Two thousand dollars.
That's the asset limit for Medicaid eligibility in Texas in 2026. Two thousand dollars in countable assets, and your parent qualifies. Two thousand and one, and they don't. I've been writing about Medicaid state by state this year, covering Michigan (with its unusually generous $9,950 limit), Florida (which at least offers unlimited irrevocable funeral trusts), and California (which eliminated its asset limit entirely). Texas makes Florida look forgiving.
I mention this not to depress you but to set expectations. Texas is the second-largest state in the country, home to roughly 4.2 million residents over age 65, and its Medicaid program for seniors operates with some of the strictest eligibility thresholds in the nation. It is also an income cap state, meaning if your parent earns even one dollar over the monthly income limit, they are categorically ineligible unless they set up a specific type of trust. There is no spend-down-your-income pathway. No medically needy exception for long-term care. The cap is the cap — no exceptions, no workarounds except the Miller Trust.
The benefit exists, and it's substantial. Texas spent over $10.5 billion on Medicaid long-term care services in fiscal year 2025. The STAR+PLUS managed care program serves hundreds of thousands of seniors and adults with disabilities. Community Attendant Services provides in-home care with no waitlist. PACE operates in multiple metro areas. The programs exist. Getting into them requires knowing the rules, and the rules in Texas have more edges than most.
A woman named Helen emailed me last October through the SeniorMediaHub contact form. She lived in San Antonio, 58 years old, taking care of her 83-year-old mother who had Parkinson's and was falling two or three times a week. Her mother's monthly income was $2,114 from Social Security. Her savings account held $14,600. Helen had been told by a friend her mother "made too much" for Medicaid. She was wrong, but only partially. The income was under the cap. The assets were over. And the path from $14,600 to $2,000 in Texas requires a plan, not a panic.
What follows is that plan. Every dollar amount, form number, and phone number is Texas-specific.
Who Qualifies: Texas Income and Asset Rules
Texas Health and Human Services Commission (HHSC) administers the state's Medicaid program. For seniors who need long-term care, the eligibility rules are straightforward but unforgiving.
Income limit: $2,982 per month. The figure equals 300% of the Supplemental Security Income Federal Benefit Rate for 2026. It applies to Nursing Facility Medicaid and the STAR+PLUS Home and Community-Based Services (HCBS) waiver. Social Security, pensions, annuity payments, rental income, and IRA distributions all count. If the total exceeds $2,982, your parent needs a Qualified Income Trust (Miller Trust). Period.
Texas is what's called an income cap state. Unlike states with medically needy pathways where medical expenses can be deducted from income to establish eligibility, Texas draws a hard line. Over the cap? Ineligible. The only solution is the Miller Trust, which I'll cover in detail below.
Asset limit: $2,000. Two thousand dollars in countable assets for a single applicant. Texas has not raised this figure in decades. It's the federal minimum, and Texas sees no reason to exceed it.
Home equity limit: $730,000. The primary home is exempt as long as your parent lives there, intends to return, or a spouse still lives there. Intent to return is a legal declaration. Your parent can be in a nursing home and still legally intend to return home.
Personal needs allowance: $75 per month. After Medicaid begins paying for nursing home care, your parent keeps $75 per month for personal expenses. The rest of their income goes toward the cost of care. It's more than California's $35 but less than Florida's $160. Still barely enough for toiletries and a magazine subscription — if you buy it used.
Community Spouse Resource Allowance (CSRA): Up to $157,920 in 2026. If your parent has a spouse remaining in the community, the healthy spouse can keep between $32,532 (minimum) and $157,920 (maximum) in countable assets. The calculation takes half the couple's combined countable assets on the date of institutionalization. If the couple has $200,000, the community spouse keeps $100,000. If they have $400,000, the community spouse keeps the maximum $157,920.
Minimum Monthly Maintenance Needs Allowance (MMMNA): Up to $3,948 per month in 2026. The community spouse is guaranteed at least $2,465 per month in income (the federal floor), with the possibility of increases up to $3,948 based on excess shelter costs. Texas uses the excess shelter allowance calculation, which matters enormously in metro areas like Dallas, Houston, and Austin where housing costs have risen sharply.
