Texas Medicaid Spousal Impoverishment 2026: CSRA Guide

Texas Medicaid spousal impoverishment rules protect the at-home spouse when a partner enters nursing home care. In 2026, the community spouse can keep between $32,532 and $162,660 in assets and up to $4,066.50 per month in income.

How Texas Medicaid Spousal Impoverishment Works

When one spouse enters a nursing facility or qualifies for a home- and community-based services (HCBS) waiver, Texas Medicaid applies federal spousal impoverishment protections under 42 USC §1396r-5. These rules have two components: a resource (asset) allowance for the at-home spouse of between $32,532 and $162,660, and an income allowance of up to $4,066.50 per month.2

Texas Medicaid long-term services and supports is administered by the Texas Health and Human Services Commission (HHSC). Before Congress passed the Medicare Catastrophic Coverage Act of 1988, a spouse entering a nursing home on Medicaid could leave the at-home partner with almost nothing, because both spouses' assets were counted together and had to be nearly exhausted first. The spousal impoverishment provisions, now codified at 42 USC §1396r-5, set protected minimums for the at-home spouse and separate the two spouses' finances for Medicaid purposes once the institutionalized spouse enters long-term care.

The at-home spouse is called the community spouse. The spouse entering long-term care is called the institutionalized spouse.

How the CSRA Works

The Community Spouse Resource Allowance (CSRA) is the amount of countable assets the community spouse keeps when the institutionalized spouse applies for Medicaid long-term care coverage.

The Snapshot Date

Before calculating the CSRA, Texas takes a snapshot of the couple's total countable assets. The snapshot date is the first day of a continuous period of institutionalization, typically when the institutionalized spouse enters a nursing facility or hospital for a stay of 30 or more consecutive days.

The CSRA is calculated from that frozen snapshot figure. Countable assets include bank accounts, CDs, stocks, bonds, and most other financial holdings, pooled for both spouses regardless of whose name is on the account.

The Half-of-Assets Formula

Texas uses the standard federal formula: the community spouse keeps half of the couple's total countable assets, subject to the 2026 federal minimum and maximum. Texas does not elect a higher minimum, so a community spouse with modest assets is not automatically brought up to the ceiling. The maximum is a cap, not a floor.1

• Minimum CSRA: $32,5321
• Maximum CSRA: $162,6601

A worked example illustrating the formula:

The figures below are hypothetical and shown only to illustrate how the calculation works. They are not a real case and not a prediction of your own result.

A couple in Houston has $120,000 in joint savings and brokerage accounts at the snapshot date. Half of $120,000 is $60,000, which falls between the $32,532 floor and the $162,660 ceiling, so the community spouse keeps $60,000.1 The institutionalized spouse's $60,000 share must be spent down to the $2,000 applicant resource limit before Medicaid long-term care coverage begins.3

If instead the couple had only $50,000 in countable assets, half is $25,000, which is below the $32,532 floor. The community spouse would keep the floor amount of $32,532, and the institutionalized spouse would spend down the remaining $17,468 to $2,000.1

What Counts as a Countable Asset

Both spouses' assets are pooled for the snapshot. Countable assets generally include:

• Checking and savings accounts
• CDs and money market funds
• Stocks, bonds, and mutual funds
• Both spouses' IRAs and 401(k)s
• Non-home real estate

Exempt assets (not counted):

• Primary residence (equity up to $752,000 while the community spouse lives there)5
• One vehicle
• Household goods and personal effects
• Term life insurance with no cash value
• Prepaid irrevocable burial contracts

How the MMNA Works

The Monthly Maintenance Needs Allowance (MMNA) sets a floor and ceiling on the monthly income the community spouse may keep.

For 2026:

• Floor (minimum MMNA): $2,705.00/month (effective 7/1/2026 through 6/30/2027)2
• Ceiling (maximum MMNA): $4,066.50/month (effective 1/1/2026 through 12/31/2026)2

The Name-on-the-Check Rule

Under 42 USC §1396r-5(b)(2), the community spouse keeps all of her own income regardless of amount. Only the institutionalized spouse's income flows toward the nursing facility cost.

