable (exempt) assets include personal belongings, household furnishings, one automobile, irrevocable burial trusts, and generally one's primary home (subject to the home equity limit). IRAs and 401(k)s are exempt if in "payout status" — meaning Required Minimum Distributions are being withdrawn. All assets of a married couple are considered jointly owned regardless of which spouse applies.

Nationally, Holocaust restitution payments are not counted as income. In Texas, Veteran's Aid & Attendance and Housebound Allowances (above Basic VA Pension) do NOT count as income for Medicaid eligibility purposes. For Nursing Home Medicaid and Waivers, only the applicant spouse's income is counted — non-applicant spouse income is disregarded. For Regular Medicaid (MEPD), both spouses' income is counted toward the eligibility limit.

Veterans and Long-Term Care in Texas

Texas has the second-largest veteran population in the country, with approximately 1.5 million veterans. Major military installations include Fort Cavazos (formerly Fort Hood, near Killeen), Joint Base San Antonio (Fort Sam Houston, Lackland AFB, and Randolph AFB), Fort Bliss (El Paso), and Naval Air Station Corpus Christi. The VA operates multiple healthcare systems across the state, including the Michael E. DeBakey VA Medical Center in Houston, the VA North Texas Health Care System in Dallas, and the South Texas Veterans Health Care System in San Antonio. Texas also operates nine State Veterans Homes providing skilled nursing care.

The VA Aid & Attendance benefit provides additional monthly income to veterans and surviving spouses who require assistance with activities of daily living. In Texas, VA Aid & Attendance and Housebound Allowances do NOT count as income for Medicaid eligibility purposes, allowing veterans to potentially qualify for both benefits simultaneously. For a comprehensive overview of veteran long-term care benefits, see our Veterans Long-Term Care Guide.

Planning Ahead: How to Pay for Nursing Home Care in Texas

Understanding how to pay for nursing home care in Texas — or any long-term care setting — requires evaluating multiple funding sources. With nursing home costs at $5,627/month (well below the national average), a 60-month look-back period, and a $2,982/month income limit, advance planning is essential. Texas long-term care insurance policies, personal savings, veterans benefits, and Medicaid each play a role. Key steps include:

• Understanding your current financial position relative to Texas Medicaid eligibility thresholds
• Knowing that Texas's income limit is $2,982/month for Nursing Home Medicaid and STAR+PLUS HCBS — with Miller Trusts available for those over the limit
• Recognizing that Texas uses the maximum MMMNA ($4,066.50) as the standard — simplifying spousal income protections compared to states that use shelter allowance calculations
• Exploring multiple self-direction programs (CFC and PHC) that allow hiring family caregivers, including adult children
• Taking advantage of the IRA/401(k) exemption when accounts are in payout status — unlike states that count retirement accounts as assets
• Researching Texas long-term care insurance options while still healthy enough to qualify
• Exploring veterans benefits if the care recipient or spouse served during wartime — Texas's large veteran population often underutilizes these benefits
• Consulting with a Texas elder law attorney or Certified Medicaid Planner to protect assets and avoid look-back penalties

Estate Recovery: Protecting Your Home in Texas

Texas operates a Medicaid Estate Recovery Program (MERP), which allows the state to seek reimbursement from a deceased Medicaid beneficiary's estate for long-term care costs paid by Medicaid. This can include the family home if proper protections are not in place. The primary home is automatically exempt if the applicant's spouse, child under 21, or permanently blind or disabled child (of any age) lives in it.

If no qualifying family member lives in the home, there is a home equity interest limit of $730,000 (in 2026). Home equity is the value of the home after subtracting outstanding debt. If neither the applicant nor qualifying family live in the home, the applicant must demonstrate Intent to Return. There is no home equity limit for Regular Medicaid (MEPD). The home is NOT exempt from estate recovery — families should consult a Texas elder law attorney to explore legal protections including irrevocable trusts, the caretaker child exemption, and the sibling equity interest exemption.

Regional Cost Variations Across Texas

Long-term care costs in Texas vary significantly by region due to the state's enormous size. The Houston metropolitan area (Harris, Fort Bend, Montgomery, and Brazoria Counties) has among the highest costs in the state, driven by population density and demand. The Dallas–Fort Worth Metroplex (Dallas, Tarrant, Collin, Denton Counties) sees similarly elevated pricing, particularly in affluent suburbs like Plano, Frisco, and Southlake. Austin (Travis County) has experienced rapid cost increases in recent years due to population growth. San Antonio and El Paso offer more moderate costs. The Rio Grande Valley (McAllen, Brownsville, Harlingen) and rural West Texas (Midland, Odessa, Lubbock, Amarillo) generally have lower costs but significantly fewer available facilities and home care providers.

Application Timeline and Process

Texas Medicaid applications can be submitted through several channels:

• Apply online at Your Texas Benefits (yourtexasbenefits.com)
• Submit a completed paper application to Texas Health and Human Services
• For assistance or to request a mailed application, call Texas Health and Human Services at 1-877-541-7905 or dial 2-1-1
• Contact your local Area Agency on Aging for program questions and application assistance

It is vital that applicants are confident they meet all eligibility criteria before submitting a Medicaid application. For seniors who don't meet the requirements, Medicaid Planning is recommended. Processing times vary but typically take 45–90 days. Application process varies by program — ensure all eligibility requirements are met before applying.

Federal Policy Update: One Big Beautiful Bill Act (OBBBA)

The One Big Beautiful Bill Act (OBBBA) includes approximately $1 trillion in Medicaid cuts over 10 years. While Nursing Home Medicaid is largely protected from future funding reductions, Home and Community Based Services (HCBS) — including Texas's STAR+PLUS HCBS waiver and Community First Choice program — are likely targets for cuts. Texas did not expand Medicaid under the ACA, which means the state's Medicaid population is already more narrowly defined than expansion states. This law is still facing legal challenges. Families relying on or planning to use STAR+PLUS HCBS or CFC should monitor developments and consider applying early.

Last updated: September 2026. Data sources: Texas Health and Human Services Commission, CareScout 2025 care cost survey (updated March 2026). All Medicaid figures reflect 2026 eligibility thresholds. This guide is for informational purposes only and does not constitute legal or financial advice.