How Texas Medicaid pays for a nursing home

Who qualifies for Medicaid nursing home care in Texas in 2026?

A resident must meet nursing facility medical necessity, have income at or below $2,982 a month (the 2026 special income limit) and have countable assets of $2,000 or less, with the home and certain other property generally excluded.

Applications go through YourTexasBenefits.com or a local HHSC benefits office, and the nursing home's business office usually helps start one. Texas looks back five years for gifts or sales below fair value; a transfer inside that window can delay eligibility.

How much of a resident's income goes to the nursing home?

Nearly all of it: after a $75 monthly personal needs allowance, health insurance premiums and any allowance for a spouse at home, the rest of the resident's income is paid to the nursing home as applied income, and Medicaid pays the remainder of the daily rate.

Texas raised the personal needs allowance from $60 to $75 for individuals ($150 for couples) effective January 1, 2024, under State Plan Amendment TX-23-0027. The allowance pays for haircuts, clothing, phone and personal items, and the home may hold it in a trust account for the resident with monthly statements.

Which Hidalgo County nursing homes take Medicaid?

In CMS's data, 22 of Hidalgo County's 23 licensed nursing homes are certified for Medicaid, so a long-term resident who qualifies can stay on Medicaid in almost any of them; the exception is the medical center at John Knox Village in Weslaco, which is state-licensed but not certified.

Certification for Medicaid does not guarantee an open Medicaid bed on the day you need one. Ask each home whether it has long-term Medicaid beds available, whether a resident who enters as private pay or Medicare rehab can convert to Medicaid in the same room, and how long the business office expects private payment before an application.

What protections does a spouse at home have?

A spouse who stays at home keeps a share of the couple's assets and can receive part of the resident's income: in 2026 the federal community spouse resource allowance runs from $32,532 to $162,660 and the monthly maintenance needs allowance from $2,705 to $4,066.50.

Source: CMS Informational Bulletin, Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026).

Texas applies its own calculation within those federal standards; HHSC or an elder law attorney can confirm the figures for a specific couple. See spouse protections for more.

Does Texas recover nursing home costs from an estate?

Yes, through the Medicaid Estate Recovery Program, for recipients who were 55 or older and first applied for long-term services on or after March 1, 2005, but never more than the state paid and with exemptions and hardship waivers.

The claim is made after the recipient's death, not during life, and it is deferred while a surviving spouse, a child under 21, or a blind or disabled child is living. A home lived in by a qualifying relative may also be protected. Ask an elder law attorney how this applies before you transfer or sell anything.