How Texas Medicaid eligibility works

Texas Medicaid for long-term care is administered by the Texas Health and Human Services Commission (HHSC). Three tests:

The Qualified Income Trust (Miller Trust)

Texas is one of about 25 “income cap” states. Retirees with income over $2,901/month don’t lose eligibility — they need a Qualified Income Trust, often called a Miller Trust after the seminal case.2

How it works:

  1. Each month, your parent’s income above the cap is routed into the QIT.
  2. The QIT pays the nursing facility (or care provider) directly.
  3. For eligibility-counting purposes, the income that went into the QIT no longer counts.
  4. At your parent’s death, any remaining QIT balance goes to the state as estate recovery.

Setup fee for a QIT through a Texas elder-law attorney runs $500–$1,500. Monthly administration is minimal — usually just moving money between bank accounts. This is paperwork, not magic.

STAR+PLUS managed-care LTC

Once Medicaid-eligible, most Texas LTC recipients enroll in STAR+PLUS — HHSC’s managed-care program for long-term services and supports. The recipient selects a managed-care organization (MCO) from those operating in their service area:3

The MCO authorizes service hours, contracts with home-care agencies, and coordinates care. Plan choice matters: two MCOs in the same service area can authorize different hours for similar diagnostic profiles.

Community property and Medicaid planning

Texas is a community-property state, which affects how Medicaid treats spousal assets. The general principle is protective of the community spouse:

The five most common Texas Medicaid mistakes

What to do this quarter

For the broader federal Medicaid framework, see our Medicaid pillar. For Florida’s similar approach (income cap state, but with unlimited homestead like Texas), see Florida Medicaid.