Texas Medicaid Eligibility: Income Limits, Asset Rules & How to Apply

Texas Medicaid serves over 5 million Texans — more than any non-expansion state in the country — through one of the most elaborate managed care architectures in the United States.

Almost every Texas Medicaid recipient gets coverage through a named managed care program — STAR, STAR+PLUS, or STAR Kids — each targeting a different population and delivering a different set of services through private health plans contracted by the Texas Health and Human Services Commission (HHSC).

What Texas doesn’t have: Medicaid expansion.

Non-disabled adults without dependent children have no Texas Medicaid pathway regardless of income. With Texas having one of the highest uninsured rates in the country, the coverage gap here affects an estimated 1.5–2 million Texans — more than the entire Medicaid population of many smaller states.

Two features set Texas distinctly apart from other non-expansion states:

Community First Choice (CFC) — Texas implemented the federal CFC option in 2015, meaning there are no waiting lists for attendant care for people who qualify for Medicaid. Most states have significant HCBS waiting lists.

STAR Kids — Texas built a standalone managed care program specifically for children and youth under 21 with disabilities, launched in 2016, with dedicated service coordinators and individualized service plans.

This guide covers every Texas Medicaid program, 2026 income limits, the STAR+PLUS HCBS structure, QIT/Miller Trust rules, the IDD waiver waitlist crisis, and how to apply. For how Texas compares to expansion states, see Medicaid income limits across all 50 states.

Texas Medicaid Programs

Texas delivers Medicaid through distinct managed care programs. Which program you’re in depends on your age, disability status, and care needs.

STAR (State of Texas Access Reform) is the base Medicaid managed care program for low-income children, pregnant women, and families.

Children, pregnant women, and parents who qualify for Texas Medicaid receive care through STAR — choosing a health plan from those available in their service area. STAR has operated since 1993 and covers most of the state’s urban and suburban areas.

STAR+PLUS is Texas’s integrated managed care program for adults with disabilities and seniors who need both medical care and long-term services and supports (LTSS).

STAR+PLUS covers nursing home residents, ABD Medicaid recipients, and enrollees in the STAR+PLUS HCBS Program. It absorbed the former Community Based Alternatives (CBA) waiver — so HCBS in Texas flows through STAR+PLUS rather than through standalone waivers as in most states. Each STAR+PLUS member receives service coordination — a dedicated coordinator who assesses needs, connects members to services, and develops an individualized care plan.

STAR+PLUS HCBS (Home and Community Based Services) is Texas’s primary in-home care program for seniors and disabled adults who need nursing home-level care but want to remain at home.

Unlike most states where HCBS waivers have significant waiting lists, Texas implemented the Community First Choice (CFC) option in 2015 — which means attendant care cannot have waiting lists for people who qualify for Medicaid. This is a significant structural advantage. Other HCBS services within STAR+PLUS may still have limited availability.

STAR Kids is Texas’s managed care program specifically for children and youth under age 21 with disabilities.

Launched in 2016, STAR Kids consolidated coverage for children with SSI-related Medicaid and those enrolled in HCBS/IDD waiver programs. Every STAR Kids member receives a service coordinator who makes home visits, assesses needs, and coordinates care across providers. STAR Kids includes children enrolled in:

• Medically Dependent Children Program (MDCP) — for medically fragile/technology-dependent children
• Home and Community-Based Services (HCS) — for IDD
• Community Living Assistance and Support Services (CLASS)
• Deaf Blind with Multiple Disabilities (DBMD)
• Texas Home Living (TxHmL)
• Youth Empowerment Services (YES) — for children 3–18 with serious emotional disturbance

STAR Health covers children in foster care and certain other children in the conservatorship of the Department of Family and Protective Services.

Regular Medicaid (Aged, Blind, and Disabled — ABD) covers low-income elderly, blind, or disabled Texans not requiring nursing home care.

Income limit: $967/month (single). Asset limit: $2,000 (single).

Nursing Home / Institutional Medicaid covers long-term care in Medicaid-certified nursing facilities and ICF/IID facilities.

This is an entitlement — eligible applicants cannot be denied. Income limit: $2,901/month (single). Asset limit: $2,000 (single).

Perinatal Medicaid / CHIP Perinatal covers pregnant women not otherwise eligible for full Medicaid, providing prenatal care and delivery coverage for the unborn child.

Texas CHIP covers children up to age 19 in households with incomes above the Medicaid limit but at or below 213% FPL.

Income Limits — 2026

All figures are monthly gross income. The Federal Benefit Rate (FBR) is $967/month for 2026.

Key Notes on Texas’s Income Rules

The coverage gap at scale: Texas’s 18% FPL parent threshold ($234/month) is tied with South Dakota for the lowest in this series.

