Paying for long-term care is the financial question that keeps Texas families up at night. A stroke, a fall, or a slow progression of dementia can turn a comfortable retirement into a monthly bill for a nursing facility, an assisted living community, or round-the-clock help at home. A Texas long-term care attorney helps you understand which of those costs Medicare will and will not pay, how Texas Medicaid’s STAR+PLUS program covers nursing facility and home-based care, where long-term care insurance and veterans benefits fit, and what you are actually agreeing to when you sign a facility’s admission paperwork.
Holmes Law is the practice of Michael Holmes, an attorney licensed in Texas who works with clients remotely across the state, from Houston and Dallas-Fort Worth to Austin, San Antonio, El Paso, and the Rio Grande Valley. This page explains the Texas long-term care landscape in plain language. It is a starting point for a conversation, not a substitute for advice about your own facts, and it connects to the broader Texas elder law services that Holmes Law provides.
What “Long-Term Care” Means Under Texas Law
Long-term care is help with the basic activities of daily living, such as bathing, dressing, eating, toileting, transferring, and continence, or supervision needed because of cognitive impairment. It is different from medical care aimed at curing an illness. That distinction matters because most health insurance, including Medicare, is built to pay for medical treatment and rehabilitation, not for ongoing custodial help.
Texas licenses and regulates the main settings where long-term care is delivered through the Texas Health and Human Services Commission (HHSC):
- Nursing facilities, licensed under Chapter 242 of the Texas Health and Safety Code, which provide 24-hour nursing care and are the setting most often paid for by Medicaid.
- Assisted living facilities, licensed under Chapter 247 of the Health and Safety Code, which provide housing, meals, and personal care, with Type A and Type B licenses depending on residents’ ability to evacuate and need for night-time attendance.
- Home and community support services agencies, licensed under Chapter 142 of the Health and Safety Code, which send attendants, nurses, and therapists into private homes.
- Adult day programs and day activity and health services, which provide daytime supervision and care while a family caregiver works.
Each setting has its own price structure and its own set of payment sources. A sound Texas long-term care plan matches the setting to the person’s needs and then lines up the right mix of funding.
Medicare’s Limits: Why It Rarely Pays for Long-Term Care
Many Texans assume Medicare will pay for a nursing home. It usually will not, at least not for long. Medicare Part A covers skilled nursing facility care only after a qualifying inpatient hospital stay of at least three midnights, only when the person needs daily skilled nursing or therapy, and only for up to 100 days in a benefit period, with daily coinsurance after the first 20 days. Once a resident stops improving or no longer needs skilled services, Medicare coverage ends even if the person still cannot live safely at home.
Two traps are worth knowing about:
- Observation status. A patient can spend several nights in a hospital bed “under observation” as an outpatient. Those nights do not count toward the three-day inpatient requirement, so a later nursing facility stay may not be covered. Ask the hospital, in writing if possible, whether the patient has been formally admitted.
- Custodial care. Medicare does not pay for custodial care in any setting, including assisted living. Medicare Advantage plans offered in Texas follow the same basic rule, though they may require prior authorization and use their own networks of skilled nursing facilities.
Medicare’s home health benefit is also narrower than people expect. It covers intermittent skilled care for homebound patients, not full-time attendants. For a deeper look at enrollment windows and appeals, see the Texas Medicare page.
Texas Medicaid for Nursing Facility Care
For most families facing an extended nursing facility stay, Texas Medicaid becomes the primary payer. HHSC administers the program, and since 2015 nursing facility services for most adults have been delivered through STAR+PLUS, Texas’s managed care program for people who are 65 or older or who have a disability. The resident chooses a STAR+PLUS managed care organization, and that organization coordinates the resident’s Medicaid-covered services.
To qualify, an applicant must meet a medical necessity standard, confirmed through a clinical assessment, and must meet financial rules on both income and countable resources. According to HHSC’s Medicaid for the Elderly and People with Disabilities Handbook, effective January 1, 2026 the countable resource limit is $2,000 for an individual, and the special income limit for nursing facility and waiver programs is $2,982 per month for an individual. Texas is an “income cap” state, so an applicant whose gross income exceeds that limit must use a Qualified Income Trust, often called a Miller trust, to become eligible.
