How to Get Medicaid Help in Texas: A Step-by-Step Guide for Families

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 (where a prepaid funeral contract written through a funeral home has no cap at all), and California (which eliminated its asset limit in 2024, then reinstated it on January 1, 2026 at $130,000). 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's fee-for-service Medicaid long-term care spending alone was $4.94 billion in fiscal 2024, by KFF's tabulation of CMS Form 64 filings, and that figure excludes the STAR+PLUS managed care payments that carry most of the state's long-term care. 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: $752,000 (2026). 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 $162,660 in 2026. If your parent has a spouse remaining in the community, the healthy spouse can keep between $32,532 (minimum) and $162,660 (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 $162,660.

Monthly Maintenance Needs Allowance: a flat $4,066.50 per month in 2026. This is where Texas differs from most states, and the difference is worth money. Many states start the community spouse at the federal floor and make you document excess shelter costs to argue your way up. Texas does not run that calculation. Its own budget reference chart (MEPD Appendix XXXI) lists a single figure -- the spousal allowance, $4,066.50, which is the federal maximum. If the community spouse's own monthly income falls below that, income is diverted from the institutionalized spouse to make up the shortfall. If it already meets or exceeds $4,066.50, there is no diversion. You do not need to build a shelter-cost case to reach the ceiling in Texas, because Texas starts everyone there.

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 $752,000 in 2026, with intent to return or a spouse living there)
• One vehicle, regardless of value
• Household goods and personal belongings
• Burial fund exclusion of $1,500 per person -- reduced dollar for dollar by the face value of any irrevocable prepaid funeral contract, not stacked on top of it
• Separately itemized burial spaces, excludable in addition, but only where the contract is paid in full or specifies that burial space items are paid before funeral service items
• 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:

1. Irrevocable prepaid funeral and burial spaces. This is where Texas families most often overestimate what they can shelter. Texas's burial fund exclusion is $1,500 per person, and an irrevocable prepaid funeral contract reduces that $1,500 dollar for dollar rather than stacking on top of it. What does add to it is separately itemized burial spaces -- the plot, vault, marker, opening and closing -- which can be excluded in addition, provided the contract is paid in full or specifies that burial space items are paid before funeral service items. Itemize them. A funeral home that writes Medicaid contracts routinely will know how.

1. 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.

1. 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.

1. 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.

1. 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.

1. Prepay insurance premiums. Medicare Part B, Medigap supplemental insurance, Part D prescription drug coverage. Paying several months ahead reduces countable assets.

1. 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 is total value of improper transfers divided by the penalty divisor -- but Texas runs this differently from most states, and the difference is worth understanding before you do the arithmetic.

Texas uses a single statewide daily rate, not a regional monthly one. Effective September 1, 2025, that rate is $262.37 per day, and it is the same in Dallas, in Houston and in every rural county in the state. Texas updates it every two years, so it holds until the next revision. Because the divisor is daily, the penalty comes out in days, and Texas rounds down to whole days -- a small mercy, but a real one.

Here's the math. If your parent gave $30,000 to a family member two years ago, Texas divides $30,000 by $262.37. That comes to 114.3 days, rounded down to 114 days -- about three and three-quarter months during which your parent is technically eligible for Medicaid but receives zero benefits. At Texas private-pay rates that is roughly $30,000 of care someone has to cover out of pocket. Note what that means: the penalty costs the family about what the gift was worth. That is the whole design.

Notice what that daily rate works out to. At $262.37 a day, Texas's divisor is equivalent to roughly $7,990 a month -- well below California's 2026 figure of $14,440 a month, and below Florida's and Michigan's as well. A lower divisor is not good news. It means each dollar of improper transfer buys a longer penalty. The same $30,000 gift that costs about 114 days in Texas would produce a materially shorter penalty in a state with a higher divisor. If your parent moved to Texas late in life, do not carry over gifting assumptions from a more expensive 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 $262.37 equals 45.7 days, rounded down to 45 days. Six and a half 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:

1. The $75 personal needs allowance goes to your parent
2. Medicare premiums (Part B, Part D, Medigap) are paid
3. If there's a community spouse, the spousal income allowance is paid
4. The remaining balance (the patient responsibility) goes to the nursing home or waiver program
5. 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
• Wellpoint (this is Amerigroup under its new name -- Amerigroup Texas was rebranded, so older guides and even some clinic paperwork still say Amerigroup)
• Superior HealthPlan
• Community First Health Plans (Bexar)
• El Paso Health (El Paso)
• Community Health Choice (Harris)

Plan availability varies by HHSC service region, and three of these are single-region plans -- so the list your parent actually chooses from is shorter than the list above. Note that Aetna Better Health does not offer a STAR+PLUS plan in Texas. It participates in STAR and STAR Kids, which are different programs, and that trips families up: an Aetna plan a grandchild is on is not a plan your parent can join for long-term care. 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) provides a fundamentally different model of care than either STAR+PLUS or CAS. In Texas it also barely exists, which is the first thing to know before you get your hopes up.

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 has three PACE sites. Not three dozen, and not one in every metro. Three, per the state's own Medicaid handbook (section O-2100, revised June 2025):

• Bienvivir All-Inclusive Senior Health — El Paso, from three centers
• The Basics at Jan Werner — Amarillo and Canyon
• Silver Star PACE (Silver Star Health Network) — Lubbock

If your parent lives anywhere else in Texas, including Houston, Dallas, Austin, Fort Worth and San Antonio, PACE is not an option. Not a waiting list. Not available.