A single parent earning $250/month has no Texas Medicaid pathway and no Marketplace subsidy eligibility. With over 3.2 million uninsured Texans — the most of any state — and a large low-wage workforce in agriculture, construction, and food service, the coverage gap has an outsized impact here.

Nursing Home/HCBS: Income above $2,901/month goes toward care costs after protecting a Personal Needs Allowance of $75/month for nursing home residents — the highest PNA in this state series (SD: $30, TN: $50, SC: $65, PA: $45).

If income exceeds $2,901, a Qualified Income Trust (QIT) redirects excess income to restore eligibility.

Community Spouse Allowance: When one spouse enters a nursing facility or STAR+PLUS HCBS, the community spouse may keep income up to $3,948/month as a Minimum Monthly Maintenance Needs Allowance — if housing and utility costs exceed $793.13/month (effective July 1, 2025 – June 30, 2026).

Pregnant Women: Coverage extends 12 months postpartum. No asset test.

Texas’s QIT/Miller Trust — Important State-Specific Rules

Texas was one of the earliest states to implement Qualified Income Trusts — which Texas has informally called Miller Trusts since HHSC first approved them in the mid-1990s.

Texas follows the “name on the check” rule for income counting: whichever individual’s name appears on a check or payment is deemed to have received that income for Medicaid purposes.

For 2026, the Texas LTC income cap is approximately $2,982/month (updated January 2026 — slightly above the source document’s $2,901 based on the 300% FBR calculation; confirm with HHSC for the precise current figure).

If income exceeds the limit, the excess is deposited monthly into the QIT bank account. The income in the trust is then directed:

• For nursing home residents: as a co-payment to the nursing facility (after subtracting the $75 PNA, Medicare premiums, and other protected amounts)
• For community-based STAR+PLUS HCBS recipients: the person may keep income up to the cap
• For married applicants: up to $4,066/month can be diverted to the community spouse

Texas Medicaid must be named as a remainder beneficiary of the trust. The Social Security Number of the applicant — not the trust — should be used for the trust’s bank account.

Consult a Texas elder law attorney or Certified Medicaid Planner before establishing a QIT. Errors in trust setup can delay or disqualify eligibility.

Federal Poverty Level Reference — 2026

Use the federal poverty level calculator to find the exact threshold for your household size.

Asset Rules for Texas Medicaid

No asset test applies to children, pregnant women, parents, or CHIP. Asset limits apply to nursing home, STAR+PLUS HCBS, and ABD programs.

Home equity limit: The primary home is exempt while the applicant or spouse resides there or intends to return. Texas’s home equity cap is $730,000.

Exempt (Non-Countable) Assets

• Primary home (within the $730,000 cap)
• One vehicle
• Household goods and personal effects
• Irrevocable Funeral Trusts (IFTs)
• Medicaid Compliant Annuities
• Life insurance with face value $1,500 or less

The IDD Waiver Waiting List

One of Texas’s most significant Medicaid access issues is the IDD waiver waiting list.

As of recent reporting: over 311,000 people with developmental disabilities, 22,600+ people with physical disabilities, and 8,300+ medically fragile children are on Texas’s waiver waiting lists.

These individuals have been determined to need HCBS but cannot access it due to limited enrollment capacity. Texas’s waiting list for IDD services is among the largest in the country — a longstanding policy challenge driven by population scale, funding constraints, and the sheer number of qualifying Texans.

The Community First Choice exception: Texas CFC covers attendant care (personal assistance and habilitation) without a waiting list for all Medicaid-qualified individuals. This is meaningful because it provides some in-home support even to those on the IDD waiver waiting list — but it doesn’t replace the full scope of waiver services.

If you or a family member needs IDD waiver services, apply immediately even if you’re told there’s a long wait. Call 1-877-438-5658 or contact your local IDD authority.

Texas’s 60-Month Look-Back Period

Texas enforces a 60-month (5-year) look-back for Nursing Home Medicaid and STAR+PLUS HCBS.

When you apply, HHSC reviews all asset transfers from the 5 years before your application date. Transfers below fair market value — gifts, below-market sales, or certain trust transfers — trigger a penalty period of ineligibility.

Exempt transfers:

• Transfers to a spouse
• Transfers to a blind or disabled child
• Home transfer to a caregiver child who lived there at least 2 years before institutionalization and whose care delayed nursing home placement
• Transfer to a sibling with an equity interest who lived in the home at least 1 year before institutionalization

No look-back applies to ABD Regular Medicaid, children, pregnant women, or parents.

Medical and Functional Requirements

To qualify for Nursing Home Medicaid or STAR+PLUS HCBS, applicants must demonstrate Nursing Facility Level of Care (NFLOC) through documented limitations in:

ADLs: Mobility, bathing, dressing, eating, and toileting.

