Short answer: 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.
Once eligible, the resident’s total income (including any income run through a Qualified Income Trust) goes into HHSC’s co-payment budget. Deductions include:
- Personal needs allowance: $75 per month in a nursing facility; $85 per month in foster care or assisted living.
- Spousal allowance for a spouse at home, up to the $4,066.50 per month 2026 maintenance figure, and dependent allowances.
- Court-ordered guardianship fees, generally up to $250 per month.
- Home maintenance deduction, capped at the SSI income limit, for up to six months when the resident expects to return home and HHSC’s conditions are met.
- Incurred medical expenses for medical or remedial care.
What remains is the co-payment (often called applied income) owed to the facility each month. Families should plan for this: the resident’s Social Security and pension largely go to the nursing home.
Sources
Texas HHSC MEPD Handbook, Appendix XXXI, Budget Reference Chart (Revision 26-2)fhb.hhs.texas.gov/handbooks/medicaid-elderly-people-disabilities-handbook/appendix-xxxi-budget-reference-chartTexas HHSC MEPD Handbook H-1500, Personal Needs Allowancefhb.hhs.texas.gov/handbooks/medicaid-elderly-people-disabilities-handbook/h-1500-personal-needs-allowanceTexas HHSC MEPD Handbook H-1700fhb.hhs.texas.gov/handbooks/medicaid-elderly-people-disabilities-handbook/h-1700-deduction-home-maintenance