Texas Medicaid does not take every dollar your parent earns. That assumption is one of the most common — and most damaging — fears Houston families carry into the assisted living conversation, and it leads some families to delay a move that their parent genuinely needs. The reality is more manageable, though the rules are specific to Texas and worth understanding before any paperwork gets signed. In this guide, the Houston Senior Living Guide team explores how Texas Medicaid calculates what a resident owes each month, what protections exist for spouses, and why not every Houston facility accepts Medicaid in the first place.
Key Takeaways
- Texas Medicaid does NOT take all income. Residents keep a Personal Needs Allowance (PNA) of $60/month — one of the lowest in the country, but it is guaranteed.
- The STAR+PLUS income cap is approximately $2,742/month (300% of the SSI Federal Benefit Rate as of 2026; verify at Texas Health and Human Services since this adjusts annually).
- Spouses living at home are protected. The community spouse resource allowance (CSRA) lets the at-home spouse keep up to approximately $148,620 in countable assets under federal Medicaid spousal impoverishment rules.
- STAR+PLUS covers care services, not full room and board. A housing gap often remains — and most families discover this after the move, not before.
- Texas has a Medicaid Estate Recovery Program (MERP) that can reclaim costs from a deceased recipient's estate. Families should ask about this before signing anything.
Reviewed by the HSLG Editorial Team. Houston Senior Living Guide's editorial content is developed using verified data from the Texas Health and Human Services Commission (HHSC), CMS star ratings, Google Reviews, Bureau of Labor Statistics wage data, and Genworth Cost of Care surveys. Our directory indexes 1,500+ licensed facilities across five Houston-area counties.
How Texas STAR+PLUS Calculates What You Owe Each Month
The STAR+PLUS Home and Community Based Services (HCBS) waiver is the Texas Medicaid program that funds personal care and health coordination services for income-eligible seniors living in assisted living facilities (ALFs). It is administered through managed care organizations (MCOs) in Harris County, which means Houston families are working through an MCO enrollment process — not a direct application to the state. To qualify, a senior's gross monthly income must fall at or below approximately $2,742/month (300% of the SSI Federal Benefit Rate as of 2026). Seniors with income above that threshold may still qualify through a Miller Trust, also called a Qualified Income Trust, which shelters excess income for Medicaid purposes. Once approved, the program calculates a monthly cost-of-care contribution: typically most of the resident's income, minus the $60/month PNA they are entitled to keep. That $60 figure is not a typo. Texas sets one of the lowest personal needs allowances in the country, and it is a fair point of criticism — sixty dollars does not cover much in a city with Houston's cost of living.
Here is the part that surprises most families: STAR+PLUS pays for services inside an ALF — personal care, medication management, some health coordination — but it does not cover the full cost of room and board. The housing portion is a separate calculation. In practice, the resident's remaining monthly income (after the PNA) typically flows toward the room-and-board balance, and families often discover there is still a gap that must be covered another way. To understand what that gap looks like in dollar terms, see what assisted living costs in Houston. The common assumption — that Medicaid "covers" assisted living — is incomplete. It covers the services. The roof over your parent's head is a different line item, and getting clear on that distinction early prevents a very painful conversation later.
What You Keep: Spousal Protections and Asset Rules in Texas
The second question Houston families almost always ask is some version of: "Will Medicaid drain my other parent's savings too?" Federal law requires states to protect the community spouse — the husband or wife still living at home — from being left with nothing. In Texas, those protections follow the federal Minimum Monthly Maintenance Needs Allowance (MMMNA) framework. The at-home spouse keeps their own income entirely. If their income falls below the MMMNA floor, they may also receive a portion of the institutionalized spouse's income as a supplement. On the asset side, the Community Spouse Resource Allowance (CSRA) allows the at-home spouse to keep up to approximately $148,620 in countable assets (the 2026 federal figure, subject to annual adjustment). The primary home is exempt while the community spouse lives there. One vehicle is exempt. Personal belongings are exempt. These protections are real, but they require active planning to use correctly.