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, 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 living in Lubbock, he was one of the few Texans who had the option at all. His daughter enrolled him at Silver Star 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.

That limitation is worth restating plainly, because most Texas families reading this will hit it: three sites, three cities. Everywhere else in the state, PACE is not a program you can apply to.

Protecting the Home: Transfer on Death Deeds and Lady Bird Deeds

Texas recognizes Lady Bird deeds -- but not in the way most families assume, and the difference is where the expensive mistakes happen.

There is no Texas statute creating them. Enhanced life estate deeds exist in Texas under common law, and the state's own Medicaid eligibility handbook tells caseworkers how to treat one: an enhanced life estate deed, "sometimes known as a Lady Bird Deed," transfers property to heirs "while at the same time retaining a life estate with powers including the right to sell the property in their lifetime." The handbook adds a line families almost never hear: "All Enhanced Life Estate Deeds must be reviewed by the regional attorney."

And here is the part that undercuts the whole strategy while your parent is alive. Because the deed keeps the power to sell, Texas counts the property's full equity value as a countable resource unless it is excluded on some other ground -- most commonly as the home your parent intends to return to. A Lady Bird deed does not make the house disappear from the asset test. It is a probate-avoidance tool, not a spend-down tool.

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: a TODD does not automatically put the home beyond Medicaid estate recovery in every case. 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, and note that it is shorter than most families expect. HHSC sends the Notice of Intent to File a Claim within 30 days of being notified of the death. From the date on that notice, the estate has 60 days -- not 90, not 120 -- to return the questionnaire and file any undue hardship waiver request, with supporting documentation attached. A request filed without documentation is not acted on. Miss the 60 days and the hardship argument becomes far harder to make. 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 ($162,660), Judith keeps $90,000. Morris's half must be spent down to $2,000.

Income was just as important as the asset math, and this is the part families most often get wrong -- usually by underestimating what they are owed. Judith's own Social Security was $1,340 per month. Texas sets the spousal allowance at a flat $4,066.50, so the gap between her income and that figure -- $2,726.50 a month -- could be diverted from Morris's Social Security and pension to her, for as long as his income covered it. Their housing costs in Arlington, including mortgage, taxes, insurance, and utilities, ran $2,800 per month. Judith did not have to document any of that. In a state that starts couples at the federal floor she would have had to prove her shelter costs to argue her way up; in Texas the ceiling is the starting point, and the diversion is simply the shortfall.

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:

1. The home is always exempt when the community spouse lives there. Always.
2. One vehicle is exempt. Keep it.
3. 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 impartial HHSC hearings officer reviews the case -- Texas does not use administrative law judges for these, and 1 TAC 357.5 requires the officer to have had no personal involvement in the decision being appealed. You can present documents, bring witnesses, and have an attorney or advocate represent you. There is a number worth looking up before you decide, and in Texas it is a discouraging one. In its 2024 managed-care reporting Texas logged 3,862 Medicaid fair hearing requests; 2,998 reached a decision, and only about 9 percent went the enrollee's way. Read that as a rough benchmark rather than your personal odds: it covers managed-care service denials rather than eligibility determinations, which are not broken out separately. Before that number talks you out of filing, consider what the number does not cover: it counts managed-care service denials, and the most common reason an eligibility denial gets reversed is simply that the family supplies a document the caseworker never had.

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, legalaidtx.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 State Long-Term Care Ombudsman: 1-800-252-2412, ltco.texas.gov (the advocate for nursing facility and assisted living residents -- this is who you want for a problem with a facility, and it is not the same office as the HHSC Ombudsman listed above, which does not handle long-term care complaints)
• HHSC Complaint and Incident Intake: 1-800-458-9858 (complaints about the care or treatment of anyone served by a state-regulated provider, including allegations of abuse, neglect, or exploitation)

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: naela.org/TXNAELA/TX/Home.aspx
• Benefits screening: benefitscheckup.org

PACE Providers:

• Bienvivir All-Inclusive Senior Health: El Paso, bienvivir.org
• The Basics at Jan Werner: Amarillo and Canyon, janwerneradultdaycare.org
• Silver Star PACE: Lubbock, silverstar.org
• Texas HHS keeps the current site list in its Medicaid handbook, section O-2100

For Veterans:

• VA Aid and Attendance: 1-800-827-1000 (up to $2,874/month for a veteran with a dependent spouse, VA rates effective December 1, 2025 through November 30, 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 $752,000), one vehicle, a $1,500 burial fund (reduced dollar for dollar by any irrevocable prepaid funeral contract), 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?

Yes, though not by statute. Texas recognizes enhanced life estate ("Lady Bird") deeds under common law, and HHSC requires every one to be reviewed by a regional attorney. Note that because the owner keeps the power to sell, Texas counts the property's full equity value as a resource during their lifetime unless it is otherwise excluded. Texas also offers a statutory Transfer on Death Deed under Chapter 114 of the Texas Estates Code. 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 bought an irrevocable prepaid funeral contract with the burial spaces itemized separately -- the plot, the vault, the marker, the opening and closing ($8,900). They paid off a small credit card balance ($940), replaced a failing water heater and had the bathroom grab bars and a walk-in shower installed ($3,300). Countable assets dropped to $1,460. Note what they did not do: there is no $10,000 Texas burial trust to hide money in, and the $1,500 burial fund exclusion is consumed dollar for dollar by the prepaid contract. The shelter came from itemizing burial spaces and from spending on the house, not from a trust.

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.