Nursing Homes in Texas
Health care in Texas is more affordable than the average nationwide cost. The state’s high-ranking hospitals include Houston Methodist Hospital, UT Southwestern Medical Center, St. David’s Medical Center and Methodist Hospital – San Antonio. Around 30 million people live in Texas, with seniors aged 65 and over making up approximately 13.1% of the state’s population. As of July 2022, over 81,000 of the state’s older adults lived in nursing homes. Texas has around 1,200 nursing homes to support its aging population.
Nursing homes provide 24/7 high-level care to seniors with medical needs. They are suitable for older adults who don’t need to be in a hospital but can’t live at home or in a less-intensive care setting. Services may include pain management, medication administration, post-operative care and rehabilitation therapies. Nursing aides typically assist residents with everyday tasks, such as bathing, eating and using the toilet.
This guide gives information about nursing home care in Texas. It looks at state rules and regulations for nursing facilities, discusses ways to pay for nursing home care and lists useful resources.
Popular Cities in Texas
Cost of Texas Nursing Homes
The average cost of nursing homes in Texas is $140 per day. This is higher than the national average which is $228 per day.
Can You Use Medicaid to Pay for Nursing Home Care in Texas?
Texas’ state Medicaid program directly covers nursing home care for eligible seniors via its Long-Term Services and Supports program. Per KFF, around 5.5 million Texans are enrolled in Medicaid, and approximately three in five nursing home residents receive Medicaid.
Individuals who need nursing home level of care but wish to remain in the community may qualify for an LTSS Waiver Program, particularly the STAR+PLUS managed care program. Unlike the state Medicaid program, this waiver isn’t an entitlement program; qualifying individuals may need to wait for services.
Eligibility for Medicaid in Texas
Seniors must satisfy income and resource criteria to qualify for Medicaid for institutional care. Those who qualify are entitled to funding. Single applicants have an annual income limit of $32,904 and an asset cap of $2,000. For couples where both spouses apply for Medicaid, the income limit increases to $65,808, and the asset limit rises to $3,000. Nursing home residents must pay all their income toward their care, except a monthly personal needs allowance of $60 and the cost of Medicare or health insurance premiums.
| Income Limits* | Asset Limits | |
|---|---|---|
| Single Person | $32,904 | $2,000 |
| Two-Person Household | $65,808 | $3,000 |
*Per year
Medicaid also has strict eligibility criteria regarding citizenship, residency and medical need. Applicants must:
- Prove they are a U.S. citizen or qualifying noncitizen
- Demonstrate permanent in-state residency
- Need nursing home level of care
Applying for Medicaid in Texas
Seniors can conveniently apply online for Medicaid at Your Texas Benefits. They can also obtain help and apply over the telephone by contacting their local Aging and Disability Resource Center at (855) 937-2372 or the Department of Health and Human Services at (800) 252-8263.
What Information You Will Need
Applicants will need to supply supporting evidence when applying for Texas Medicaid. Failure to provide information in a timely manner may delay claims being processed. Documents include:
- Photographic proof of identification
- Proof of date of birth
- Proof of citizenship status
- Proof of local residency
- Bank statements
- Proof of all income, including Social Security benefit award letters and private pension plans
- Details about all countable assets, including stocks and shares
- Information about all insurance policies, including health and life insurance
- Property tax assessment or rental agreement
Additional Medicaid Support & Resources in Texas
Navigating the Medicaid system can be daunting, but several organizations can help steer individuals through the process and ensure they check all boxes when it comes to completing forms and providing supporting evidence. The following resources may be useful.
| Contact | Service | |
|---|---|---|
| Aging and Disability Resource Centers | Individuals can find contact details for their local ADRC via Texas HHS’s website | Staff at Aging and Disability Resource Centers provides free assistance with an array of aging and disability related topics, including Medicaid. Advisors can assess eligibility and help individuals submit claims. |
| Area Agencies on Aging | Seniors can use Texas HHS's online search tool to locate their nearest AAA or call (855) 937-2372 | Texas has a statewide network of 28 Area Agencies on Aging through which seniors can access a range of direct services. These include Medicaid assistance. Advisors can help individuals to complete claims and appeal unfavorable decisions. |
| Your Texas Benefits | (877) 541-7905 | Individuals can apply online for Medicaid through Your Texas Benefits portal. They can also check claim statuses, upload documents and report any changes in circumstances. The website has comprehensive information, and seniors can use the Help Center to search for specific topics. |
Can You Use Medicare to Pay for Nursing Home Care in Texas?
Medicare provides limited coverage for short-term stays in a skilled nursing facility following a hospital stay, but seniors must meet a number of specific requirements. This benefit is available to beneficiaries who have been hospitalized for at least three days, excluding the date of discharge, so it's most valuable for those who are recovering from an injury, illness, or surgery.
Once seniors meet the hospitalization requirement, Medicare will pay for up to 100 days of skilled nursing per benefit period. The first 20 days are covered in full. Starting on day 21, beneficiaries must pay a daily coinsurance rate. After day 100, seniors are responsible for the entire cost.
