Individual Coverage

Medicare pays first for a qualifying skilled nursing facility stay: for 2026, $0 per day for days 1 to 20 after the $1,736 deductible and $217 per day coinsurance for days 21 to 100, with Medicaid covering that cost sharing for someone with full Medicaid or QMB. When skilled care ends or day 100 passes, Medicaid nursing facility coverage pays if the person qualifies.

Possibly. Heirs can request an undue hardship waiver, and can ask MERP to deduct documented home maintenance costs and costs of care that delayed the nursing home stay; both requests must be made within 60 days of MERP’s Notice of Intent to File a Claim.

It can file a claim. Texas’s Medicaid Estate Recovery Program (MERP) seeks repayment from the estate for long-term care services received at age 55 or older, but it makes no claim while there is a surviving spouse, a child under 21, a blind or disabled child, or an unmarried adult child who lived in the home for at least a year before the death.

Texas requires a medical necessity determination: the person’s condition must need care beyond what an untrained person can give, with licensed nurse supervision available only in an institution. The nursing facility submits the MDS assessment, and the state’s Medicaid claims administrator approves or denies it.

Partly, at most. STAR+PLUS HCBS can pay for assisted living services for a person who qualifies, but federal waiver rules generally do not pay for room and board, so the resident still pays rent and meals from their own income.

Yes. STAR+PLUS Home and Community Based Services (HCBS) serves Medicaid-eligible adults 21 and older who need a nursing-facility level of care but can be served at home or in the community, with services like personal assistance, home-delivered meals, minor home modifications and respite.

STAR+PLUS is the Texas Medicaid managed care program for adults 65 and older and adults with disabilities. It covers regular health care plus long-term services and supports, and it is how most adult nursing home residents on Medicaid receive their Medicaid benefits.

Yes. If the at-home spouse’s own income is below the monthly maintenance needs allowance ($4,066.50 per month in Texas for 2026), part of the nursing home spouse’s income can be paid to the at-home spouse instead of to the facility.

A Texas nursing facility resident on Medicaid keeps a personal needs allowance of $75 per month (since January 1, 2024). Most of the rest of their income, after allowed deductions, is paid to the facility as their co-payment, and Medicaid pays the balance.

For 2026, the spouse at home keeps the home, one vehicle and a protected share of the couple’s countable resources: one-half of the combined total, but no less than $32,532 and no more than $162,660. The rest above the applicant’s $2,000 limit must be spent down.

Yes, if the child lived in the parent’s home for at least two years immediately before the parent entered the facility and provided care that let the parent stay home instead of in an institution. The care has to be shown to the state’s satisfaction.

Federal law exempts transfers to a spouse (or for the spouse’s sole benefit), to a blind or disabled child (or a trust solely for that child), to a trust solely for a disabled person under 65, and transfers of the home to a spouse, child under 21, blind or disabled child, a sibling with an equity interest who lived there one year, or a caregiver child who lived there two years.

No. The IRS annual gift tax exclusion has nothing to do with Medicaid. A gift that owes no gift tax can still be a penalized transfer if it falls in the 60-month look-back.

For gifts made on or after 02-08-2006, the penalty starts on the first day of the month the person would otherwise be eligible for Medicaid and receiving long-term care, not when the gift was made. So it begins just when the money has run out.

Texas divides the total uncompensated value of all transfers in the look-back by a daily divisor of $262.37 (for cases decided on or after 09-01-2025) and rounds down; the result is the number of days Medicaid will not pay for long-term care. A $50,000 gift, for example, is a 190-day penalty.

When someone applies for nursing facility or HCBS waiver Medicaid, HHSC reviews asset transfers made in the 60 months before the later of the application date or the date of entering the facility. Gifts or below-value transfers in that window can cause a period when Medicaid will not pay for long-term care.

Spending down means reducing countable resources to the limit ($2,000 for a single person in 2026) by spending at fair market value, such as paying for care, paying debts, or buying excluded items like a prepaid funeral or home repairs. Giving money away or selling below value is a transfer that can cause a penalty.

Yes. For 2026, a person whose equity in the home exceeds $752,000 cannot get Medicaid payment for nursing facility care or HCBS waiver services, unless a spouse, a child under 21, or a blind or disabled child lives in the home.

Usually not. The home stays excluded while a spouse or dependent relative lives there, or while the resident states an intent to return home (HHSC Form H1245), even if return is unlikely; very high equity and estate recovery are separate issues.

Cash, bank accounts, investments and other property that can be turned into cash generally count toward the $2,000 limit (for 2026, $3,000 for a couple). The home (within limits), one vehicle used for transportation, household goods and personal effects, and qualifying burial funds and spaces are excluded.

The common failures are depositing income late (not in the month received), depositing only part of the income source, and paying money out of the trust to the person; any month the countable income ends up over the cap is an ineligible month.

A Qualified Income Trust is an irrevocable trust that holds only the person’s income; income directed into it each month is disregarded when HHSC tests eligibility, so someone over the $2,982 per month 2026 cap can still qualify. The state must be named to receive what is left at death, up to what Medicaid paid.

For 2026, an individual’s countable income must be no more than $2,982 per month, which is 300% of the $994 SSI federal benefit rate. The couple figure is $5,964 per month.

Texas nursing home Medicaid has a financial test (for 2026, countable income no more than $2,982 per month and countable resources no more than $2,000 for a single person) and a medical test (the person must need nursing-facility-level care). Both have to be met, along with a review of gifts made in the prior 60 months.