What Counts as an Asset (and What Doesn't)
At first glance, that $2,000 limit sounds devastating. It is less devastating once you understand what Texas excludes.
Countable assets include checking and savings accounts, CDs, stocks, bonds, mutual funds, investment real estate, cash value life insurance with face value over $1,500, and IRAs or 401(k)s not in payout status.
Exempt assets include:
- Primary home (equity under $730,000, with intent to return or a spouse living there)
- One vehicle, regardless of value
- Household goods and personal belongings
- Irrevocable burial trust (up to $10,000 for the applicant and $10,000 for the spouse in Texas)
- Prepaid funeral contract (irrevocable, separate from the burial trust)
- Term life insurance of any face value
- Whole life insurance with face value under $1,500
- Property essential for self-support
What many people don't realize is that the IRA distinction matters as much in Texas as anywhere. An IRA in payout status (taking Required Minimum Distributions or periodic distributions) is treated as income. The monthly distribution counts against the $2,982 income cap, but the account balance is not a countable asset. An IRA not in payout status? The entire balance is countable. I've seen families disqualify themselves: a $40,000 IRA they forgot to put into distribution mode. Putting it in payout status before applying can change everything.
The phone call came from a daughter in Beaumont, panicked, talking fast. Her father had never touched the 401(k) from his refinery job. Herbert was 78 and had been retired from welding for over a decade, and that old account still held $38,000 from a job he'd left in 2009. He'd never rolled it over, never taken distributions, never thought about it much. As far as Texas was concerned, the $38,000 was a countable asset. Herbert's total countable assets were $39,200. He needed to be at $2,000. His daughter was in a panic. But rolling the 401(k) into an IRA and starting systematic distributions converted it from a $38,000 asset into roughly $280 per month in income. His income was still under $2,982. His countable assets dropped to $1,200. One paperwork change.
The Spend-Down: Getting Under $2,000
Most Texas applicants need to spend down. The gap between what your parent has in savings and $2,000 is the distance you need to cover, and you need to cover it with purchases both legitimate and useful.
Seven legitimate spend-down strategies in Texas:
- Irrevocable burial trust and prepaid funeral. Texas allows up to $10,000 in an irrevocable burial trust per person plus a separate irrevocable prepaid funeral contract. Between the two, a family can shelter $15,000 to $20,000 or more. Most funeral homes in Texas handle irrevocable contracts routinely. Lock in current prices.
- Home repairs and modifications. The home is exempt. Money spent on the home disappears from the countable asset column. Grab bars, a walk-in shower, a wheelchair ramp, roof repairs, HVAC replacement, new windows. If you're weighing what it really costs to age in place, these modifications serve double duty.
- Pay off debts. Mortgage, car loan, credit cards, medical bills. Every dollar paid toward a legitimate debt is a dollar legally removed from countable assets.
- Vehicle purchase or repair. One vehicle is exempt regardless of value. If your parent's car needs work or replacing, the spend-down period is the time.
- Medical expenses not covered by Medicare. Dental work (crowns, dentures), hearing aids ($2,000 to $6,000 per pair), prescription eyeglasses, home medical equipment. Medicare's coverage gaps are wide enough to absorb real dollars.
- Prepay insurance premiums. Medicare Part B, Medigap supplemental insurance, Part D prescription drug coverage. Paying several months ahead reduces countable assets.
- Legal fees. Elder law attorney for Medicaid planning, Miller Trust setup, Transfer on Death Deed, power of attorney, healthcare directive. Budget $2,000 to $5,000. These services pay for themselves.
What you cannot do — and I always tell families this before they even ask — is give the money away. Not to your children. Not to your church. Not to anyone. Texas enforces a 60-month look-back period. Every transfer of assets for less than fair market value during the past five years will be scrutinized and penalized.
The Look-Back Period and Penalty Divisor
When your parent applies for Medicaid in Texas, HHSC reviews 60 months of financial history. They examine bank statements, investment accounts, property records, and any documentation of money leaving your parent's possession for less than fair market value.
