A semi-private room in a Texas nursing home costs about $5,627 per month ($67,525 a year) in 2026, well below the national median. If your loved one qualifies for Medicaid, it pays the facility directly, and nursing facility care sits in regular Medicaid rather than in a waiver, so it isn't subject to the enrollment caps and interest lists Texas may put on its waiver programs. But finding the right facility takes more than looking at a price tag.

This guide walks through what nursing homes in Texas actually cost, how Medicaid pays for care, and how to check a facility's track record before making a decision.

In This Guide

Nursing Home Costs in Texas

Texas is one of the more affordable states for nursing home care, running well below the national median. Per the CareScout 2025 Cost of Care Survey, the statewide medians are about $67,525 a year (roughly $185 a day, or $5,627 a month) for a semi-private room and about $91,250 a year (roughly $250 a day, or $7,604 a month) for a private room.

Care setting Texas (year) Texas (day) National (year)
Nursing home, semi-private room about $67,525 about $185 about $114,975
Nursing home, private room about $91,250 about $250 about $129,575

The statewide semi-private median of about $67,525 a year runs far below the national $114,975, and the private-room median of about $91,250 sits well under the national $129,575. That gap matters. For families paying out of pocket, Texas gives you more runway before savings run out. These are statewide medians from an industry survey, not government rates and not maximums; costs vary by metro area within the state.

Private-pay rates are what facilities charge families without Medicaid or insurance coverage. If your loved one is on Medicaid, the state pays the facility directly at a negotiated rate.

Wondering how to pay for nursing home care? Chat with Brevy's care navigator to explore your family's coverage options.

How Medicaid Pays for Nursing Home Care in Texas

Here's the most important thing to know: nursing facility care is regular Medicaid, not a waiver. Texas HHSC is allowed to cap how many people a 1915(c) waiver serves and to open an interest list when demand runs past that capacity, which is not how regular Medicaid works. That difference is why nursing home placement sometimes happens faster than getting home-based services approved.

Who Qualifies

To qualify for Texas Medicaid nursing home coverage in 2026, your loved one must meet both financial and medical requirements.

Financial requirements for 2026 are summarized below.

Requirement Single Applicant Married (both applying) Married (one applying)
Income limit $2,982/month $5,964/month $2,982/month (applicant)
Asset limit $2,000 $3,000 $2,000 (applicant)
Spouse protected assets (SPRA) N/A N/A Half the couple's combined countable resources, but at least $32,532 and no more than $162,660

Medical requirements: The applicant must need a "nursing facility level of care," determined by assessing their ability to perform Activities of Daily Living (bathing, dressing, eating, mobility, toileting) and any cognitive or behavioral issues.

How the Money Works

Once approved, Medicaid pays the nursing home directly. But it isn't free for the resident. HHSC starts from the resident's total countable income and deducts, in order, the $75/month personal needs allowance Texas sets for a nursing facility resident, guardianship fees, the maintenance needs of a spouse, the maintenance needs of the family, and incurred medical expenses. What's left is the resident's co-payment toward the cost of care. Medicaid picks up the difference between that co-payment and the facility's rate. The $75 figure is specific to a nursing facility: Texas sets the allowance at $85 for someone in assisted living or foster care and at $2,901 for someone on an HCBS waiver.

For married couples where only one spouse enters a facility, the at-home spouse gets protections to avoid going broke:

  • Spousal Protected Resource Amount (SPRA), the Texas name for the Community Spouse Resource Allowance: the at-home spouse keeps the greater of half the couple's combined countable resources or $32,532, the federal minimum, and in no case more than $162,660, the federal maximum. The ceiling is not a flat allowance: most couples protect half their countable resources, and only a couple whose resources are large enough for half to exceed the cap reaches $162,660.
  • Monthly maintenance needs allowance, $4,066.50/month: income can be diverted from the nursing home spouse to bring the at-home spouse up to this figure. Note the labels conflict. Texas's own budget reference chart calls $4,066.50 the Minimum Monthly Maintenance Needs Allowance, or Spousal Allowance, while CMS publishes the identical $4,066.50 as the 2026 federal Maximum Monthly Maintenance Needs Allowance. The number is the same either way, and the figure a Texas caseworker applies is the one on the HHSC chart.

The 5-Year Look-Back

Texas enforces a 60-month (5-year) look-back period, and the clock is not counted back from the application alone: it runs 60 months back from the later of the date your loved one was institutionalized or the date of the Medicaid application. If assets were given away or sold below fair market value inside that window, it can trigger a penalty period where Medicaid won't pay for care.

This is where families get tripped up most often. Gifting money to grandchildren, transferring a house to an adult child, or paying off a relative's debt within five years of applying can all create problems. Talk to a Medicaid planning attorney before making large financial moves if nursing home care is on the horizon.

The Admission Process

Before anyone enters a Medicaid-certified nursing facility in Texas, they go through a PASRR (Preadmission Screening and Resident Review) screening. This is a federal requirement, not optional.

PASRR screens every person for mental illness or intellectual/developmental disability, regardless of how they're paying for care. The screening serves three purposes: identifying people with MI or IDD, making sure the nursing home is the right placement (and not a community-based alternative), and ensuring the person gets any specialized services they need.

