Texas is a hard income-cap state where a Miller trust is not optional, and where the word conservatorship means something entirely different than it does in California. Michael Holmes is licensed in Texas and advises families there on paying for long-term care, protecting a home from estate recovery, and putting decision-making authority in place before a crisis forces the issue. Figures below are current for 2026 and change annually.
Paying for Long-Term Care in Texas
Texas, like Idaho, is a hard income-cap state. Gross monthly income above the cap disqualifies an applicant outright. There is no medically needy spend-down alternative.
- Income limit: $2,982 per month for an individual — the federal special income level, 300% of the SSI federal benefit rate.
- Resource limit: $2,000 for a single applicant.
- Personal needs allowance: $75 per month.
- Over the cap? A Qualified Income Trust (Miller trust) is mandatory, and must be funded every month without fail.
- Penalty divisor: $262.37 per day, effective September 1, 2025. Note that the widely circulated $242.13 figure is stale.
- Home equity limit: $752,000. Lookback: 60 months.
Texas is a community property state, which affects how assets are characterized before the community spouse resource allowance ($32,532 to $162,660) is calculated. The Texas homestead exemption is unusually protective in creditor contexts, but it is a separate body of law from Medicaid exemption and estate recovery, and the two should not be conflated.
Estate Recovery in Texas
Texas draws bright lines that spare a great many modest estates. No claim is made where the estate is worth $10,000 or less, or where total Medicaid costs were $3,000 or less. Recovery covers long-term care services received after age 55 — nursing facility, ICF/IID, STAR+PLUS and other waiver services.
Hardship waivers are available where the homestead is valued under $100,000 and heirs meet income limits, and for a family business or farm that is the primary income source. Texas also allows deductions from a claim for home maintenance costs and for care costs that kept the person at home longer.
Incapacity Documents That Work in Texas
Texas has not adopted the Uniform Power of Attorney Act. It uses its own Durable Power of Attorney Act at Estates Code Chapters 751 through 753, with a statutory form at section 752.051. A 2017 overhaul imported uniform-act-style rules on third-party acceptance and refusal, so a Texas power of attorney has more force against a reluctant bank than it once did.
Health care planning in Texas uses two separate instruments: the Medical Power of Attorney (Health and Safety Code section 166.164) names an agent, and the Directive to Physicians (section 166.033) records end-of-life wishes. Section 166.036 provides that notarization is not required and that a particular form may not be demanded. Texas has no statewide POLST statute; its portable medical order is the Out-of-Hospital DNR under Health and Safety Code Chapter 166, Subchapter C.
Guardianship and Conservatorship in Texas
A vocabulary warning that matters. In Texas, conservatorship means child custody under the Family Code. The adult protective proceeding is guardianship — guardian of the person, guardian of the estate, or both — under Estates Code Title 3. Families arriving from California, where conservatorship is the adult proceeding, routinely ask for the wrong thing.
Estates Code section 1101.101(a)(1) requires clear and convincing evidence that alternatives to guardianship and available supports and services have been considered and determined not to be feasible before a guardian is appointed, and section 1001.001(b) directs that limited guardianships be designed to encourage maximum self-reliance.
Texas was also first in the nation on supported decision-making, enacting the Supported Decision-Making Agreement Act at Estates Code Chapter 1357 in 2015. For many adults with diminished but not absent capacity, that agreement plus a durable power of attorney does what a guardianship would have done, without stripping anyone of the right to decide.
Talk to a Texas Elder Law Attorney
Elder law questions arrive on someone else’s schedule — a hospital discharge, a diagnosis, a spouse told to “spend down.” For the multi-state picture, see our elder law overview, and for everything else we handle in the state, our Texas page. When you are ready, contact the Texas office or call the number listed there.