IADLs: Cooking, shopping, managing finances, medication management.

Cognitive or behavioral issues: Alzheimer’s, dementia, or other conditions — diagnosis alone is not sufficient; functional limitations must be formally assessed.

For ABD Regular Medicaid, proof of disability or blindness per SSA standards is required — NFLOC is not necessary.

Medicaid Estate Recovery

Texas’s Medicaid Estate Recovery Program may seek reimbursement for long-term care costs from a beneficiary’s estate after death.

Recovery most commonly targets the primary home when not protected through a surviving spouse, qualifying disabled child, or caregiver child exemption.

Options If You Exceed the Limits

Qualified Income Trusts (QITs / Miller Trusts): Texas follows the name-on-the-check income rule. If your income exceeds $2,901+/month, a properly structured QIT restores LTC eligibility.

See the QIT section above for Texas-specific rules. Always use an attorney or Certified Medicaid Planner.

Irrevocable Funeral Trusts (IFTs): Pre-paid funeral costs in an irrevocable trust are exempt from asset limits.

Spend Down: Convert countable assets into exempt ones — home modifications, vehicle purchase, paying off debt.

Medicaid Compliant Annuities: Convert excess assets into an income stream, reducing countable assets while directing income toward care.

What to Do If You’re in the Coverage Gap

Texas adults without dependent children, who are not disabled, and who earn below 100% FPL have no Texas Medicaid pathway.

Your options:

Federally Qualified Health Centers (FQHCs) — Texas has over 70 FQHC organizations operating 600+ service sites, providing primary care on a sliding fee scale statewide.

Find the nearest location at findahealthcenter.hrsa.gov or call 2-1-1 for referrals.

HealthCare.gov Marketplace — If your income is at or above 100% FPL, subsidized Marketplace coverage may be available. Use healthcare.gov to compare plans during Open Enrollment (November–January).

Texas community health centers — Border communities in South Texas, the Rio Grande Valley, and colonias have dedicated community health resources. Contact local federally qualified health centers.

Hospital charity care — Texas hospitals are required to maintain financial assistance programs for uninsured patients.

Veterans: If you’re a veteran and have no other coverage, explore VA healthcare eligibility at va.gov/health-care. See Medicaid and food stamp eligibility for veterans.

Federal Policy Changes Coming to Texas Medicaid

Work Requirements (January 2027): OBBBA work requirements target ACA expansion adults.

Since Texas has not expanded Medicaid, the federal expansion-adult work requirement framework doesn’t apply here. Parents enrolled in Texas Medicaid may face state-specific work rules — check with HHSC. See how the One Big Beautiful Bill affects SNAP and Medicaid for the full policy context.

Reduced Retroactive Coverage (January 2027): Medicaid will cover only 2 months prior to application, down from 90 days.

Apply promptly once you believe you qualify.

More Frequent Renewals (December 2026): Renewals shift to every 6 months for most enrollees.

Use Your Texas Benefits at yourtexasbenefits.com to renew online.

New Cost-Sharing (October 2028): Non-exempt enrollees may face up to $35 per specialist visit. Primary care and preventive services remain free.

Children, pregnant women, nursing facility residents, and seniors are exempt.

Texas Medicaid and SNAP: Same Agency, Integrated Portal

Unlike Tennessee (two separate agencies) or South Carolina (two agencies), Texas HHSC administers both Medicaid and SNAP through the same agency and the same Your Texas Benefits portal (yourtexasbenefits.com), also available as a mobile app.

A single application can establish eligibility for both programs simultaneously.

Texas SNAP (Lone Star Card) uses 200% FPL BBCE, meaning most Texas households have no asset test. Texas also uses the $5,000 elderly/disabled asset cap — higher than the federal standard.

Useful links for Texas residents:

• Texas SNAP monthly benefits, income limits, and eligibility
• How to apply for SNAP in Texas through Your Texas Benefits
• Texas WIC income guidelines
• Whether seniors on Social Security can also qualify for food stamps

How to Apply for Texas Medicaid

Online (Recommended): Apply through Your Texas Benefits at yourtexasbenefits.com.

The portal also has a mobile app — useful given Texas’s geographic scale and high rate of smartphone-only internet access in rural and border communities. A single application covers Medicaid, CHIP, SNAP, and other HHSC programs.

By Phone: Call 2-1-1 — Texas’s statewide benefits and social services hotline with multilingual caseworkers. Select the Medicaid option. Or call the Texas Medicaid Client Hotline directly at 1-800-252-8263.

In Person: Visit your nearest HHSC benefits office. Texas has offices across all 254 counties. Find locations at hhs.texas.gov.

By Mail: Download applications at hhs.texas.gov and mail to your local HHSC office.

