Medicaid Long-Term Care Guide in Texas
Long-term care eligibility, benefits, and how to apply through the Texas Health and Human Services.
What makes Texas Medicaid different
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. 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 uses Qualified Income Trusts (Miller Trusts) for applicants over the income cap and offers a maximum MMNA ($4,066.50) as the standard. Texas did not expand Medicaid under the Affordable Care Act.
Administered by the Texas Health and Human Services.
Program Types
Institutional / Nursing Home Medicaid
An entitlement program providing care in Medicaid-certified nursing home facilities
Level of care: Nursing Facility Level of Care (NFLOC)
Medicaid Waivers / HCBS
Home and Community Based Services with limited participant slots and potential interest lists
Level of care: Nursing Facility Level of Care (NFLOC)
Regular Medicaid / Medicaid for the Elderly and People with Disabilities (MEPD)
Medicaid for the Elderly and People with Disabilities with various long-term care benefits like personal care assistance
Level of care: Help with ADLs (not NFLOC)
2026 Texas Medicaid Long-Term Care Eligibility for Seniors
Institutional / Nursing Home Medicaid
Medicaid Waivers / HCBS
Regular Medicaid / MEPD‡
*All of a beneficiary's monthly income, with the exception of a Personal Needs Allowance of $75/month, Medicare premiums, and possibly a Needs Allowance for a non-applicant spouse, must go towards nursing home costs (Patient Liability).
†Based on one's living setting, a program beneficiary may not be able to keep monthly income up to this level.
‡To be eligible for Regular Medicaid, a senior must receive SSI. Persons who are determined eligible for SSI are automatically eligible for TX Medicaid.
Explore Texas Medicaid Programs
Compare programs, see caregiver pay rates, get step-by-step application guidance, and check your eligibility — all specific to Texas.
Long-term care Medicaid guide
Eligibility · Caregiver pay · How to apply · 2026 data
Important: Rates vary — contact your state Medicaid office for current figures. This tool provides general guidance, not legal or financial advice.
Compare Medicaid Programs — Texas
How the main LTC programs available in Texas compare side by side.
| Program | Pay | Pay type | Tax-free? | Spouse OK? | Waitlist? |
|---|---|---|---|---|---|
| Consumer-directed HCBS | $14–17/hr | Hourly wage | No | Usually no | Often |
| Structured Family Caregiving (SFC) | Not in Texas | Daily stipend | Yes | Usually no | Often |
| Personal Care Agreement | Market rate (from assets) | Private pay | No | Yes | No |
| VA Aid & Attendance | Up to $2,874/mo | Monthly pension | Yes | Yes | No |
Texas Medicaid programs
STAR+PLUS HCBS
Community First Choice (CFC)
Sources: KFF (Jan 2026), medicaidplanningassistance.org (Feb 2026). Programs and rates change — verify with your state Medicaid office.
How Family Caregivers Get Paid Through Medicaid in Texas
If you're a family member providing care, you may be able to get paid through Medicaid — often at rates comparable to a home care agency.
Consumer-directed care — hourly pay
Available in TexasHow it works: The person receiving care becomes the "employer" — they hire you and a fiscal intermediary handles payroll, taxes, and paperwork on their behalf. You receive a paycheck just like a regular job.
How to apply: HHSC · hhs.texas.gov
Personal Care Agreement — private pay from assets
Available to any familySources: KFF Medicaid Home Care Survey 2025 (Jan 2026), Careforth FAQ (Jan 2026), IRS Notice 2014-7.
How to Apply for Medicaid Long-Term Care in Texas
What to expect when applying for LTC Medicaid and getting family caregiver pay set up in Texas. The process typically takes 45–90 days from application to first paycheck.
Apply in Texas: HHSC · hhs.texas.gov
Medicaid Eligibility Screener — Texas
Answer 7 quick questions — we'll check the financial and care requirements for Texas and explain what each one means.
What is the marital status of the person who needs care?
Medicaid looks at only the applicant's income and assets — but being married triggers special protections that let the healthy spouse keep significantly more money.
Sources
- CMS Medicaid — eligibility, HCBS waivers, and long-term services medicaid.gov/medicaid/eligibility
- CMS Medicaid — Home & Community-Based Services (HCBS) medicaid.gov/medicaid/home-community-based-services
- Social Security Administration — SSI Federal Benefit Rate (2026 figures) ssa.gov/oact/cola/SSI.html
- CMS — Spousal Impoverishment standards (CSRA & MMMNA) medicaid.gov/medicaid/eligibility/spousal-impoverishment
- CMS — Estate Recovery and the 5-year lookback period medicaid.gov/medicaid/eligibility/estate-recovery
- IRS Notice 2014-7 — Tax treatment of Medicaid caregiver payments irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income
Educational guidance only — not legal or financial advice. Your state Medicaid office determines actual eligibility.
