Texas Medicaid planning,
in plain English.

The numbers that matter in Texas

• Penalty divisor (2026): $7,339/month — every $7,339 in gifted assets during the 5-year lookback = 1 month of Medicaid ineligibility.
• Nursing-home cost (2026, semi-private): ~$5,080/month = $60,960/year.
• CSRA ceiling: $162,660 (community-spouse resource allowance).
• MMMNA band: $2,643.75 to $4,066.50/month (minimum monthly maintenance needs allowance).
• Home equity limit: $752,000.
• Applicant asset cap: $2,000 (non-exempt).
• Applicant income cap: $2,901/month (state-federal common threshold, 2026).
• Managed long-term care: Yes — enrollment required after eligibility.
• Estate recovery posture: Minimum (only TEFRA-required).

Texas is a low-divisor, minimum-estate-recovery, managed-LTC state

Texas pairs two features that change the planning math significantly. First, the penalty divisor is low (~$5,700/month in 2026 — among the lowest nationally), which means existing gifts create longer ineligibility periods than they would in high-divisor states. Second, Texas holds a minimum-TEFRA estate-recovery posture, so post-death recovery exposure is narrower than in expanded-recovery states.

Texas runs Managed Long-Term Care via STAR+PLUS. Applicants enroll in a plan after establishing eligibility and receive services through that plan's network. The CSRA rule is federal-maximum, consistent with generous community-spouse protection.

Texas also has a robust homestead exemption rooted in state constitutional law — one of the strongest in the country. That exemption interacts favorably with Medicaid's home treatment, though families need to understand that while Medicaid can't touch the homestead during the applicant's lifetime, the federal MERP floor still allows some post-death recovery unless structured correctly.

Programs and acronyms in Texas

If you're searching for help with long-term-care Medicaid in Texas, these are the names and acronyms you'll encounter on state-agency forms, in elder-law conversations, and in nursing-facility paperwork.

• Texas Medicaid. The state's Medicaid program brand.
• Texas Health and Human Services Commission (HHSC) — administers Texas Medicaid and processes long-term-care eligibility decisions.
• STAR+PLUS — Texas's mandatory MLTSS for adults 65+ and adults with disabilities — capitated MCOs cover nursing-facility, HCBS, and acute care statewide.
• STAR+PLUS Home and Community-Based Services (STAR+PLUS HCBS) — Waiver component of STAR+PLUS providing intensive in-home services as alternative to nursing-facility placement.
• STAR Kids — Mandatory managed-care program for children 20 and under with disabilities — covers acute care plus LTSS.
• Community Living Assistance and Support Services (CLASS) — HCBS waiver for Texans with related conditions (cerebral palsy, autism, etc.) providing habilitation and personal care.
• Community Attendant Services (CAS) — State-plan personal-care program for Texans needing daily-activity assistance who do not meet waiver thresholds.
• YourTexasBenefits — Texas's online Medicaid application portal: www.yourtexasbenefits.com/
• MEPD — Medicaid for the Elderly and People with Disabilities (Eligibility category).
• QIT — Qualified Income Trust (Miller Trust) (Required for TX income-cap workaround).
• MDCP — Medically Dependent Children Program (Children's HCBS waiver).
• TxHmL — Texas Home Living (I/DD waiver).

The Texas planning levers

Every Medicaid plan in Texas pulls some combination of five levers: (1) community-spouse asset re-allocation inside the CSRA ceiling, (2) spend-down on exempt assets (home improvements, new car for the community spouse, pre-paid funeral), (3) irrevocable trust transfer outside the 5-year window, (4) caregiver-child exception or disabled-child exception on the home, and (5) personal-service contracts paying a family member for documented caregiving hours.

Which lever fits depends on the specific assets, the crisis timeline, and — critically — whether the applicant is already in a facility. If a family member is already admitted, the playbook narrows to levers (1), (2), and (5) only.

What planning looks like, by timeline

5+ years out: full menu available. Irrevocable-trust transfers, gifting, long-term-care insurance — all work if executed cleanly. Time is the most valuable asset in Medicaid planning.

1–5 years out: half-menu. Transfers still trigger the lookback but a known penalty period can be absorbed by private pay. Community-spouse re-allocation is still a big lever.

Already in a facility: crisis planning. Most gifting is off the table. Spend-down, community-spouse allowance, personal-service contracts, and exempt-asset purchases become primary. See the crisis playbook.