Elder Law

Texas Medicaid pays for nursing home care for residents who meet HHSC income and asset limits. The program covers room, board, and skilled nursing services at participating facilities. To qualify, a single applicant must generally reduce countable assets below $2,000, while a married couple has protections for the spouse remaining at home.

The exact income and asset limits change each year. For married applicants, the community spouse keeps a protected share of the couple's assets, called the Community Spouse Resource Allowance, plus a protected monthly income. The institutionalized spouse's income above HHSC's threshold goes to the nursing facility as a patient pay amount. Medicaid pays the difference between the patient pay amount and the facility's Medicaid rate. An elder law attorney reviews whether a family's current picture meets HHSC's eligibility rules or whether planning steps are available.

Protecting assets from nursing home costs in Texas depends on how much time is available. Families who plan five or more years before care is needed have the broadest set of lawful options. Families in a care crisis still have options, but they are more limited because of the Medicaid look-back period.

Strategies vary by the family's specific asset picture and timing. For proactive situations, they may include irrevocable trusts, converting countable assets into exempt ones, and coordinating with an estate plan. For crisis situations, they may include paying off debt, purchasing exempt assets, spousal transfers under federal Medicaid law, and in some cases Medicaid-compliant annuities. No single strategy works for every family. The starting point is a conversation with an elder law attorney who can review the actual numbers.

Medicare is a federal health insurance program for people 65 and older and certain disabled individuals. It covers short-term skilled nursing care after a qualifying hospital stay, up to 100 days with cost-sharing after day 20. Medicaid is a joint federal-state program that covers long-term nursing home care for people who meet income and asset requirements.

Many families arrive at an elder law consultation believing Medicare will pay for nursing home care long-term. Medicare does not. Once the Medicare skilled nursing benefit is exhausted, residents must pay privately, use long-term care insurance, or qualify for Medicaid. Understanding this distinction early is one reason elder law planning has value even for families who believe they are adequately covered.

To obtain guardianship of an elderly parent in Texas, you file an application in the county where the proposed ward lives, submit a physician's certificate of medical examination, pass a background check, and attend a court hearing. In Harris County, these cases are handled by the statutory probate courts.

The court appoints an attorney ad litem to represent the interests of the proposed ward before deciding whether guardianship is warranted and who should serve as guardian. The court considers whether a less restrictive alternative, such as a supported decision-making agreement, is adequate. If guardianship is granted, the guardian files annual reports and accountings with the court for as long as the guardianship continues. An attorney guides the family through the filing requirements and the hearing.

The most effective time to start Medicaid planning in Texas is at least five years before nursing home care is anticipated, because Texas Medicaid applies a 60-month look-back period to asset transfers. For families with a diagnosis of Alzheimer's, Parkinson's, or another progressive condition, planning should begin promptly after the diagnosis.

Even families who cannot reasonably anticipate a nursing home need benefit from reviewing their estate plan documents, powers of attorney, and asset structure with an elder law lens. That review surfaces vulnerabilities that would become costly in a crisis. Families who have already deferred planning and are now facing an immediate care need still have options; the conversation with an attorney should happen before any transfers are made, since unadvised transactions during the look-back period can create Medicaid penalty periods.