Long-Term Care / Nursing Home: Call 1-855-937-2372 to connect with long-term care resources and initiate the NFLOC assessment process.

IDD Waivers: Call 1-877-438-5658 or contact your local IDD authority. Given the scale of the waiting list, apply immediately — your wait-time clock does not start until you apply.

STAR Kids: Apply for Medicaid through Your Texas Benefits first. Once approved, STAR Kids enrollment is initiated automatically for eligible children.

For the complete application walkthrough: the Texas Medicaid application guide.

Documents You’ll Need

• Texas residency proof (utility bill, lease, or official mail)
• U.S. citizenship or qualifying immigration status documentation
• Income proof: pay stubs, SSA award letters, pension statements
• SSNs for all household members
• For LTC / ABD: bank statements, property records, 60 months of financial history
• For disability: SSA disability documentation or physician letter
• For STAR Kids: medical documentation of disability or qualifying waiver enrollment

Processing Times

• Standard applications: Up to 45 days
• Disability-based applications: Up to 90 days
• Children / pregnant women: Expedited processing available

Frequently Asked Questions

What is the difference between STAR, STAR+PLUS, and STAR Kids?

These are three separate Texas Medicaid managed care programs for three different populations.

STAR covers children, pregnant women, and families through standard managed care. STAR+PLUS covers adults with disabilities and seniors who need both medical care and long-term services — including nursing home residents and HCBS recipients. STAR Kids covers children and youth under 21 with disabilities (including SSI recipients and HCBS/IDD waiver enrollees) with dedicated service coordinators and individualized care plans.

What is Community First Choice and why does it matter?

Texas implemented the Community First Choice (CFC) option in 2015, which federally requires that attendant care cannot have waiting lists for people who qualify for Medicaid.

This means that unlike most states — including Tennessee, South Carolina, and Rhode Island — Texas cannot legally maintain a waiting list for personal attendant and habilitation services for Medicaid-qualified individuals. It’s a meaningful protection, though it covers attendant care specifically, not the full range of HCBS waiver services.

What is the IDD waiver waiting list in Texas and how long is it?

Over 311,000 people with developmental disabilities are currently on Texas’s IDD HCBS waiver waiting list — one of the largest such lists in the country.

Texas’s scale (the most populous non-expansion state) means the demand for IDD services vastly outpaces funding. Apply immediately even if you’re told the wait is long. Your place on the list doesn’t begin until you apply. Call 1-877-438-5658 or contact your local IDD authority.

What is a QIT/Miller Trust in Texas and when do I need one?

A Qualified Income Trust (QIT) — informally called a Miller Trust in Texas — is an irrevocable trust used to redirect excess monthly income when an applicant exceeds the nursing home/STAR+PLUS HCBS income limit.

Texas was among the first states to use QITs and follows the “name on the check” rule — income is attributed to whoever’s name appears on the payment. If your income exceeds ~$2,982/month (the 2026 cap — confirm with HHSC), excess must go into the QIT each month. Work with a Texas elder law attorney to set it up correctly.

Why doesn’t Texas cover most working-age adults through Medicaid?

Texas has not expanded Medicaid under the ACA, so non-disabled adults without dependent children cannot qualify regardless of income.

With the 18% FPL parent threshold ($234/month) and no expansion pathway, Texas has the largest coverage gap of any state — an estimated 1.5–2 million uninsured adults who would qualify in expansion states. For uninsured adults, FQHCs (findahealthcenter.hrsa.gov) and HealthCare.gov (at or above 100% FPL) are the primary options.

Can I get both Texas Medicaid and SNAP through the same portal?

Yes — Texas HHSC administers both programs and the Your Texas Benefits portal (yourtexasbenefits.com) handles applications for both simultaneously.

This is more integrated than Tennessee or South Carolina, where Medicaid and SNAP go through separate agencies. The Your Texas Benefits mobile app makes this accessible even in areas with limited computer access. See Texas SNAP benefits and eligibility for SNAP-specific income limits.

What is the Personal Needs Allowance for Texas nursing home residents?

$75/month — the amount a nursing home resident on Texas Medicaid keeps after their income goes toward care costs.

At $75/month, Texas’s PNA is the most generous of any non-expansion state in this series: higher than South Dakota ($30), Rhode Island ($50), Tennessee ($50), Pennsylvania ($45), and South Carolina ($65). For long-term care planning, this is a meaningful distinction.

Last updated: 2026 | Sources: Texas Health and Human Services Commission (HHSC), hhs.texas.gov, STAR+PLUS program documentation, Texas elder law sources, USDA FPL guidelines, CMS.gov. Verify current income caps at yourtexasbenefits.com or by calling 2-1-1. This guide is for informational purposes only — eligibility is determined by Texas HHSC.