Protecting the spouse at home when one partner needs care

How much can the spouse at home keep under Texas Medicaid?

When one spouse needs nursing facility or STAR+PLUS HCBS care, the spouse at home (the community spouse) can keep a share of the couple's countable resources, between the federal minimum of $32,532 and maximum of $162,660 in 2026, plus income protected by the monthly maintenance needs allowance.

Source: CMS Informational Bulletin, Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026).

Texas uses its own method to divide resources at the start of care; ask HHSC or an elder law attorney to confirm the current figures before you rely on them.

Does a Texas couple lose the house when one spouse needs Medicaid?

Usually not while the spouse at home lives there: the home is generally exempt when a spouse or dependent lives in it, and federal home equity limits for 2026 apply to a single applicant whose home equity is very high.

The bigger risk is after both spouses have died, through estate recovery. Keep records of who owns the home and how, and get advice before transferring it.

What income does a Texas nursing facility resident keep?

A Texas Medicaid resident of a nursing facility keeps a personal needs allowance of $75 a month, raised from $60 in January 2024; most of the remaining income, after Medicare premiums, any allowance for the spouse at home and allowable medical expenses, goes toward the cost of care.

The personal needs allowance pays for clothing, haircuts, phone and small personal items. Families should not expect the facility to provide those items. Keep the resident's personal funds account statements and review them periodically.

What is Texas Medicaid estate recovery?

The Texas Medicaid Estate Recovery Program (MERP) can file a claim against the estate of a deceased recipient who was 55 or older when services were received and who first applied for long-term services on or after March 1, 2005, for nursing facility care, waivers including STAR+PLUS HCBS, and Community Attendant Services.

Texas never recovers more than it paid, and exemptions and hardship waivers exist, including when a spouse, a child under 21 or a disabled child survives. Ask an elder law attorney how MERP would apply to your parent's home before applying.

Does Texas look back at gifts before Medicaid?

Yes. Texas reviews transfers made in the five years before a Medicaid application for long-term care, and gifts or sales below fair value can create a period of ineligibility.

Paying a family member for care without a written agreement can be treated as a gift. If a family member provides care, a written personal services agreement set up with an attorney protects both sides. Never move money to qualify without professional advice.