Once eligible, the resident pays most of his or her income toward the cost of care as “applied income,” keeping a personal needs allowance, and Medicaid pays the balance to the facility. A spouse who remains at home is protected by the federal spousal impoverishment rules. The details of countable assets, the five-year look-back, transfer penalties, and Texas estate recovery are covered on the Texas Medicaid planning page.
Home and Community-Based Care Through STAR+PLUS
Many Texans would rather receive care at home or in assisted living. Texas Medicaid supports that choice through several programs, each with its own eligibility rules:
- STAR+PLUS Home and Community-Based Services (HCBS). This waiver program serves people who meet nursing facility level of care but choose to live in the community. It can cover personal assistance, adult foster care, assisted living services, nursing, therapies, home modifications, adaptive aids, and respite. It does not pay room and board in assisted living. Enrollment has historically been managed through an interest list, though some pathways, such as moving from a nursing facility to the community, can shorten the wait.
- Community Attendant Services (CAS) and Primary Home Care (PHC). These programs provide attendant help with daily living activities for people who meet functional and financial criteria that differ from the nursing facility standard.
- Day Activity and Health Services (DAHS). Adult day care with nursing supervision for eligible individuals.
- PACE (Program of All-Inclusive Care for the Elderly). Available only in certain Texas service areas, PACE combines medical and long-term care through a single provider for people 55 and older who meet nursing facility level of care.
Because these programs change and availability varies by region, a Texas long-term care attorney will usually confirm current program rules with HHSC and the relevant managed care organization before a family makes irreversible financial decisions.
Long-Term Care Insurance and the Texas Partnership Program
Private long-term care insurance can pay for care in a nursing facility, assisted living, or at home, depending on the policy. Policies sold in Texas are regulated by the Texas Department of Insurance. When a claim arises, the details matter: the benefit trigger (usually inability to perform two or more activities of daily living or a severe cognitive impairment), the elimination period, the daily or monthly maximum, inflation protection, and whether the policy pays the provider directly or reimburses the policyholder.
Texas participates in the Long-Term Care Partnership Program. A qualified Partnership policy offers an asset disregard: for each dollar the policy pays in benefits, a dollar of the policyholder’s assets can be protected when he or she later applies for Texas Medicaid. Partnership protection can also reduce exposure to Medicaid estate recovery. If you own an older policy, it is worth confirming whether it qualifies.
Hybrid life insurance and annuity products with long-term care riders are also common. They can work well for some families, but they have different tax and Medicaid consequences than a traditional policy. Holmes Law does not sell insurance and can review a policy’s terms as part of a broader plan.
Veterans Benefits That Help Pay for Care
Wartime veterans and their surviving spouses may qualify for VA pension with the Aid and Attendance enhancement, which is designed to help pay for in-home care, assisted living, or nursing facility care. VA pension has its own net worth limit and a 36-month look-back on asset transfers that has applied since October 18, 2018, and those rules are different from Texas Medicaid’s five-year look-back. A transfer that makes sense for VA purposes can create a Medicaid penalty, and the reverse is also true.
Texas also has its own resources. The Texas Veterans Land Board operates the Texas State Veterans Homes, which provide skilled nursing care for eligible veterans, certain spouses, and Gold Star parents. The Texas Veterans Commission offers free claims assistance through accredited representatives. For more detail, see the Texas veterans benefits page.
Private Pay and Using Your Own Resources Wisely
Many Texans pay privately for at least part of their care, especially for assisted living, which Medicaid does not fully cover. Private pay does not have to mean spending down without a plan. Sources of private funds include savings, retirement accounts, the sale of a home, a reverse mortgage on a Texas homestead, life insurance with accelerated death benefits or cash value, and contributions from family members.
Each source carries tax and eligibility consequences. Withdrawing a large sum from an IRA can create a spike in taxable income. Selling a homestead converts an exempt asset into a countable one for Medicaid purposes. Family members who pay for a parent’s care should document whether the payments are gifts or loans, and adult children who provide hands-on care should consider a written personal care agreement so that payments to them are not later treated as uncompensated transfers. Planning ahead lets a family use private resources in a way that preserves future eligibility.
Facility Contracts and Admission Agreements
Admission agreements for Texas nursing facilities and assisted living communities are long, dense, and presented at a stressful moment. Read them carefully, and do not sign anything you do not understand. Key issues to review include:
- Responsible party language. Federal law prohibits a Medicare- or Medicaid-certified nursing facility from requiring a third-party guarantee of payment as a condition of admission. Adult children are often asked to sign as “responsible party.” Sign only in a representative capacity, such as agent under a power of attorney, and never as a personal guarantor.