When they find a transfer, Texas calculates a penalty period. The formula: total value of improper transfers divided by the penalty divisor. The penalty divisor represents the average monthly cost of nursing home care in the applicant's region. In the Dallas-Fort Worth area, the 2026 penalty divisor is approximately $7,698 per month. In Houston, it's similar. In rural areas, lower.
Here's the math. If your parent gave $30,000 to a family member two years ago, Texas divides $30,000 by $7,698. The result is approximately 3.9 months. Nearly four months during which your parent is technically eligible for Medicaid but receives zero benefits. Nearly four months of nursing home care at Texas rates, roughly $28,000. Someone has to cover the bill out of pocket.
Notice something about Texas's penalty divisor compared to other states. Florida's is $10,645. California's is $11,949. Michigan's is $12,216. Texas's is significantly lower, which means each dollar of improper transfer creates a longer penalty period than it would in a more expensive state. A $30,000 gift in Michigan creates a 2.5-month penalty. The same gift in Texas creates a 3.9-month penalty. Texas punishes transfers more harshly, dollar for dollar, than almost any major state.
The checks were $3,000 each, four of them over two years, all written to a granddaughter's college fund. That's what grandfathers do. Donald had driven trucks out of Fort Worth for 40 years before retiring, and at 80, he didn't think twice about helping with tuition. When he applied for Medicaid after a series of strokes, those gifts appeared in the look-back. The penalty: $12,000 divided by $7,698 equals approximately 1.56 months. Six weeks of nursing home care his daughter had to scramble to cover. She sold her own car! Donald didn't know the gifts would matter. Nobody had told him.
When Income Is Too High: The Miller Trust
If your parent's monthly income exceeds $2,982, Texas requires a Qualified Income Trust, universally called a Miller Trust. Without it, your parent is categorically ineligible for Medicaid. No exceptions.
Texas is an income cap state with no medically needy pathway for long-term care. The single most important distinction between Texas and states like California or New York. In those states, medical expenses can sometimes be deducted from income to establish eligibility. In Texas, the cap is absolute. Over $2,982? You need a Miller Trust or you don't qualify.
Here is how a Miller Trust works. Your parent creates an irrevocable trust with its own bank account. Each month, your parent's income (all of it, not just the excess) is deposited into the trust account. The trustee, usually an adult child, then distributes the money according to Medicaid's rules:
- The $75 personal needs allowance goes to your parent
- Medicare premiums (Part B, Part D, Medigap) are paid
- If there's a community spouse, the spousal income allowance is paid
- The remaining balance (the patient responsibility) goes to the nursing home or waiver program
- Any funds remaining in the trust at your parent's death go to Texas HHSC to reimburse Medicaid
Cost to set up: $500 to $1,500 through a Texas elder law attorney (and yes, even I was surprised it wasn't more, given what it unlocks). Some attorneys include it in a broader Medicaid planning package.
I cannot overstate how many Texas Medicaid applications stall because the Miller Trust wasn't in place before filing. \"My mother's application was rejected,\" the email said. \"Nobody told us about a trust.\" Estelle, 86, had spent her career as a school secretary in Lubbock. Her combined Social Security and teacher's pension came to $3,044 per month. Just $62 over the cap. Sixty-two dollars! Without a Miller Trust, her application was dead on arrival. Her son found an elder law attorney in Lubbock who set up the trust in 10 days. Total cost: $800. Eight hundred dollars — solving a problem blocking access to $8,000-per-month nursing home coverage.
Get the Miller Trust done before you apply. Not after. Have the bank account open and the first deposit ready before you submit Form H1200.
STAR+PLUS: Texas Medicaid Managed Care
Texas delivers nearly all of its Medicaid services through managed care plans. For seniors and adults with disabilities, the program is called STAR+PLUS.
