A semi-private room in a Texas nursing home costs about $5,080 per month in 2026, which is roughly half what you'd pay in most other states. If your loved one qualifies for Medicaid, it covers the full cost of nursing home care with no waitlist. 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
- Key Takeaways
- Nursing Home Costs in Texas
- How Medicaid Pays for Nursing Home Care
- The Admission Process
- How to Check Facility Quality
- What to Look for When You Visit
- Resident Rights and the Ombudsman Program
- Alternatives to Nursing Homes
- Frequently Asked Questions
- Next Steps
Key Takeaways
- Semi-private rooms average about $5,080/month statewide ($167/day). Private rooms run around $6,250/month ($206/day).
- Texas Medicaid covers nursing home care in full with no waitlist, unlike HCBS waivers. Income limit is $2,982/month and asset limit is $2,000.
- Texas has about 1,184 certified nursing homes with an average quality rating of 2.5 out of 5 stars, ranking 49th nationally.
- Check any facility's rating at Medicare Care Compare before visiting.
- The Long-Term Care Ombudsman (1-800-252-2412) advocates for residents and investigates complaints.
Nursing Home Costs in Texas
Texas is one of the more affordable states for nursing home care, running roughly half the national average.
| City / Area | Semi-Private (per day) | Private (per day) | Semi-Private (per month) |
|---|---|---|---|
| Statewide average | $167 | $206 | ~$5,080 |
| Houston | $200 | $264 | ~$6,080 |
| Dallas | $195 | $276 | ~$5,930 |
| Austin | $219 | $294 | ~$6,660 |
| National average | $327 | $365 | ~$9,950 |
The statewide average for a semi-private room comes to about $60,955 per year, compared to the national average of $119,340. That gap matters. For families paying out of pocket, Texas gives you more runway before savings run out.
Austin is the priciest major metro for nursing home care, running about 30% above the state average. Houston and Dallas fall in between. Smaller cities and rural areas tend to be closer to (or below) the statewide average, though availability can be limited.
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 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 home Medicaid is an entitlement in Texas. That means if you qualify, you get in. There's no waitlist, unlike HCBS waiver programs where tens of thousands of Texans are waiting for a spot. This 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:
| 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 | N/A | N/A | Up to $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. All of the resident's income, except a $75/month personal needs allowance, goes toward the cost of care. Medicaid picks up the difference between what the resident contributes and the facility's rate.
For married couples where only one spouse enters a facility, the at-home spouse gets protections to avoid going broke:
- Community Spouse Resource Allowance (CSRA): The at-home spouse can keep up to $162,660 in assets.
- Monthly Maintenance Needs Allowance (MMNA): Up to $4,066.50/month can be diverted from the nursing home spouse's income to support the at-home spouse.
The 5-Year Look-Back
Texas enforces a 5-year look-back period. When you apply, Medicaid reviews the past five years of financial transactions. If assets were given away or sold below fair market value during 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.
Not sure if your parent qualifies for Medicaid nursing home coverage? Ask Brevy's chatbot about eligibility for a quick assessment.
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.
HHSC Provider Search
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.
Looking for nursing homes in your area? Chat with Brevy to get help comparing facilities and understanding your options.
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.
- LTC Ombudsman: 1-800-252-2412
- HHSC Complaints Hotline: 1-800-458-9858
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:
- Home care through STAR+PLUS: Medicaid can cover personal attendant services at home, including through the Consumer Directed Services option where a family member gets paid to provide care
- Assisted living: Average cost of $4,570/month in Texas, and Medicaid HCBS covers care services (but not room and board)
- PACE programs: Available in El Paso, Amarillo, and Lubbock, PACE wraps medical care, home care, and adult day services into one program
- Home health care: Medicare covers skilled nursing and therapy at home at $0 cost if your loved one is homebound
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
No. Unlike HCBS waiver programs (which have waitlists of 100,000+ people), nursing home Medicaid is an entitlement. If you meet the financial and medical requirements, you qualify. This is one reason some families end up in nursing homes even when they'd prefer home-based care: the nursing home coverage is immediately available while waiver services are not.
Only $75 per month, called the Personal Needs Allowance. Everything else (Social Security, pension, any other income) goes toward the cost of care. Medicaid covers the gap between what the resident pays and the facility's rate.
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.
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:
- Check facility ratings at Medicare Care Compare and HHSC Provider Search
- Learn about Medicaid eligibility: Our guide to Texas Medicaid programs covers the full picture
- Explore STAR+PLUS waivers: The STAR+PLUS waiver program guide explains home-based alternatives
- Consider home care first: Read our home care vs home health guide to see if your loved one can stay home
- Understand assisted living: Our assisted living guide compares costs and Medicaid coverage
- Find skilled nursing care near you 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. Medicaid rules vary by state and change frequently. Always verify eligibility and benefits with your state Medicaid agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.