In practice, the hospital or referring facility usually initiates the PASRR screening. If your loved one is being discharged from a hospital to a nursing home, the discharge planner handles most of this. But if you're arranging admission directly, ask the nursing home about the PASRR process. They deal with it daily.

How to Check Nursing Home Quality in Texas

Texas has about 1,184 Medicare- and Medicaid-certified nursing homes with roughly 134,425 beds. The average quality rating across the state is 2.5 out of 5 stars, which ranks 49th nationally. That means you need to be selective. There are good facilities, but the average isn't great.

Medicare Care Compare

The best starting point is Medicare Care Compare. Enter your ZIP code and it shows every nursing home nearby with ratings across three areas:

  • Health inspections: Based on the last three years of state surveys and complaint investigations
  • Staffing: Hours of nursing care per resident per day, including RN hours
  • Quality measures: Clinical outcomes like falls, pressure ulcers, and use of restraints

A 4 or 5-star overall rating is a good starting point. But don't stop there. Look at the individual category ratings. A facility might have a 4-star overall but a 1-star health inspection score, which means recent surveys found problems.

You can also search for licensed facilities and check inspection history through HHSC's provider search. This shows state-level licensing data that sometimes includes details not on the Medicare site.

What to Look for When You Visit

Online ratings tell you part of the story. Visiting tells you the rest. Here's what to pay attention to:

  • Smell and cleanliness. Walk the hallways. A persistent urine smell is a red flag.
  • Staff interactions. Are staff talking to residents by name? Do they seem rushed or calm?
  • Residents' appearance. Are residents dressed, groomed, and positioned comfortably?
  • Call light response. If a call light goes off while you're there, time how long it takes staff to respond.
  • Activity schedule. Ask to see the monthly calendar. A blank or sparse schedule suggests limited programming.
  • Meals. Visit during a mealtime if possible. Watch whether residents get help eating if they need it.
  • Ask about staffing ratios. How many CNAs per resident on each shift? Night shift staffing is typically thinnest. Texas doesn't mandate specific nursing home staffing ratios, so this varies widely.

Visit at different times of day, including evenings or weekends, when staffing tends to be lighter. The Wednesday afternoon tour with the admissions director is designed to impress you. The Saturday evening walk-through shows you the reality.

Resident Rights and the Ombudsman Program

Every nursing home resident in Texas has legal rights, regardless of how they're paying for care.

Key rights include:

  • Being treated with respect and dignity
  • Privacy in visits, mail, and phone calls
  • The right to make complaints without fear of retaliation
  • Protection from transfer or discharge without cause and proper notice
  • Participation in their own care planning

The Long-Term Care Ombudsman

If something goes wrong, the Texas Long-Term Care Ombudsman program is your first call. Ombudsmen are independent advocates who investigate complaints, mediate disputes, and help protect residents.

One thing to know: ombudsmen only act with the consent of the resident or their legal representative. They won't intervene without permission, even if a family member calls.

Alternatives to Nursing Homes

Not everyone who's considering a nursing home actually needs one. If your loved one primarily needs help with daily activities (not round-the-clock medical supervision), other options may work better and cost less:

The key question is whether your loved one needs 24-hour nursing supervision. If yes, a nursing home is likely the right fit. If they mainly need help with daily tasks and periodic medical oversight, home-based or assisted living options can work.

Frequently Asked Questions

Does Medicaid have a waitlist for nursing home care in Texas?

Not the way the home-based waivers do. The interest lists belong to the waiver programs: Texas is allowed to cap the number of people a 1915(c) HCBS waiver serves and to run an interest list when demand exceeds that capacity, which is not something regular Medicaid does, and nursing facility care is covered under regular Medicaid. This is one reason some families end up in nursing homes even when they'd prefer home-based care.

How much does a nursing home resident get to keep from their income?

$75 a month, the personal needs allowance Texas sets for a nursing facility resident. The rest of their income goes toward the cost of care after the other allowed deductions, which include guardianship fees, a spousal or family maintenance allowance, and incurred medical expenses. Medicaid covers the gap between what the resident pays and the facility's rate. In a different setting the allowance is different: $85 in assisted living or foster care, $2,901 on an HCBS waiver.

Can a nursing home kick out a Medicaid resident?

A facility can't simply discharge a resident for being on Medicaid. Texas law requires proper cause (such as the facility closing, the resident's needs exceeding what the facility can provide, or non-payment of the required share). The facility must give written notice and allow time to appeal. If you believe a discharge is improper, call the LTC Ombudsman at 1-800-252-2412.

What happens to the family home when someone goes on Medicaid for nursing home care?

The primary residence is typically exempt from Medicaid's asset count while the applicant is alive, as long as the applicant intends to return home (or a spouse, dependent child, or certain other family members live there). However, Texas has an estate recovery program that may seek repayment from the estate after the Medicaid recipient passes. Talk to a Medicaid planning attorney about protecting the home.

Next Steps

Choosing a nursing home is one of the harder decisions families face. Start with the numbers (can you afford it, and does Medicaid apply?), then focus on quality (check ratings, visit in person, talk to current families).

Here's where to go from here:

Learn More

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Find personalized help choosing a Texas nursing home at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.