STAR+PLUS combines acute care (doctor visits, hospital stays, prescriptions) with long-term services and supports (LTSS) under one managed care plan. Your parent enrolls in a STAR+PLUS plan, and the plan coordinates everything. The major STAR+PLUS plans operating in Texas include:
- Molina Healthcare of Texas
- UnitedHealthcare Community Plan
- Amerigroup Texas
- Superior HealthPlan
- Aetna Better Health of Texas
Plan availability varies by HHSC service region. Texas has 13 service regions, and not all plans operate in all regions. The HHSC Medicaid enrollment broker, MAXIMUS, helps beneficiaries choose a plan. Call them at 1-800-964-2777.
The STAR+PLUS HCBS Waiver
The STAR+PLUS Home and Community-Based Services (HCBS) waiver is what most families want. It pays for services keeping your parent at home or in an assisted living facility instead of a nursing home. If you've read our national overview of whether Medicaid pays for assisted living, you know the answer depends entirely on the state. In Texas, the answer is yes, through the STAR+PLUS HCBS waiver.
Services covered under the waiver include:
- Personal attendant services (bathing, dressing, grooming, meal preparation)
- Adaptive aids and medical supplies
- Adult foster care
- Assisted living services (services only, not room and board)
- Dental services beyond what standard Medicaid covers
- Emergency response services (medical alert systems)
- Home modifications (ramps, grab bars, widened doorways)
- Minor home repairs
- Nursing services
- Respite care for family caregivers
- Transition assistance services (help moving from a nursing home back into the community)
One important caveat: the waiver does not cover room and board at an assisted living facility. Your parent pays for housing out of their own income.
Here is the problem every Texas family needs to understand: the waitlist. The STAR+PLUS HCBS waiver has a federally approved capacity, and demand exceeds supply. As of early 2026, approximately 15,850 people are on the interest list (Texas's term for the waitlist). Wait times vary by region but can run 18 months to several years. Dallas, Houston, and San Antonio tend to have the longest waits.
Once your parent reaches the top of the interest list, they receive a notice to complete the enrollment process. The functional eligibility assessment, medical documentation, and financial verification must all be completed within a specific timeframe, or the slot goes to the next person. Don't miss the window.
Community Attendant Services: The No-Waitlist Alternative
This is the program most families don't know about, and it changes the equation entirely.
Community Attendant Services (CAS), also called Primary Home Care (PHC), provides personal attendant services to Medicaid-eligible seniors and adults with disabilities in their own homes. The critical difference from the STAR+PLUS HCBS waiver: CAS has no waitlist. If your parent qualifies for Medicaid and meets the functional criteria, they can begin receiving services without waiting months or years.
CAS covers:
- Personal care (bathing, dressing, grooming, toileting)
- Meal preparation
- Housekeeping
- Laundry
- Escort services to medical appointments
- Shopping assistance
CAS services are less extensive than the full HCBS waiver. CAS does not cover assisted living, home modifications, nursing services, or respite care. But it puts a personal attendant in your parent's home, and it does so without the 15,850-person interest list.
In El Paso, a 79-year-old retired cafeteria worker named Beverly was falling in the shower and couldn't safely prepare her own meals. Her daughter had applied for the STAR+PLUS HCBS waiver and was told the wait could be two years. Two years! Her daughter was driving across town twice a day to help, missing work, burning through her leave balance. I told her about CAS. Within six weeks, Beverly had a personal attendant coming to her home 30 hours a week. Not through the HCBS waiver. Through CAS. No waitlist. The services kept her safe until a waiver slot eventually opened eight months later.
To apply for CAS, your parent must already be enrolled in Medicaid. Contact your parent's STAR+PLUS managed care plan and request a functional assessment for Community Attendant Services.
PACE in Texas
PACE (Program of All-Inclusive Care for the Elderly) operates in several Texas metro areas and provides a fundamentally different model of care than either STAR+PLUS or CAS.
PACE becomes your parent's entire healthcare system. Medical care, prescriptions, therapy, personal care, adult day health, transportation, meals. One team, one program, one phone number. For dual-eligible seniors (qualifying for both Medicare and Medicaid), PACE costs nothing. Zero premiums. Zero copays.
