Medicaid Eligibility

We know navigating Medicaid eligibility can be challenging so we’ve documented a breakdown of the basic financial and non-financial requirements.

The good news: If you’re an individual or couple who receives or needs long-term care in a nursing facility, Medicaid assistance is available to you, and you do not need to lose all your assets to receive benefits.

Note: The vast majority of people considering long-term care Medicaid are over the income or asset limits, or both, have given a gift, have too much property, one too many vehicles, excess life insurance, and most still cannot afford the cost of long-term care. We can help!

Non-Financial Eligibility Requirements

Age or Disability: You must be age 65 or older. If under 65, you must be declared disabled by Social Security, Railroad Retirement, or Supplemental Security Income (SSI) and receive disability benefits.
Citizenship: You must be a U.S. citizen or a qualified U.S. legal resident.
Residence: You must be a Texas resident.
Medical Necessity: You must be determined to require full-time services of a licensed nurse in a nursing facility. Texas Medicaid & Health Partnership (TMHP), which is the Medicaid claims administrator for Texas, is the one who makes this determination. A registered nurse completes an assessment known as a Minimum Data Set (MDS) and once completed, TMHP conducts a review to determine medical necessity.
30-day stay: You must stay at a Medicaid-certified nursing facility for 30 consecutive days. The date of admittance to a nursing facility or qualifying hospital stay is day zero. Example: your loved enters a hospital then transfers to a nursing facility, then day zero will be the date of admittance into the hospital.

Medicaid for Long-term Care Basics

Non-Financial Eligibility Requirements

For Medicaid eligibility all income that an applicant receives is counted. This income can come from any source. Examples include employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Retirement Income (RSDI), annuities, rental income, mineral right earnings, and stock dividends.

(Income limits as of January 1, 2023)

Single applicant:

$2,742 per month for a single person (or spouse in the nursing home)

Couple (both in the nursing home):

$5,484 per month combined income.

All resources of both you and your spouse, regardless, if joint or separate, are considered countable. Some resources may be excluded such as a homestead, vehicle, certain types of life insurance and burial funds.

Asset Limits as of 1 January 2023:

$2,000 for a single person (unmarried)
$3,000 if both spouses are in the same nursing home

Spousal Info.

Medicaid Protections for the community Spouse

Spousal Protected Resource Amount (SPRA) — The portion of a couple's combined countable resources reserved for the community spouse and deducted from the couple's combined countable resources in determining eligibility.

Spousal Income Protections: There is a rule that allows the Medicaid applicant to transfer income to the community spouse to ensure he or she has sufficient funds with which to live. This is called the Minimum Monthly Maintenance Needs Allowance (MMMNA) and this is the minimum amount of combined monthly income to which the community spouse is entitled to retain.

What this means for you: When applying for Medicaid as a married couple there are some added protections for the spouse at home to prevent impoverishment (i.e. leaving the spouse at home with little or no income or resources). The spouse at home is called the community spouse. Medicaid allows for the community spouse to keep some of the income and assets from the partner entering the nursing home. Medicaid income eligibility is based on the spouse applying for long-term care Medicaid AND the combined resources of both spouses. This includes marital/community property or separate/pre-marital property OR the spouse’s respective ownership interest in community property.

Medicaid Estate Recovery

Your guide to Medicaid Estate Recovery Program (MERP)

Who does MERP affect?

This program will affect only long-term care services and supports you receive after the age of 55, and only if you applied after March 1, 2005.

The following services and programs are affected by MERP:

Nursing facility care (nursing homes)
Intermediate Care Facility for Individuals with an Intellectual Disability or Related Condition (ICF/IID)
The following Medicaid waiver programs:
- Community Attendant Services (CAS)
- Community Based Alternatives (CBA)
- Community Living Assistance and Support Services (CLASS)
- Consolidated Waiver Program (CWP)
- Deaf-Blind with Multiple Disabilities (DBMD)
- Home and Community-based Services (HCS)
- Integrated Care Management (ICM)
- STAR+PLUS (long-term care services)
- Texas Home Living (TxHmL)

MERP also affects the costs of certain hospital and prescription drug services you receive. Primary Home Care (PHC) is not affected by MERP.

How does this program work?

When a person applies for Medicaid and long-term services and supports, the state provides a notice that explains MERP. When the person dies, the state sends a different notice to the estate representative or heirs to let them know that the state intends to file a claim. The notice will ask the representative for information so the state can decide whether to file a MERP claim.

What is an estate?

An estate is property, such as money, a house, or other things of value that a person leaves to family members or others (heirs) when he or she dies. MERP does not apply to all property that a person may own.

Examples of property that the state will not collect on include:

Life insurance policies that name a person to receive the payment.
Bank accounts that are paid on death to another person.

Are there times when the state will not ask for money back?

Yes, the state will not ask for money when:

There is a spouse who is still alive.
There is a child under 21 years of age.
There is a child of any age who is blind or permanently and totally disabled under Social Security requirements.
The value of the estate is $10,000 or less.
The amount of Medicaid costs is $3,000 or less.
There is an unmarried adult child who lived full-time in the Medicaid person's home for at least one year before this person died.
The cost of selling the property is more than the property is worth.

Also, the state will not ask for money when this would cause an undue hardship for the heirs.

What happens if I give away or transfer my assets before moving into a nursing home?

Giving away resources for no compensation, or refusing to accept income, or reducing income you could receive before moving into a nursing home may result in:

A penalty against you for not paying for nursing facility or ICF/IID facility services when you were able to do so; or
A decision by the state that you are ineligible for waiver program services or state supported living center services.

The state may "look back" up to 60 months before you applied for nursing home, ICF/IID or waiver services to determine when your income was reduced, and resources were transferred.

Learn More

We know this is a lot of information. Do not hesitate to reach out as there are ways to protect you before you apply for Medicaid.

Find out more

Medicaid Eligibility

Non-Financial Eligibility Requirements

Non-Financial Eligibility Requirements

Non-Financial Eligibility Requirements

Medicaid for Long-term Care Basics

Non-Financial Eligibility Requirements

Non-Financial Eligibility Requirements

Spousal Info.

Medicaid Protections for the community Spouse

Medicaid Estate Recovery

Your guide to Medicaid Estate Recovery Program (MERP)

Who does MERP affect?

How does this program work?

What is an estate?

Are there times when the state will not ask for money back?

What happens if I give away or transfer my assets before moving into a nursing home?

Learn More

This website uses cookies.