Short answer: 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.
The penalty is not a permanent bar. It is a period of ineligibility for long-term care services:
- Add up the uncompensated value of every transfer in the 60-month look-back. Multiple transfers are lumped together into one penalty.
- Divide by the transfer of assets divisor, the average daily private-pay nursing facility cost. Effective 09-01-2025 it is $262.37 per day. HHSC reviews the rate every other year (it was $242.13 from 09-01-2023).
- Round down to whole days.
Example: $50,000 / $262.37 = 190.57, so 190 days.
If a transferred asset is returned, the penalty can be removed. During a penalty, a nursing facility resident is still Medicaid-eligible for other services, but Medicaid will not pay the facility.
Sources
Texas HHSC MEPD Handbook I-5100, Transfer of Assets Divisorfhb.hhs.texas.gov/handbooks/medicaid-elderly-people-disabilities-handbook/i-5100-transfer-assets-divisorTexas HHSC MEPD Handbook I-5200, The Penalty Start Datefhb.hhs.texas.gov/handbooks/medicaid-elderly-people-disabilities-handbook/i-5200-penalty-start-date42 U.S.C. 1396p (transfers, trusts, estate recovery, home equity)law.cornell.edu/uscode/text/42/1396p