Texas Nursing Home Medicaid

Last updated: August 21, 2026 Jurisdiction: Texas

Texas nursing-facility Medicaid has medical and financial gates

HHSC's published nursing-facility criteria require an applicant to be age 65 or older or meet the Social Security disability definition, meet medical-necessity criteria, be a Texas resident and U.S. citizen or qualified alien, and reside in a Medicaid-contracted long-term-care facility for at least 30 consecutive days. Financial eligibility is a separate part of the analysis (HHSC Appendix XII).

For 2026, the institutional special income limit is $2,982 per month for one person. When countable income is over the cap, a compliant Qualified Income Trust may be needed rather than an income spend-down (HHSC Appendix XXXVI).

Most income goes toward the cost of care

Texas uses a co-payment calculation instead of a monthly nursing-facility Medicaid premium. For an individual without a community spouse, HHSC describes the calculation as gross income less the $75 personal-needs allowance, with other authorized deductions where applicable (HHSC Appendix XII).

Personal needs allowance: $75 under HHSC's published rule, effective beginning January 1, 2024. The allowance is not the applicant's full income; it is the amount generally retained for personal use in the institutional setting (HHSC personal-needs policy).

Spousal and expense deductions can change the co-payment

For a resident with a spouse at home, HHSC's 2026 calculation allows the $75 personal-needs allowance, an allocation up to $4,066.50 for the community spouse, and an amount for qualifying dependents. Health-insurance premiums, permitted guardianship fees, and incurred uncovered medical expenses may also be relevant deductions (HHSC Appendix XII; HHSC allowance and guardianship-fee policy).

A calculation should therefore be built from current income, insurance costs, spouse and dependent facts, and documented uncovered medical expenses rather than from the income cap alone.

Facility planning should not stop at a Medicaid application

Nursing-facility coverage, a resident's co-payment, and a QIT can involve different timelines and paperwork. See Florida's nursing-home Medicaid page for a contrasting state presentation, but do not apply Florida figures in Texas (HHSC Appendix XII).

For the core program framework, see Medicaid (Baseline). A qualified Texas benefits professional can help verify the current co-payment and application requirements.

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Texas nursing-facility Medicaid has medical and financial gates

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