Texas Medicaid for seniors and long-term care

Last verified: June 2026

Medicaid for the Elderly and People with Disabilities (MEPD): who it covers

Medicaid for the Elderly and People with Disabilities (MEPD) is the Texas Medicaid program for adults 65 and older, adults with disabilities, and some children with disabilities who do not have health insurance. MEPD applicants must be Texas residents and U.S. citizens or qualified non-citizens. Income and asset limits apply — see the income limits page for specific figures.

MEPD covers medical care, prescription drugs, and long-term services and supports (LTSS). Most adults who qualify for MEPD are enrolled in STAR+PLUS, which coordinates all services through a single managed care plan. In some counties, MEPD services are provided through traditional fee-for-service Medicaid (where the state pays providers directly) rather than a managed care plan.

Adults applying for MEPD must contact an HHSC benefits office, call 2-1-1, or apply online at YourTexasBenefits.com. Families navigating MEPD applications for a loved one can also contact their local Aging and Disability Resource Center (ADRC) — find the nearest ADRC at hhs.texas.gov/services/aging.

STAR+PLUS: how Texas coordinates care for dual eligibles

STAR+PLUS is the Texas Medicaid managed care program for adults with disabilities and seniors who are enrolled in both Medicare and Medicaid (dual eligibles). It is administered by managed care organizations under contract with HHSC. Plans operating in Texas under STAR+PLUS include Aetna Better Health, Molina Healthcare, Superior HealthPlan, and others depending on service area.

Each STAR+PLUS enrollee is assigned a Service Coordinator through their MCO. The Service Coordinator helps the member access medical, behavioral health, and long-term services — including home health, personal attendant services, and community-based supports. For members with complex needs, the coordinator also helps manage transitions between home care, assisted living, and nursing facility placement.

• Medical and hospital services
• Prescription drug coverage (Medicaid portion — Medicare Part D covers most drugs for dual eligibles)
• Mental health and substance use treatment
• Home health services
• Personal attendant services through Community First Choice
• Nursing facility coverage
• Adult day care and respite care
• Durable medical equipment

Community First Choice: personal attendant services in your home

Texas participates in Community First Choice (CFC), the federal Section 1915(k) option that provides attendant and habilitation services to Medicaid members with disabilities who need assistance with activities of daily living. CFC allows eligible MEPD and STAR+PLUS members to receive personal care services — bathing, dressing, mobility assistance, medication management — in their home or community rather than in a nursing facility.

The CFC program is a mandatory benefit once a state adopts it. Texas implemented CFC as part of STAR+PLUS. Unlike waiver programs (1915(c)), CFC is not subject to enrollment caps or waiting lists — every eligible Medicaid member who meets the functional criteria has a right to CFC services.

CFC services in Texas are delivered through STAR+PLUS managed care plans. A member's Service Coordinator arranges an assessment to determine the number of authorized attendant hours per week. For more information: hhs.texas.gov community first choice.

Nursing facility Medicaid: income cap and Qualified Income Trusts

Texas is an income cap state for nursing facility Medicaid. An applicant whose monthly income exceeds the special income limit (approximately $2,829/month in 2026 — 300% of the SSI Federal Benefit Rate) cannot qualify for nursing facility Medicaid through the regular MEPD rules alone. To become eligible despite exceeding the cap, the applicant must establish a Qualified Income Trust (QIT), commonly called a Miller Trust.

A Miller Trust is an irrevocable trust into which the applicant deposits excess monthly income. The trust must be set up with an attorney before the Medicaid application is submitted — HHSC cannot approve a retroactive trust. Once in place, the excess income flows through the trust and is no longer counted against the income cap. Contact an elder law attorney familiar with Texas MEPD rules before applying.

Asset limits for nursing facility Medicaid are $2,000 for an individual. The primary home is exempt if a spouse, minor child, or qualifying dependent lives there — but it is subject to estate recovery after the Medicaid recipient's death (see estate recovery section below).

Spousal impoverishment protections: protecting the community spouse

When one spouse enters a nursing facility and applies for Medicaid, the spouse remaining at home (the "community spouse") is protected from complete asset depletion under federal spousal impoverishment rules (42 U.S.C. § 1396r-5). Texas applies these protections within MEPD.

The community spouse may retain up to the Community Spouse Resource Allowance (CSRA). The 2026 CSRA maximum is approximately $157,920 (updated annually by CMS). The community spouse also retains a Minimum Monthly Maintenance Needs Allowance (MMMNA) from the institutionalized spouse's income — in 2026, this is approximately $2,465/month, per CMS.

These protections prevent the healthy spouse from being left with no resources while the ill spouse receives Medicaid. Calculating exactly what can be protected requires a formal HHSC assets assessment — request one at the time of application.

HHSC Estate Recovery Program: what happens to your assets after death

Texas operates an Estate Recovery Program under HHSC. Federal law (42 U.S.C. § 1396p) requires states to seek recovery from the estates of Medicaid recipients who were 55 or older when they received Medicaid nursing facility, home- and community-based, or related services. Texas recovers from the deceased recipient's probate estate — typically the home and other assets that passed through the estate.

The claim attaches after the Medicaid recipient dies and after the death of a surviving spouse. It does not remove a surviving spouse, minor child, or disabled child from the home during their lifetime. Exemptions and hardship waivers are available — for example, if the estate is an income-producing property that is the heir's primary source of income.

Spousal impoverishment protections at a glance

Federal law (42 U.S.C. § 1396r-5) protects the community spouse (the spouse remaining at home) from complete asset depletion when the other spouse applies for nursing facility Medicaid. Texas applies these federal protections within MEPD.

Source: CMS 2026 spousal impoverishment standards; HHSC MEPD rules. Request a formal assets assessment from HHSC at the time of application to determine the exact CSRA applicable to your situation.

What Texas long-term care Medicaid covers

• Skilled nursing facility care — room, board, nursing services, and most medical care in the facility
• Personal attendant services at home through Community First Choice (CFC) — no waiting list
• Home health aide visits for those receiving care at home
• Adult day care and respite care for family caregivers
• Physical, occupational, and speech therapy
• Durable medical equipment prescribed by a physician
• Transportation to and from medical appointments
• Behavioral health services coordinated through STAR+PLUS