What Does Medicare Cover?
Medicare covers a number of specific services, including:
- Meals
- A semiprivate room
- Medications
- Skilled nursing
- Physical therapy
- Occupational therapy
- Speech therapy
- Audiologist care
- Medical supplies
- Medical social services
- Nutritional counseling
- Ambulance transportation
What Isn't Covered by Medicare?
Medicare does not cover long-term custodial care that addresses seniors' day-to-day needs. This includes help with daily activities, such as bathing, dressing and using medical equipment.
For more information about Medicare and when it covers Nursing Home Care, read our Guide to Nursing Homes.
Medicare Support & Resources in Texas
Older Texans and their loved ones can access Medicare support through several agencies and nonprofit organizations. Assistance includes comparing and understanding coverage options, reporting billing discrepancies and avoiding fraud.
| Contact | Service | |
|---|---|---|
| Texas Department of Insurance | (800) 252-3439 | The Texas Department of Insurance manages the statewide Health Information, Counseling and Advocacy Program, through which seniors can obtain free, unbiased counseling about Medicare and health insurance. Advisors ensure seniors understand their options and signpost to Senior Medicare Patrol volunteers for fraud-related issues. |
| Texas Legal Services Center | Call (800) 622-2520 or access outreach services at a legal clinic | Advisors at Texas Legal Services Center provide HICAP services as well as free legal assistance on a range of topics, including consumer rights and public benefits. The organization aims to help people achieve financial security. |
| Social Security Administration | Call (800) 772-121 or visit the local SSA field office | SSA advisors can help seniors enroll for Medicare coverage, check the status of claims and order replacement Medicare cards. The main website contains comprehensive information about the different parts of Medicare. |
Other Financial Assistance Options for Nursing Home Care in Texas
While Medicaid and Medicare are two of the most common programs used to pay for Nursing Home Care, there are other financial assistance options available, depending on your unique situation.
| How to Apply | How It Works | |
|---|---|---|
| Aid and Attendance | Learn more and | Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for skilled nursing care. |
| Reverse Mortgages | Learn more about your options and how to apply at ftc.gov. | If you own a home, you may be able to use a reverse mortgage to help pay for nursing care. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. This type of funding can be especially useful for married couples when only one partner needs nursing care, as the other residents of the home may continue living there. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan. |
| Long-Term Care (LTC) Insurance | Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov. | Seniors who already have long-term care insurance may be covered for skilled nursing care. Most policies cover at least a portion of the cost of nursing home care, but it depends on the specific policy terms. Note that older adults who are already in need of skilled nursing care will not be eligible to sign up for a LTC insurance policy. |
Nursing Home Laws and Regulations in Texas
| Licensing Requirements | Texas Health and Human Services is responsible for licensing, certifying and monitoring nursing facilities throughout the state. The department ensures compliance with local, state and national laws and regulations. All nursing homes must be licensed. Those that accept Medicare or Medicaid must also be certified. |
| Staffing Requirements | Texas' nursing homes must ensure sufficient 24/7 staffing to maintain adequate care in accordance with residents' care plans. The medical director must be a licensed doctor or, in facilities with fewer than 60 residents, a physician can act as a medical consultant. |
| Staff Training Requirements | All care staff must complete specialized training that includes listed topics, including fire and accident prevention, HIV/AIDS awareness, dementia, infection control, disaster preparation and residents' rights. Caregivers must also complete ongoing training and education. |
| Admission Restrictions | Facilities must be able to provide adequate care to meet residents' needs. If a resident's medical situation changes, a facility can't keep them if they can't provide suitable care. Facilities can only admit new residents with infectious diseases if isolation measures are in place. |
| Care Planning Requirements | New residents must have a nursing evaluation and a doctor's assessment, including medical history, diagnosis, recommendations and prognosis. Within 7 days of evaluations, the facility must compile a personalized care plan that details all services. |
| Dietary and Nutritional Services Requirements | Nursing homes must employ a full-time director of food services, who must either be a registered dietitian or work in consultation with a licensed dietitian. Facilities must keep a one-week supply of long-lasting food. |
| Specialized Rehabilitative Services | Nursing facilities must provide rehabilitative services to those who need them. Such services must be detailed in a resident's care plan. |
| Medication and Pharmaceutical Services | Texas' nursing facilities must employ or use the services of a licensed consultant pharmacist responsible for maintaining up-to-date drug records. Refrigerated drugs must be locked away and only accessed by licensed team members. |
| Activities Requirements | Nursing homes must offer enrichment and engagement activities and facilitate access to external recreational and health care opportunities and services. |
| Infection Control Requirements | Influenza vaccines must be available for all residents. Staff must follow infection control measures as set out in facility policies. |
| Medicaid Coverage | Texas seniors aged 65 or older who need nursing home level of care and don't exceed maximum income and asset limits may qualify for institutional Medicaid to cover all costs of nursing home care. |
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