Income Diversion

When the community spouse's own income falls below the MMNA floor, Texas allows an income diversion from the institutionalized spouse's income to bring the community spouse up to the floor.

The institutionalized spouse's income is first reduced by the $75/month personal needs allowance,6 any Medicare premiums, and other allowed deductions. From the remainder, enough is diverted to the community spouse to meet the MMNA. The net remaining amount, called the patient liability, goes to the nursing facility, and Medicaid covers the rest of the bill. The exact deductions applied to your case are set by HHSC, so confirm your own figures with the agency.

The MMNA ceiling of $4,066.50/month is reached through an excess shelter allowance, which raises the community spouse's protected income when housing costs (rent or mortgage, property taxes, insurance, utilities, and a standard maintenance amount) exceed a federal shelter standard that resets periodically. HHSC or an elder-law attorney can calculate the exact excess shelter figure for the community spouse's housing situation.2

A worked example illustrating income diversion:

The figures below are hypothetical and shown only to illustrate how the calculation works. They are not a real case and not a prediction of your own result.

The community spouse receives $1,700/month from Social Security. The MMNA floor is $2,705.00/month, so her shortfall is $1,005.00/month.2 The institutionalized spouse receives $2,400/month. After subtracting the $75 personal needs allowance and any Medicare premium deduction,6 most of the remainder is available for diversion. Of that, $1,005.00 is diverted to the community spouse to meet the floor, and the balance goes toward the facility cost. The community spouse's income rises to the $2,705.00 floor.

The Texas Income Cap and the Miller Trust

Texas is an income-cap state. To qualify for nursing-facility or HCBS-waiver Medicaid, the institutionalized spouse's gross monthly income must be at or below the special income limit of $2,982 for an individual in 2026, which equals 300% of the individual SSI federal benefit rate.4

If the institutionalized spouse's income exceeds $2,982/month, Texas does not offer a medically needy spend-down for institutional care. Instead, the applicant must set up a Qualified Income Trust (QIT), also called a Miller Trust, and deposit the excess income into it each month. Income placed in the trust is not counted against the special income limit, which lets an over-income applicant qualify while the trust funds are still applied to the cost of care.4 Without a properly funded QIT, an over-income applicant cannot qualify even if assets are within limits.

The community spouse's income is not subject to this cap. The name-on-the-check rule means the community spouse's own income never counts against the institutionalized spouse's income limit.

The Home

The primary residence is exempt from Medicaid eligibility calculations as long as the community spouse lives there. Texas applies the 2026 federal minimum home equity limit of $752,000.5 Texas also applies a 60-month look-back on asset transfers before a nursing home application.3

Texas runs one of the most family-protective estate recovery programs in the country and recovers only from the probate estate after both spouses have died. For details, see Texas Medicaid Estate Recovery.

Planning Strategies

Once assets are spent down toward the CSRA, there are legitimate ways to preserve what remains:

• Convert countable assets to exempt ones. Before applying, the couple can prepay funeral expenses through an irrevocable contract, pay off the home mortgage, buy a needed vehicle, or make home repairs.
• Use a Medicaid-compliant annuity. A community spouse can convert countable assets into a Medicaid-compliant Single Premium Immediate Annuity that pays income over the community spouse's actuarial life expectancy. Because it pays income rather than holding a lump sum, the converted amount generally becomes non-countable for the institutionalized spouse.
• Request a fair-hearing increase. Under 42 USC §1396r-5(e), either spouse may request a fair hearing to seek an increased CSRA above $32,532 or MMNA above the $2,705.00 floor if the community spouse cannot otherwise meet their monthly maintenance needs. This is a formal process that benefits from legal representation.2

The Application Process

Texas long-term care Medicaid is administered by HHSC. Protecting the community spouse's share works best when you lock the snapshot early, so the sequence below starts before you file.

For a step-by-step walkthrough of the application itself, see How to Apply for Texas Medicaid.

Where to Get Help With Texas Medicaid Spousal Impoverishment

Learn More

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.