- Arbitration clauses. Federal rules bar certified nursing facilities from requiring residents to sign a pre-dispute arbitration agreement as a condition of admission. If an arbitration agreement is offered, it should be a separate, optional document that you may decline.
- Private pay requirements. A certified facility generally may not require residents to remain private pay for a set period before applying for Medicaid.
- Discharge and transfer rights. Nursing facility residents have federal and Texas protections against involuntary discharge, including notice and appeal rights. Assisted living contracts are governed more by the contract itself and Chapter 247, so the termination provisions deserve close reading.
- Fees and deposits. Assisted living agreements may include community fees, level-of-care charges, and annual increases. Understand how rates change as care needs rise.
The Texas Long-Term Care Ombudsman Program, operated through HHSC, advocates for residents of nursing facilities and assisted living facilities and can help resolve disputes about care and discharge.
Legal Documents Every Texas Long-Term Care Plan Needs
Paying for care is only half the plan. Someone must have legal authority to apply for benefits, sign admission agreements, move money into a Qualified Income Trust, and make medical decisions. In Texas, that means a statutory durable power of attorney under Chapter 752 of the Estates Code with the specific powers needed for Medicaid planning, a medical power of attorney and directive to physicians under Chapter 166 of the Health and Safety Code, and HIPAA authorizations. Without them, a family may need to seek guardianship in court. The Texas incapacity and powers of attorney page explains these documents in detail, and your overall plan should coordinate with your Texas will and any Texas trust.
How a Texas Long-Term Care Attorney Helps
Holmes Law’s approach is practical. Michael Holmes starts by understanding the person’s health, the likely care setting, the family’s budget, and the assets involved, including the Texas homestead. From there, the work often includes:
- Mapping realistic payment sources over the next several years, including Medicare, Medicaid, insurance, VA benefits, and private funds.
- Evaluating Texas Medicaid eligibility and timing, including whether a Qualified Income Trust is needed.
- Reviewing admission agreements before they are signed and identifying provisions to strike or clarify.
- Preparing or updating powers of attorney, medical directives, and estate planning documents.
- Coordinating with care managers, financial advisors, and accountants the family already works with.
Because Holmes Law is a remote practice, meetings happen by video and phone, and documents can be reviewed and signed with notarization arranged where you are.
Frequently Asked Questions
Does Medicare pay for assisted living in Texas?
No. Medicare does not pay for custodial care or room and board in assisted living. Texas Medicaid’s STAR+PLUS HCBS program can pay for assisted living services for eligible individuals, but not room and board. Many families combine private funds, long-term care insurance, or VA benefits to cover assisted living.
Will my parent have to sell the house to qualify for Texas Medicaid?
Not necessarily. A Texas homestead is generally excluded as a countable resource if the applicant lives there or intends to return, or if a spouse or certain dependents live there, subject to a federal home equity limit. The house may, however, be exposed to Texas Medicaid estate recovery after death, which is why planning matters.
Can a nursing home make me personally responsible for my mother’s bill?
A Medicare- or Medicaid-certified nursing facility cannot require a third-party guarantee as a condition of admission. Read the agreement carefully and sign only in a representative capacity. If you have already signed, have the document reviewed.
How long does it take to get STAR+PLUS home care?
It depends on the program. Some community programs can begin relatively quickly once eligibility is confirmed, while the STAR+PLUS HCBS waiver has historically involved an interest list. Timing varies, so it helps to apply early and confirm current status with HHSC.
Is a long-term care insurance policy counted as an asset for Medicaid?
The policy itself generally is not a countable resource, but benefits it pays can affect income and eligibility. A qualified Texas Partnership policy can also protect assets dollar for dollar when you later apply for Medicaid.
Do I need a lawyer to apply for Texas Medicaid?
You can apply on your own through Your Texas Benefits. Families often consult a Texas long-term care attorney when there are assets to protect, a spouse at home, income over the special income limit, recent gifts, or a homestead exposed to estate recovery.
Speak With a Texas Long-Term Care Attorney
A long-term care crisis rarely waits for a convenient moment. Whether you are planning years in advance or a loved one is being discharged to a nursing facility next week, Holmes Law can help you understand your options and put the right documents in place. Contact Holmes Law to schedule a remote consultation with Michael Holmes about long-term care planning in Texas.