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 is a benefit every state's Medicaid plan must include rather than a waiver service, 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 resident's income left after a short list of allowed deductions goes toward the cost of care as a co-payment, and Medicaid covers the care beyond that (see How the Money Works below).

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. Nursing facility services are a mandatory benefit that every state's Medicaid plan must include. 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 and other requirements: The applicant must meet medical necessity criteria, meaning a determination that they need a nursing facility level of care. They must also be 65 or older or meet Social Security's definition of disability, be a Texas resident and a U.S. citizen or an alien with approved status, and live in a Medicaid-contracted long-term care facility for at least 30 consecutive days.

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: a couple protects half its countable resources unless half falls below $32,532 or above $162,660, so 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. It is not paid on top of what the at-home spouse already has: HHSC adds the at-home spouse's own countable income into the budget before it subtracts the allowance, so that income offsets it. 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 inside that 60-month window 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 the services they need for MI or IDD.

It runs in two stages: everyone gets a preliminary Level I screen, and only someone who screens positive goes on to an in-depth Level II evaluation. If your loved one is moving from a hospital to a nursing home, ask the discharge planner how the screening will be handled. If you're arranging admission directly, ask the nursing home about its PASRR process.

How to Check Nursing Home Quality in Texas

In Texas, HHSC licenses and certifies nursing homes, inspects each one once a year, and investigates complaints. Every Medicare- or Medicaid-certified home also carries a CMS star rating. CMS itself cautions that no rating can capture everything that matters, such as dementia care or how easy the home is for family to visit, so use the stars alongside a visit and local sources such as the ombudsman program.

Medicare Care Compare

The best starting point is Medicare Care Compare. It gives each certified nursing home an overall rating of 1 to 5 stars, plus separate ratings in three areas:

A 4 or 5-star overall rating is a good starting point. But don't stop there. Look at the individual category ratings. CMS builds the overall rating by starting from the health-inspection rating and then adding or subtracting a star for staffing and for quality measures, so a home can reach 4 stars overall with only a 2-star health inspection score, which means recent inspections found problems.

You can also find and compare Texas nursing homes, freestanding and hospital-based, through HHSC's Long-Term Care Provider Search. HHSC is the agency that licenses and inspects Texas homes, so it's the state-side check on what the Medicare site shows.

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, including nights? No federal minimum for nurse-staffing hours per resident is in effect: CMS repealed its 2024 minimum-staffing rule effective February 2, 2026, leaving the older floor of sufficient nursing staff, licensed nurses around the clock, and a registered nurse at least 8 consecutive hours a day (those last two can be waived).

Visit at different times of day, including evenings or weekends. Care Compare grades weekend staffing on its own, so a home can post acceptable weekday hours and still be marked down for thin weekend coverage. 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: federal and state laws guarantee rights specific to nursing facility residents, and the facility must protect and promote them.

Key rights include:

The Long-Term Care Ombudsman

If something goes wrong, the Texas Long-Term Care Ombudsman program is your first call. Its services are free, confidential and available statewide, and ombudsmen advocate for residents' rights, including when a resident faces an involuntary transfer or discharge. They don't license or certify homes, though; HHSC does, and a formal complaint goes to HHSC instead.

One thing to know: ombudsmen take action only 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:

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. Federal rules allow a transfer or discharge only for specific reasons: the resident's needs can't be met there, their health has improved enough that they no longer need the care, the safety or health of others in the facility is endangered, the stay goes unpaid after reasonable notice, or the facility closes. For a resident who becomes eligible for Medicaid after admission, the facility may charge only what Medicaid allows. The facility must give written notice, generally at least 30 days ahead, stating the reasons and how to appeal, and must send a copy to the ombudsman; while an appeal is pending, the facility normally can't carry out the discharge. Ombudsmen can help a resident facing an involuntary discharge. 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?

A Texas homestead your loved one plans to return to doesn't count toward the $2,000 asset limit, though Texas caps home equity at $752,000. However, Texas's Medicaid Estate Recovery Program (MERP) can file a claim against the estate of a recipient who was 55 or older when they received long-term care services. It files only after the recipient's death, and only if there is no surviving spouse, no child under 21, no blind or disabled child, and no unmarried adult child who lived in the home for at least 12 consecutive months right before the death. 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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