Texas Medicaid Long-Term Care Eligibility for 2025

Texas Long-Term Care

Texas is an income-cap state with a hard income limit for Medicaid long-term care eligibility. Unlike non-income cap states, which allow applicants to spend down excess income, Texas requires that applicants meet the income limit at the time of application unless they use specific planning tools such as a Miller Trust.

Eligibility for 2025:

Residency and Citizenship: Applicants must be residents of Texas and U.S. citizens, or have proper immigration status.
Age/Disability: Applicants must be 65 years or older, blind, or disabled. They must also meet medical requirements consistent with the level of care requested and require care for thirty (30) consecutive days.
Income Limitations:
- Applicants can place excess income into a Miller Trust (Qualified Income Trust) to qualify for Medicaid services.
- Monthly income must not exceed $3,021 for an individual. The limit is higher if both spouses require care.
- A $62/month personal needs allowance is excluded from countable income.
Asset Limitations:
- Applicants must have $2,000 or less in countable assets if single.
- The state enforces a 5-year look-back period, penalizing transfers of assets below fair market value.

Exempt Assets for 2025 in Texas:

$2,000 or less in countable assets for individuals.
One home (equity limit $788,000) is exempt if the applicant intends to return or if a spouse, child under 21, or disabled individual resides there.
One automobile (no equity amount specified).
Irrevocable burial trusts.
Non-saleable property, including household furnishings, clothing, jewelry, and personal effects.

Spousal Rules for 2025:

Community Spouse Asset Allowance: The community spouse may retain up to $152,020 in countable assets. If the community spouse’s assets fall below the minimum of $30,027, additional resources from the institutionalized spouse may be transferred.

Community Spouse Income Protection: If the community spouse’s income is below $2,389/month, they may retain part of the institutionalized spouse’s income to meet this threshold. The maximum income the community spouse may retain is $3,898.50/month, depending on living expenses.

Income First Rule: Texas requires the community spouse to first use the institutionalized spouse’s income to meet their needs before requesting an increase in the Community Spouse Resource Allowance (CSRA).

Texas Long-Term Care Insurance Partnership for 2025:

The Texas Long-Term Care Partnership Program protects assets dollar-for-dollar based on the policy’s maximum benefit payout. For example, a policy with a $165,000 benefit exempts $165,000 in assets from Medicaid eligibility calculations.

Each spouse must purchase an individual policy to qualify. Once benefits are exhausted, Medicaid considers the protected assets exempt.