Texas-specific Medicaid spend-down rules
Texas administers Medicaid through the Health and Human Services Commission (HHSC). Long-term care applications usually start at a local Aging and Disability Resource Center (ADRC) or an HHSC eligibility office in counties like Travis, Tarrant, and Hidalgo.
MEPD covers nursing facility care and certain home-based services. STAR+PLUS managed care plans handle many waiver slots, but asset tests still follow the same $2,000 resource standard for the applicant.
Texas does not offer a medically needy income spend-down for nursing home cases the way Pennsylvania does. Families above the $2,901 monthly income cap must assign excess funds to a Miller Trust, also called a Qualified Income Trust, with a Texas trustee.
Community spouses may keep the greater of the CSRA calculation or certain income protections under spousal impoverishment rules. The state uses the federal maximum home equity cap of $713,000 in 2026 unless a spouse or dependent child still lives in the house.
Burial spaces, one vehicle, and up to $1,500 in a designated burial fund can be excluded if titled correctly. Prepaid funeral contracts follow separate HHSC policy memos.
Look-back reviews cover asset transfers made within 60 months before application. Penalty length equals the uncompensated transfer amount divided by the average monthly nursing home cost published by HHSC.
Rural applicants in Lubbock and Amarillo follow the same resource test as families in Houston. Waiver interest lists vary by region, but the $2,000 asset cap does not.
Common mistake: Assuming Texas exempts a second home because it is "in the family." Non-homestead real estate counts unless occupied by a spouse or dependent child under HHSC rules. Budget property taxes and sale costs before you rely on an appraisal.