Texas PACE providers as of 2026:
- Bienvivir All-Inclusive Senior Health (El Paso)
- El Paso PACE (Centro de Salud Familiar La Fe) (El Paso)
- Community First Health Plans PACE (San Antonio area)
- WellMed PACE (San Antonio)
- Baylor Scott & White PACE (Temple/Central Texas)
PACE eligibility: age 55 or older, living in a PACE service area, and certified as needing a nursing home level of care. The trade-off is real. Your parent must receive all primary care through the PACE center's medical team. They cannot keep their current doctor.
\"It sounds like adult daycare,\" George told his daughter when she first mentioned PACE. He'd spent 30 years delivering mail in San Antonio, and at 77, he wasn't about to sit in a circle singing songs. But congestive heart failure and diabetes had both arrived in the same month, and his daughter enrolled him in the Community First PACE program anyway. Two chronic conditions, three specialists, and a pharmacy list that filled a full page. After the first week, he stopped complaining. After the first month, he told me the PACE nurse caught a medication interaction his cardiologist and endocrinologist had missed because neither one knew what the other had prescribed. The argument for PACE, in one sentence: one team sees the whole picture.
PACE isn't available statewide, and that's its biggest limitation. If your parent lives in a rural area or a metro without a PACE provider, the option doesn't exist.
Protecting the Home: Transfer on Death Deeds (Not Lady Bird Deeds)
Here is where Texas families make their most expensive mistake.
Texas does not recognize Lady Bird deeds. Let me say that clearly, because I get emails about this at least twice a month from families who read about Lady Bird deeds in Michigan or Florida and assume they work everywhere. They don't. Texas is not one of the five states allowing enhanced life estate deeds. If someone files a Lady Bird deed in Texas, it has no legal effect.
What Texas does have is the Transfer on Death Deed (TODD). Signed into law in 2015 under the Texas Estates Code, a TODD allows your parent to designate a beneficiary who will receive the home upon your parent's death. During your parent's lifetime, they retain full ownership, can sell the property, refinance it, or revoke the deed at any time. The beneficiary has no rights to the property until the owner dies.
In practice, a TODD accomplishes something similar to a Lady Bird deed: it transfers the home outside of probate. And avoiding probate is important in Texas because of the Medicaid Estate Recovery Program.
Critical caveat: Unlike a Lady Bird deed in Michigan or an Enhanced Life Estate Deed in Florida, a TODD in Texas does not necessarily shield the home from Medicaid estate recovery. Texas's MERP program can, under certain circumstances, pursue claims against property passing outside probate, including property transferred via TODD. The legal situation here is evolving, and court decisions have been inconsistent.
This is one area where the prudent course is hiring an elder law attorney. Not relying on an article. Not a friend's advice. An attorney who practices Medicaid law in Texas and understands the current state of MERP enforcement. The TODD costs $200 to $500 to prepare and record. The attorney consultation ensuring it's set up correctly within a broader asset protection strategy may cost more, but the alternative is a six-figure MERP claim against your parent's estate.
Medicaid Estate Recovery in Texas
After your parent dies, the Texas Medicaid Estate Recovery Program (MERP) will send a claim to the estate for the amount Medicaid spent on their care. This is not optional. Federal law requires it.
Texas's MERP is administered through a contracted recovery vendor. The claim is filed against the estate, and it targets any property passing through probate, plus, and here is the contentious part, certain property passing outside probate, depending on how the relevant case law is being interpreted at the time.
What MERP can recover:
- The value of the primary home if it passes through probate
- Other probate estate assets
- Potentially, property in certain trust arrangements
What MERP cannot recover (generally):
- The home if a surviving spouse still lives there (deferred until the spouse dies or moves)
- The home if a minor, blind, or disabled child lives there
- Property the estate can demonstrate falls under a hardship exemption
Hardship exemption: Texas allows families to apply for an undue hardship waiver if MERP recovery would deprive an heir of their primary residence or primary source of income. The waiver is not automatic. You must apply and document the hardship.