What Texas does not advertise widely is the Medicaid Estate Recovery Program (MERP). After both the Medicaid recipient and their community spouse have passed, the state may seek reimbursement from the estate for the cost of services paid. This does not mean the state takes the house while anyone is alive — but it does mean that home your parent owns may be subject to a state claim after death. Families who plan their estates without accounting for MERP sometimes leave their adult children with a complicated probate situation. The Texas Health and Human Services website includes MERP information, but it is buried. Most Houston families encounter it after the Medicaid paperwork is signed, not before.
"Most families in Houston learn about Medicaid estate recovery after the paperwork is signed, not before. Asking about MERP upfront is one of the smartest questions a family can bring to an elder law attorney — and one of the simplest ways to protect what's left of a parent's estate."
HSLG Editorial Team
The Houston Reality: Staffing Costs That Shape What Facilities Can Accept
Texas sets Medicaid reimbursement rates for ALFs at the state level, and those rates are typically lower than what a private-pay resident brings in. That gap matters in Houston specifically because of the city's labor market. According to the Bureau of Labor Statistics Occupational Employment and Wage Statistics for the Houston-The Woodlands-Sugar Land metropolitan area, registered nurses in the Houston metro earn a median of $47.02 per hour ($97,802 annually) — 4.5% above the national median. Healthcare social workers, who often coordinate Medicaid applications and care transitions, earn $35.11 per hour ($73,029 annually), running 7.2% above national. Those above-market wages raise the cost of staffing a compliant, well-run ALF in Harris County, which is part of why not every Houston assisted living facility has chosen to enroll as a STAR+PLUS provider. Families should ask directly — and ask early — whether a facility they are considering is enrolled in STAR+PLUS HCBS before visiting, touring, or falling in love with a community that cannot actually accept their parent's coverage.
Nursing assistants tell a different story. Houston CNAs earn a median of $17.76 per hour ($36,941 annually), which runs 6.6% below the national median — one reason smaller, leaner ALFs in Houston-area suburbs can operate on tighter margins while still accepting Medicaid. This wage spread between licensed clinical staff and direct care workers shapes which facilities can absorb Medicaid rates and which ones cannot. Families exploring assisted living in Katy or Inner Loop senior living will find very different Medicaid acceptance patterns depending on facility size and staffing model. You can also verify a facility's enrollment and licensing status through the Texas HHSC licensing portal. For a plain-English breakdown of care levels and what counts as assisted living under Texas rules, see what qualifies as assisted living in Texas. And if you are wondering whether Medicare might fill some of the coverage gap, the answer is mostly no — the details are in our guide on does Medicare cover assisted living.
Start Your Search on Houston Senior Living Guide
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Here is how families use the Guide:
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Why Houston Senior Living Guide
Houston Senior Living Guide is the largest free directory of senior care in the Greater Houston metro, with more than 1,500 licensed facilities indexed across Harris, Fort Bend, Montgomery, Galveston, and Brazoria counties. Our directory data is sourced directly from the Texas Health and Human Services Commission (HHSC) and updated regularly, so families are working from verified information rather than outdated national aggregates. We combine that data infrastructure with genuine neighborhood-level expertise — the kind of local context that national senior care websites simply cannot replicate. Whether a family is navigating the Inner Loop or evaluating options in a fast-growing suburb, Houston Senior Living Guide exists to make that search more informed and less overwhelming.
About This Guide
Houston Senior Living Guide is a free, independent resource helping families navigate senior care options across the Greater Houston metro area. Our directory includes more than 1,500 licensed facilities across Harris, Fort Bend, Montgomery, Galveston, and Brazoria counties, with data sourced directly from the Texas Health and Human Services Commission (HHSC). We exist to make the search for quality senior care less overwhelming and more informed.
Why This Guide Exists — This guide was built by a Houston-area family after navigating assisted living, memory care, and home health firsthand when our mother was diagnosed with a memory care condition. Our content is reviewed by a licensed registered nurse in Texas. We built what we wished existed when we needed it.