Texas Medicaid covers nursing home care if you meet strict financial and medical requirements. To be eligible, you must prove you need the level of care provided in a nursing facility, not just help with daily tasks. However, there are important details regarding income limits, asset rules, spousal protections, and alternatives to nursing homes that affect whether you qualify and the benefits you receive.
At The Law Office of Whitney L. Thompson, Houston Medicaid planning attorney Whitney L. Thompson can help families meet Texas Medicaid eligibility. Our experienced estate planning attorney in Houston assists clients throughout Houston, Harris County, and across Texas. We can guide you through income trusts, asset protection, and application requirements to secure the long-term care benefits you need.
This guide explains what level of care qualifies you for Medicaid, how income and asset limits work, what Qualified Income Trusts can do, and how to protect your spouse’s financial security while getting the care you need. If you are planning for nursing home care or have questions about Medicaid eligibility, contact us today at (281) 214-0173 to schedule a consultation.
What Level of Care Do You Need to Qualify for Medicaid Nursing Home Coverage?
To qualify for Medicaid nursing home coverage in Texas, you must prove you require nursing facility-level care. This means your medical condition is severe enough that you need services typically provided only in a nursing home setting. The Texas Health and Human Services Commission (HHSC) evaluates every Medicaid applicant to determine if they meet this standard.
Physical Function and Activities of Daily Living
The assessment focuses heavily on activities of daily living (ADLs), which are basic self-care tasks most people perform without assistance. If you need help with ADLs, you likely meet the physical function requirement.
ADLs include bathing, toileting, dressing, eating, and moving around your home. The state wants to know whether you can perform these tasks independently or need another person’s help. For example, if you cannot dress yourself due to limited mobility from a stroke, or if you need help getting to the bathroom safely, these limitations support your application.
Medical Needs and Health Issues
Your medical condition also matters. If you require frequent medical care beyond what family members can provide at home, this strengthens your case for nursing facility level of care. The state looks at whether you need regular professional medical intervention.
Examples include needing IV medications, frequent injections, wound care like dressing changes for bedsores, or feeding tube management. If you receive treatment at Memorial Hermann-Texas Medical Center in the Texas Medical Center or Houston Methodist Hospital at 6565 Fannin Street and your doctors certify you need ongoing skilled nursing, this medical documentation supports your application.
Cognitive and Behavioral Requirements
Cognitive impairment is a third pathway to qualifying. If Alzheimer’s disease, dementia, or another condition affects your ability to think clearly, make decisions, or process information, you may meet the nursing facility level of care standard. The state assesses whether you can manage your own care safely.
Behavioral problems also count. If you exhibit behaviors like aggression, wandering, or other actions that make in-home care unsafe without constant supervision, these issues demonstrate the need for a structured nursing facility environment.
A doctor’s diagnosis often accompanies the assessment. Medical professionals at facilities like Houston Methodist Continuing Care Hospital, located at 701 South Fry Road, often provide the clinical evidence HHSC needs to approve applications.
How Do Qualified Income Trusts Help with Medicaid Eligibility?
If your monthly income exceeds $2,901 in 2025, you cannot qualify for Texas Medicaid nursing home coverage under standard rules. This is where Qualified Income Trusts, also called Miller Trusts, become essential planning tools. These trusts allow you to redirect excess income so you meet the income requirement.
Texas uses an income cap system with no deductions for medical expenses. Your gross monthly income must fall below the limit. If your Social Security, pension, or other income sources total $3,200 per month, you exceed the cap by $299 and would normally be ineligible.
A Qualified Income Trust solves this issue by allowing you to transfer excess income each month into an irrevocable trust. The income in the trust does not count toward your Medicaid eligibility limit, though it must be used to pay your nursing home costs once you qualify. This strategy works because the trust, not you personally, receives the excess income.
The five-year lookback period does not apply to income transferred into a properly structured Qualified Income Trust. This makes it different from transferring assets, which can trigger penalties. However, the trust must be set up correctly and follow Texas law precisely, which is why working with a Houston Medicaid planning attorney is important.
Does Medicaid Cover Nursing Home Care in Texas?
Texas Medicaid covers nursing home care once you meet the income, asset, and medical necessity requirements. But you must follow specific procedural rules before coverage begins, and the coverage continues only if you consistently qualify as medically needy.
First, you must live in a nursing home for at least 30 consecutive days before applying for Medicaid services. This waiting period establishes that nursing home care is not temporary. The state wants evidence that you genuinely need long-term institutional care, not just short-term rehabilitation after a hospital stay.
During these first 30 days, you pay for nursing home costs out of pocket or through other insurance. Families often use Medicare for the first 20-100 days if the nursing home admission follows a hospital stay of at least three days, with Medicare paying 100% for the first 20 days. After Medicare coverage ends and the 30-day residency requirement is met, you can apply for Medicaid. Once approved, Medicaid covers most nursing home costs.
Continuous coverage requires regular medical evaluations. A doctor must certify every six months that you still meet the nursing facility level of care criteria. If your condition improves significantly and you no longer need nursing home care, Medicaid coverage for the facility ends.