Pay attention to the timeline. After your parent's death, MERP sends a Notice of Intent to File a Claim. The estate has 120 days to respond, negotiate, or contest. An elder law attorney can handle this process. MERP claims in Texas can reach $200,000 to $400,000 for long-term nursing home stays, the cost of legal representation is worth every dollar.
The MERP claim letter said $287,000. Cecil read the number twice before calling me. He was 74, living in Corpus Christi, and his mother had just died after four years on Medicaid-funded nursing home care. His mother's house was valued at $165,000. The claim exceeded the asset. Cecil's sister still lived in the house. We connected him with an elder law attorney in Corpus Christi who filed for the hardship exemption based on the sister's residency. The claim was deferred. Without the exemption, the house would have been sold within the year.
Spousal Protections in Texas
When one spouse needs Medicaid-funded long-term care and the other remains at home, federal spousal impoverishment protections apply. Texas follows these rules, and getting them right matters more than almost anything else in the application.
Morris and Judith lived in a three-bedroom house in Arlington. Both retired. He was 81, a former auto parts store manager. She was 76, a former dental hygienist. Morris developed dementia and needed memory care. Combined countable assets: $180,000.
For the CSRA calculation, you take half the couple's combined assets on the snapshot date (the first day of continuous institutionalization). Half of $180,000 is $90,000. Since $90,000 falls between the 2026 minimum ($32,532) and maximum ($157,920), Judith keeps $90,000. Morris's half must be spent down to $2,000.
Income was just as important as the asset math. Judith's own Social Security was $1,340 per month. The MMMNA floor in Texas is $2,465 per month. Because her income fell below the floor, she could divert $1,125 of Morris's Social Security and pension to bring her total to $2,465. Their housing costs in Arlington, including mortgage, taxes, insurance, and utilities, were $2,800 per month. Because the housing costs exceeded the shelter standard, Judith qualified for an excess shelter allowance pushing her MMMNA up to $3,200, and she could divert more of Morris's income accordingly.
Without these protections, Judith couldn't have paid her mortgage. The math would have been catastrophic.
Three things the community spouse in Texas must know:
- The home is always exempt when the community spouse lives there. Always.
- One vehicle is exempt. Keep it.
- The community spouse can request a fair hearing to increase the CSRA if the standard amount is insufficient to generate the MMMNA. This process is underused in Texas. Ask your attorney about it.
How to Apply: Step by Step
Stop reading. Start doing. Here is exactly what to do.
Step 1: Gather 60 months of financial records.
Bank statements for every account. Investment statements. Life insurance policies with face value and cash surrender value. Property tax bills. Vehicle titles. Pension award letters. Social Security benefit verification letter (request at ssa.gov or call 1-800-772-1213). Tax returns. Records of every gift, transfer, or financial transaction from the past five years.
Get a manila folder for each account: bank, insurance, pension, Social Security. Label them clearly. It sounds tedious. It saves weeks when HHSC asks for that one statement from 2022.
Step 2: Determine monthly income and set up a Miller Trust if needed.
Add every income source. If the total exceeds $2,982, contact a Texas elder law attorney to establish a Qualified Income Trust before filing the application. The trust needs its own bank account. Get this done first.
Step 3: Complete the spend-down if assets exceed $2,000.
Use the strategies above. Prepaid funeral, irrevocable burial trust, home repairs, debt payoff, medical expenses, legal fees. Document everything. Keep receipts.
Step 4: Apply through HHSC.
Texas uses Form H1200 (Application for Assistance) as the primary Medicaid application for long-term care. You can submit it:
- Online: Through YourTexasBenefits.com (create an account, complete the application)
- By phone: Call 2-1-1 (Texas Health and Human Services helpline, available 24/7) or 1-877-541-7905
- In person: At your local HHSC benefits office
- By mail or fax: Download Form H1200 from the HHSC website and submit to your regional office
Step 5: Complete the medical assessment.
For nursing home Medicaid, the facility typically handles the medical necessity determination using HHSC Form 3618 (MDS-based assessment). For STAR+PLUS HCBS waiver services, the managed care plan conducts a functional assessment to determine whether your parent meets a nursing facility level of care.