Key Rules at a Glance
- Nearly all income counts: employment wages, alimony, pensions, Social Security (including SSDI), IRA withdrawals, and stock dividends
- Nationally, Holocaust restitution payments are NOT counted
- Texas: Veteran's Aid & Attendance and Housebound Allowances (above Basic VA Pension) do NOT count as income
- Married couples (Nursing Home/Waiver): Only applicant's income is counted; non-applicant spouse income is disregarded
- Married couples (Regular Medicaid): Both spouses' income is counted toward eligibility limit
- SSI requirement: Seniors must receive SSI to be eligible for Regular Medicaid—SSI eligibility leads to automatic TX Medicaid approval
- Countable assets: cash, stocks, bonds, investments, cryptocurrency, bank accounts, and non-residential real estate
- Exempt assets: personal belongings, household furnishings, one automobile, irrevocable burial trusts, primary home (with conditions)
- IRAs/401Ks: Exempt if in 'payout status' (Required Minimum Distribution being withdrawn)
- Married couples: All assets considered jointly owned regardless of which spouse applies
- Home automatically exempt if applicant's spouse, child under 21, or blind/disabled child (any age) lives in it
- Home equity interest limit: $730,000 (2026)
- If above family members don't live in home, applicant must have 'Intent to Return'
- Regular Medicaid: No home equity interest limit applies
- Home equity = home value minus outstanding debt; equity interest = portion of equity owned by applicant
- Estate Recovery: Home is NOT exempt from Medicaid's Estate Recovery Program—state may seek reimbursement from deceased's estate
- Texas has a 5-year (60-month) Medicaid Look-Back Period for Nursing Home Medicaid and Medicaid Waivers
- State scrutinizes all asset transfers during the 60 months immediately before application date
- Gifting assets or selling for under fair market value triggers a Penalty Period of ineligibility
- Transfers by non-applicant spouses are also reviewed and can trigger penalties
- IRS Gift Tax Exemption (up to $19,000/recipient in 2026) does NOT protect transfers from Medicaid's Look-Back
- Regular Medicaid: No Look-Back Period applies
- Keep documentation of all asset transfers and expenditures to prove compliance
- MMMNA: $4,066.50/mo · CSRA: $162,660 · CSRA Min: $32,532
- Monthly Maintenance Needs Allowance (MMNA): Non-applicant spouse can receive income from applicant spouse up to $4,066.50/month (2026)
- Texas uses the maximum MMNA as the standard (no minimum floor or shelter allowance calculation)
- If non-applicant spouse already has $4,066.50+/month income, no additional allowance is provided
- Community Spouse Resource Allowance (CSRA): Non-applicant spouse can retain 50% of couple's assets, up to $162,660 (2026)
- CSRA minimum: If non-applicant's half of assets is under $32,532, they can keep 100% of assets up to $32,532
- Spousal protections apply only to Nursing Home Medicaid and Medicaid Waivers, NOT Regular Medicaid
- Qualified Income Trusts (QITs) / Miller Trusts: For applicants over the $2,982/month income cap—excess income is deposited into an irrevocable trust (terms cannot be altered or canceled) that doesn't count toward income limit
- QIT requirements: Designated trustee manages trust, funds only for approved purposes (unreimbursed medical expenses of Medicaid enrollee)
- Asset Spend-Down: Reduce countable assets by spending on exempt items—home modifications (wheelchair ramps, stair lifts)
- Additional spend-down options: Prepay funeral/burial expenses, pay off debts
- CRITICAL: Never gift assets or sell below fair market value within 5-year Look-Back Period—always keep receipts
- Medicaid Planning: Work with a Certified Medicaid Planner to employ legal strategies for eligibility and home protection from Estate Recovery
Texas Medicaid 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 during normal working hours to help families care for loved ones outside nursing homes.
Texas Community Attendant Services (CAS)
Medicaid-funded program providing non-medical personal care assistance, homemaker services, and transportation to/from medical appointments. Generally assists persons not yet Medicaid-eligible.
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.
Money Follows the Person (MFP)
Federal program helping institutionalized Medicaid-eligible individuals transition back home or into the community.
How to Apply
- Online at Your Texas Benefits
- Submit completed paper application to Texas Health and Human Services
- For assistance or to request mailed application, call Texas Health and Human Services or dial 2-1-1
- Contact local Area Agency on Aging for program questions and application assistance
Application process varies by program. Ensure all eligibility requirements are met before applying—consider Medicaid Planning if over income/asset limits or unsure about financial eligibility.
More Texas Long-Term Care Resources
Take the Next Step for Texas Medicaid
Find out if you qualify or see how Medicaid fits into your overall long-term care plan.
Sources & references
Verified May 2026- Centers for Medicare & Medicaid Services — Long-Term Services & Supports
- Administration for Community Living — State Medicaid Agencies
- Centers for Medicare & Medicaid Services — Medicaid Eligibility
- American Council on Aging — About Medicaid Planning Assistance
- Texas Health and Human Services — Texas Medicaid — Official site