For families with a loved one who needs more care than they can provide at home but does not yet qualify for nursing home admission, Texas offers the STAR+PLUS and Community-Based Services (HCBS) waiver. Services include personal care assistance, respite care, home modifications, and nursing. Applications are processed through HHSC offices.
Houston Medicaid Planning Attorney
Whitney L. Thompson
Whitney L. Thompson is a Houston estate planning and Medicaid planning attorney who helps individuals and families protect their assets while preparing for long-term care needs. With a background in probate, guardianship, and estate planning, Whitney understands how quickly medical expenses and life changes can threaten financial security. Her experience began early at Thurgood Marshall School of Law, where she advocated for clients through the wills, probate, and guardianship clinic, gaining experience that shaped her client-centered and compassionate approach.
As a first-generation college graduate and woman entrepreneur, Whitney knows what it means to plan carefully and protect what you’ve worked hard to build. Medicaid planning can feel overwhelming, especially when families are facing aging concerns, disability, or nursing home care. Whitney provides clear guidance, honest answers, and proactive strategies to help clients qualify for Medicaid while avoiding unnecessary court battles, stress, and costly mistakes. No matter what stage in the planning process, she is committed to helping clients move forward with confidence and peace of mind.
What Should You Know Before Applying for Medicaid Nursing Home Coverage?
Before applying for Medicaid nursing home coverage, you need to understand three critical areas that often surprise families: spousal protections, the lookback period, and home ownership rules. These factors determine how much of your assets you can keep and what might disqualify you.
Spousal Protections and Asset Allowances
When one spouse needs nursing home care and the other remains in the community, Medicaid treats the couple’s assets and income as jointly owned. This would normally leave the community spouse with very little to live on. Texas law prevents this through the Community Spouse Resource Allowance.
The community spouse can keep up to $157,920 in countable assets as of 2025. If the community spouse’s half of assets falls below $31,584, they can keep up to that minimum amount from the institutionalized spouse’s share.
Additionally, the community spouse receives income protections. If their monthly income is below $3,948, they may keep part of the institutionalized spouse’s income to reach this minimum monthly maintenance needs allowance. This ensures the spouse at home can pay for housing, utilities, food, and other basic needs.
You can also set aside a small monthly personal needs allowance for the spouse in the nursing home. Texas allows $75 per month, though this amount is capped at $90 for veterans. The remainder of the institutionalized spouse’s income goes toward nursing home costs.
Five-Year Lookback Period
Texas enforces a five-year lookback period for nursing home Medicaid and waiver programs. When you apply, HHSC reviews all asset transfers you and your spouse made during the five years immediately before the application date. They look for assets gifted or sold below fair market value. If the state finds transfers that violate the rules, you face a penalty period during which you are ineligible for Medicaid.
Certain transfers are exempt from penalties. You can transfer your home to your spouse, a child under 21, or a permanently blind or disabled child of any age without penalty. You can also transfer your home to a sibling who already has an equity interest and lived there at least one year before you applied, or to an adult child who lived with you for at least two years and provided care that delayed your Medicaid application.
Home Ownership and Equity Limits
Your primary residence is generally exempt from Medicaid’s asset limit if you intend to return home or if your spouse, a child under 21, or a disabled or blind child of any age lives there. The home equity limit is $730,000 as of 2025. If your home equity exceeds this amount, you may not qualify for Medicaid.
When long-term care ends, either because you recover or pass away, Texas may pursue estate recovery. This means Medicaid can place a claim against your estate to recover the cost of care provided. Your home, which was exempt during your lifetime, may be sold after death to repay Medicaid, though protections exist for surviving spouses and certain dependent children.
The Harris County Probate Court, located at 201 Caroline Street in Houston, handles estate matters, including Medicaid estate recovery claims. Understanding these rules before applying helps families plan appropriately to protect assets while securing needed care.
| Medicaid Eligibility Considerations | Description |
|---|---|
| Spousal Asset and Income Protection | Medicaid considers spouses together, allowing a certain amount of assets and income to be set aside to protect the spouse’s standard of living. This spousal amount is not counted in the Medicaid application. |
| Income Allowance and Nursing Home Costs | Medicaid allows a small income allowance varying by state, with the remainder of income paying for nursing home costs. Information about the allowance can be obtained from the local Medicaid office. |
| Look-Back Period and Asset Transfers | There’s a look-back period of up to five years for institutional Medicaid, counting asset transfers. Violations may lead to penalties, potentially affecting Medicaid coverage for nursing home stays. |
| Home Ownership and Medicaid Coverage | Home ownership impacts Medicaid eligibility; equity in the home may count as an asset, affecting eligibility. |
Consult With The Law Office of Whitney L. Thompson
Managing Texas Medicaid eligibility for nursing home care requires careful planning. The income and asset limits are strict, the lookback period creates common mistakes for applicants, and the application process demands extensive documentation. Making mistakes can delay approval for months or even years when nursing home spots are limited.
Whitney L. Thompson has helped families throughout Houston, Harris County, and across Texas secure Medicaid coverage for long-term care. Our Houston Medicaid planning attorney understands how Qualified Income Trusts work and what the spousal protections mean for your family. We know can help structure your finances to meet eligibility requirements without unnecessary asset loss.
Call The Law Office of Whitney L. Thompson today at (281) 214-0173 to schedule a consultation.