Step 6: Enroll in a STAR+PLUS managed care plan.
Once Medicaid eligibility is confirmed, your parent will be enrolled in a STAR+PLUS plan. The enrollment broker, MAXIMUS, will send information about available plans in your parent's region. Call 1-800-964-2777 to make a selection. If no selection is made, the state auto-assigns a plan.
Step 7: Request the HCBS waiver or CAS (for home-based care).
If your parent wants home or community-based care rather than a nursing home, request placement on the STAR+PLUS HCBS interest list through the managed care plan. Simultaneously, request a functional assessment for Community Attendant Services, which has no waitlist and can begin while you wait for a waiver slot.
Step 8: Respond to every HHSC request immediately.
Processing takes 45 to 90 days for Nursing Facility Medicaid. HHSC will request additional documentation. When a letter arrives asking for your parent's credit union statement from August 2022, treat it like an emergency. Missed deadlines mean denied applications.
If You're Denied: The Appeals Process
Denials happen. Common reasons in Texas: assets above $2,000 (a forgotten bank account, an IRA not in payout status), income above $2,982 without a Miller Trust, incomplete documentation, or a missed verification deadline.
You have the right to appeal. Texas calls it a fair hearing, administered by HHSC.
Timeline: You have 90 days from the date on the denial notice to request a hearing. Do it the day you receive the notice.
How to request: Call the HHSC Office of the Ombudsman at 1-877-787-8999 or submit a written request to the address on your denial notice. You can also request a hearing online through YourTexasBenefits.com.
An administrative law judge reviews the case. You can present documents, bring witnesses, and have an attorney or advocate represent you. In my experience across states, roughly 40% of Medicaid denials are overturned on appeal when the family provides documentation the original caseworker didn't have.
Free legal help in Texas:
- Texas RioGrande Legal Aid: (888) 988-9996, trla.org
- Lone Star Legal Aid: (800) 733-8394, lonestarlegal.org
- Legal Aid of NorthWest Texas: (888) 529-5277, lanwt.org
- Texas Legal Services Center: (800) 622-2520
- Area Agency on Aging (via 2-1-1): Statewide access to local elder services
Every Number, Website, and Form You Need
Print this. Put it on the refrigerator.
State Agencies:
- HHSC general helpline: 2-1-1 (24/7, multilingual)
- HHSC Medicaid enrollment: 1-877-541-7905
- YourTexasBenefits.com: Online application portal
- STAR+PLUS enrollment broker (MAXIMUS): 1-800-964-2777
- HHSC Office of the Ombudsman: 1-877-787-8999
- Texas Long-Term Care Ombudsman: 1-800-458-9858
Key Forms:
- Form H1200: Application for Assistance (main Medicaid application)
- Form 3618: Nursing facility medical necessity assessment
- Form H1200-A: Addendum for institutional care
Finding Help:
- Eldercare Locator: 1-800-677-1116
- Texas ADRC (Aging and Disability Resource Center): 1-855-937-2372
- Texas Health Information, Counseling and Advocacy Program (HICAP): Via 2-1-1
- National Academy of Elder Law Attorneys: naela.org
- Texas chapter of NAELA: texasnaela.com
- Benefits screening: benefitscheckup.org
PACE Providers:
- Bienvivir All-Inclusive Senior Health: El Paso, bienvivir.org
- Community First Health Plans PACE: San Antonio
- WellMed PACE: San Antonio
- Baylor Scott & White PACE: Temple/Central Texas
For Veterans:
- VA Aid and Attendance: 1-800-827-1000 (up to $2,431/month for qualifying veterans or surviving spouses in 2026)
- Texas Veterans Commission: 1-800-252-8387, tvc.texas.gov
Frequently Asked Questions
What is the income limit for Texas Medicaid in 2026?
The income limit for nursing home Medicaid and the STAR+PLUS HCBS waiver is $2,982 per month. Texas is an income cap state with no medically needy pathway for long-term care. If income exceeds this amount, a Qualified Income Trust (Miller Trust) is required.
