Can a nursing home refuse Medicaid applicants?

Certified facilities generally cannot discriminate against Medicaid applicants who meet other admission criteria, though bed availability can create practical wait times.

Will the facility discharge my parent if they convert from private pay to Medicaid?

No — Medicaid-certified facilities generally cannot discharge solely for this reason, as long as eligibility continues.

What is the 5-year look-back period?

Texas Medicaid reviews the prior 5 years of financial transactions. Improper transfers can trigger a penalty period delaying coverage.

Does Medicaid Cover Nursing Homes in Texas? STAR+PLUS Explained

Does Medicaid Cover Nursing Homes in Texas?

Yes — Medicaid is the primary payer for long-term nursing home care in Texas, covering the majority of nursing home residents statewide. Unlike Medicare, which provides only short-term skilled nursing coverage, Texas Medicaid covers long-term custodial nursing home care indefinitely for residents who meet both medical and financial eligibility requirements.

STAR+PLUS — Texas's Medicaid Long-Term Care Program

Most Texas Medicaid long-term care services, including nursing home care, are delivered through STAR+PLUS, a Medicaid managed care program for adults who are elderly or have disabilities. Under STAR+PLUS, eligible individuals work with a managed care organization (MCO) that coordinates their nursing home placement and ongoing care.

Medicaid Eligibility for Nursing Home Care in Texas

To qualify for Texas Medicaid nursing home coverage, an applicant must meet both medical and financial criteria:

Medical eligibility

The applicant must require a "nursing facility level of care" — assessed through a standardized evaluation that considers the individual's need for assistance with activities of daily living, medical complexity, and cognitive status.

Financial eligibility (2026 figures — verify current limits)

Income limit: Generally around $2,901/month for an individual (figures adjust annually)
Asset limit: Generally $2,000 in countable assets for an individual
Exempt assets: The primary home (under certain conditions), one vehicle, prepaid burial arrangements, and personal belongings are typically excluded from countable assets

📋 The "Income Cap" and Miller Trusts

Texas is an "income cap" state — if an applicant's income exceeds the limit, they cannot simply spend down income to qualify. Instead, they may need a Qualified Income Trust (Miller Trust) to redirect excess income, allowing them to qualify for Medicaid despite having income above the standard limit. This requires careful legal setup — consult an elder law attorney.

The Asset Spend-Down Process

Many families have assets above the Medicaid limit and must "spend down" to qualify. This involves legally and appropriately reducing countable assets — paying off debt, prepaying funeral expenses, making home modifications, or purchasing exempt assets. Improper transfers of assets can trigger a penalty period during which Medicaid coverage is delayed, so spend-down planning should always involve a qualified Medicaid planning professional or elder law attorney.

5 years

Texas Medicaid "look-back period" for asset transfers

$2,000

Approximate individual countable asset limit

Protections for the Community Spouse

When one spouse needs nursing home care and the other remains at home (the "community spouse"), Texas Medicaid rules include specific protections to prevent the at-home spouse from being impoverished:

Community Spouse Resource Allowance (CSRA): Allows the at-home spouse to retain a significant portion of joint countable assets

Minimum Monthly Maintenance Needs Allowance (MMMNA): Ensures the at-home spouse retains adequate income

The marital home is generally exempt while the community spouse continues to live there

Finding Medicaid-Accepting Facilities in Texas

Not all Texas nursing homes accept Medicaid, and some facilities limit the number of Medicaid beds available. Our Texas nursing home directory indicates ownership and payment information for each facility, helping families identify Medicaid-accepting options in their area.

Navigating Medicaid and facing care quality concerns?

Whether you're planning ahead or already facing a difficult situation, our guides and directory provide independent information to help. If you believe a Medicaid-funded resident has experienced neglect or abuse, your legal rights are the same regardless of payment source.

Frequently Asked Questions

Facilities certified for Medicaid generally cannot discriminate against Medicaid applicants for admission if they meet the facility's other admission criteria. However, not all Texas nursing homes are Medicaid-certified, and Medicaid-certified facilities may have limited Medicaid bed availability, creating practical wait times even where discrimination is not occurring.

No — once admitted, a Medicaid-certified facility generally cannot discharge a resident solely because they convert from private pay to Medicaid, as long as the resident continues to meet Medicaid eligibility requirements and the facility remains Medicaid-certified. This is an important protection under federal nursing home law.

Texas Medicaid reviews financial transactions for the 5 years preceding a Medicaid application. Asset transfers made for less than fair value during this period — such as gifting money to family members — can trigger a penalty period during which Medicaid coverage is denied. This is why proper Medicaid planning should begin as early as possible, ideally with guidance from an elder law attorney.