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Medicaid Expansion vs. Long-Term Care Medicaid in Texas

Texas has not expanded Medicaid under the ACA. That decision has no bearing on long-term-care Medicaid for seniors, a separate, decades-old eligibility pathway.

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Home›State Rules›Medicaid Expansion vs. Long-Term Care Medicaid in Te
Short answer

Texas has not expanded Medicaid under the Affordable Care Act. That fact is unrelated to long-term-care Medicaid for seniors, which uses a completely separate non-MAGI aged/blind/disabled eligibility pathway that predates the ACA by decades.

Two different populations, two different rules

ACA expansion, where states adopt it, covers working-age adults under 65 evaluated using MAGI (modified adjusted gross income) rules. Long-term-care Medicaid for seniors uses non-MAGI aged/blind/ disabled eligibility rules that exist in every state regardless of an expansion decision.

Texas's 2026 nursing facility Medicaid limits

Special income limit: $2,901/month (income above this generally requires a Miller Trust). Asset limit: $2,000 for a single applicant. Personal needs allowance: $75/month. These figures adjust annually -- confirm current numbers with HHSC or an elder law attorney before relying on them.

Questions families ask

When does in-home care make more financial sense than assisted living in the Fort Worth area?

Using Texas's CareScout median home health aide rate of roughly $28/hour, in-home care tends to cost less than assisted living's $5,250 statewide median up to roughly 40 hours a week of care -- beyond that, a licensed community frequently becomes the less expensive option.

What's the real difference between a nursing home and assisted living in Texas?

Nursing homes are licensed under a separate Texas rule chapter from assisted living and provide 24-hour licensed nursing care for higher medical acuity. Nursing homes also carry federal CMS star ratings through Medicare's Care Compare tool; assisted living facilities are not rated by that system at all.

Should a Fort Worth family consider a CCRC instead of standalone assisted living?

A Continuing Care Retirement Community (CCRC) keeps a couple together across changing care levels on one campus, typically through an entry-fee structure. Standalone assisted living is usually simpler to enter and less expensive upfront, without a large entry fee.

What does HHSC license, and what law covers assisted living in Texas?

The Texas Health and Human Services Commission (HHSC) Long Term Care Regulatory division licenses assisted living facilities under Texas Health and Safety Code Chapter 247 and 26 Texas Administrative Code Part 1, Chapter 553. HHSC issues either a Type A or Type B license depending on residents' ability to evacuate in an emergency.

Is memory care a separate license in Texas, or something else?

Texas does not issue a separate 'memory care license.' Any facility that markets or holds itself out as providing dementia care must instead file an Alzheimer's/dementia Disclosure Statement with HHSC under 26 TAC Section 553.264, and make it available to families before admission.

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