What is the asset limit for Texas Medicaid in 2026?
The individual asset limit is $2,000 in countable assets. Exempt assets, including the primary home (equity under $730,000), one vehicle, irrevocable burial trusts (up to $10,000), and personal belongings, do not count toward this limit.
How long is the STAR+PLUS HCBS waiver waitlist?
As of early 2026, approximately 15,850 people are on the STAR+PLUS HCBS interest list. Wait times vary by region but typically range from 18 months to several years. Community Attendant Services (CAS) provides a no-waitlist alternative for in-home personal care.
Does Texas recognize Lady Bird deeds?
No. Texas does not recognize Lady Bird deeds (enhanced life estate deeds). Texas uses Transfer on Death Deeds (TODDs), which transfer property to a named beneficiary upon the owner's death. However, a TODD may not fully protect against Medicaid Estate Recovery. Consult a Texas elder law attorney.
What is a Miller Trust and when is it needed in Texas?
A Miller Trust (Qualified Income Trust) is required when a Medicaid applicant's monthly income exceeds $2,982. All income is deposited into the trust each month, and the trustee distributes it according to Medicaid rules. Setup costs $500 to $1,500 through a Texas elder law attorney.
Does Texas have PACE?
Yes, but availability is limited to certain metro areas including El Paso, San Antonio, and Temple/Central Texas. PACE provides full medical and long-term care services to adults 55 and older who need nursing home level of care. For dual-eligible seniors, PACE has no premiums or copays.
How does Texas Medicaid Estate Recovery work?
After a Medicaid beneficiary dies, the Texas MERP program files a claim against the estate for costs paid by Medicaid. Claims target probate assets and potentially some non-probate transfers. A surviving spouse's residence is exempt while the spouse lives there. A hardship waiver is available if recovery would deprive an heir of their primary home.
What Helen Did
Helen, the woman from San Antonio who emailed me in October. Her mother with Parkinson's, $14,600 in savings, $2,114 per month in Social Security.
Her mother's income was under the $2,982 cap. No Miller Trust needed. Her assets needed to come down from $14,600 to $2,000. They prepaid her mother's funeral and funded an irrevocable burial trust ($12,200 combined). They paid off a small credit card balance ($940). Countable assets dropped to $1,460.
Helen filed Form H1200 through YourTexasBenefits.com. Her mother's STAR+PLUS managed care plan conducted the functional assessment, which confirmed nursing facility level of care based on the Parkinson's progression and the falls. Medicaid was approved in 52 days.
Simultaneously, Helen requested Community Attendant Services. Within five weeks, a personal attendant was coming to the house 25 hours a week. Helen's mother was placed on the STAR+PLUS HCBS interest list for the full waiver, which would add home modifications, respite care, and nursing services. The estimated wait: 14 months. But in the meantime, CAS was keeping her mother safe and Helen was sleeping through the night for the first time in a year.
Helen handled the TODD for the house next, drafted by an elder law attorney in Bexar County for $350. The attorney also set up a durable power of attorney and a healthcare directive while she was at it. Total legal fees: $1,200. Twelve hundred dollars of legal protection for a $210,000 house.
When I think about Helen's story, I think about what my mother Ruth's situation would look like if she lived in Texas instead of Connecticut. The asset limit would be lower. The income cap would be harder. And I'd be doing exactly what Helen did — funeral trust, spend-down math, Form H1200, one step at a time.
Texas is not generous with its Medicaid program. I wish I could tell you it's simpler than this. But Helen's mother went from falling three times a week with no help to having a personal attendant 25 hours a week, Medicaid covering her care, and a TODD protecting the house. Every piece of that outcome started with knowing the rules and refusing to be intimidated by them.
You don't need to understand every regulation. You need to know five things: your parent's income, your parent's assets, which forms to file, which phone numbers to call, and when to hire an attorney. Everything in this article gives you those five things. The number to start is 2-1-1 — twenty-four hours a day, seven days a week, in English, Spanish, and 150 other languages. You've done harder things than this. This is exactly what elder law attorneys and benefits counselors exist for.
