Appendix XII, Nursing Facility and Home and Community-Based Services Waiver Information

Revision 23-1; Effective March 1, 2023

Note: The following information is effective Jan. 1, 2023.

Medicaid Eligibility for the Nursing Facility Program and the Home and Community-Based Services Waiver Programs

Income — Maximum gross monthly income

  • $2,742 Individual
  • $5,484 Couple

Note: The income of parents and spouses is not considered for determining eligibility.

What counts as income?

  • Social Security benefits
  • Certain veteran's benefits
  • Private pensions
  • Interest or dividends
  • Royalty and rental payments
  • Federal employee annuities
  • Railroad benefits
  • State or local retirement benefits
  • Gifts or contributions
  • Earnings and wages

Resources — Maximum countable resources

  • $2,000 Individual
  • $3,000 Couple

What is a resource?

  • Bank accounts and certificates of deposit (CDs)
  • Real property
  • Life insurance policies
  • Burial funds
  • Individual retirement accounts (IRAs)
  • Stocks and bonds
  • Oil, gas or mineral rights
  • Jewelry and antiques
  • Cars and other vehicles
  • Boats and recreational vehicles

What can be excluded?

  • A homestead in Texas where the person intends to return.
  • Life insurance, if the face value is $1,500 or less per insured person.
  • Separately identifiable burial funds of $1,500 (less any excluded life insurance) or more, if irrevocable, for the applicant and the applicant’s spouse.
  • One vehicle is excluded, regardless of value.

Protected resources amount for a spouse in the community

$29,724 minimum to $148,620 maximum (excludes value of homestead, household goods, personal goods, one car and burial funds)

Other Eligibility Requirements

Nursing Facility

  • Be 65 or older or meet SSA’s definition of disability.
  • Meet medical necessity criteria.
  • Be a resident of Texas and a U.S. citizen or alien with approved status such as a legalized or permanent resident alien.
  • Live in a Medicaid-contracted long-term care facility for at least 30 consecutive days.

Co-payment

Individual — Total gross income, less $60 for personal needs.

Individual with a spouse in the community — Total gross couple income, less:

  • $60 for personal needs;
  • amount up to $3,715.50 for community spouse; and
  • certain amount for dependents living with community spouse.

Couple — Total gross income, less $120 for personal needs.

Note: Certain other expenses, such as health insurance premiums, guardianship fees and incurred medical expenses if the Medicaid program does not cover direct payment for the services, may be deducted if the person meets program policy requirements.

Home and Community-Based Services

  • Be 65 or older or meet SSA’s definition of disability.
  • Meet nursing facility medical criteria or ICF/IID-RC level of care criteria.
  • Be a resident of Texas and a U.S. citizen or alien with approved status such as a legalized or permanent resident alien.
  • Have an approved plan of care within the cost ceiling.
  • Meet waiver requirements.

Co-payment

In certain situations, a recipient may be required to pay a co-payment based on income.