§ 2.7 Medicaid & Elder Law

Key Figures and Where to Check Them

Almost every number in long-term care Medicaid changes annually, and several change on different schedules. This page deliberately does not reprint them. It explains what each figure is, how it is set, and where the official current value is published — which is more useful than a table that is wrong by March.

The reason for the caution is practical. Reference pages quoting stale figures are one of the more damaging things on the internet in this field, because a family that plans against last year's resource limit or last year's income cap plans wrongly, and discovers it at the worst moment.

The income cap

What it is: the gross monthly income ceiling above which an applicant is ineligible for long-term care Medicaid in Texas.

How it is set: historically three times the federal SSI benefit rate, which is adjusted each January with the Social Security cost-of-living adjustment. Because it moves with SSI, it rises every year the COLA is positive.

Why it matters: it is an absolute cliff, not a taper. Income above the cap must be routed through a qualified income trust, which is why nearly every Texas applicant with a pension needs one.

Where to check: Texas Health and Human Services, and the Social Security Administration's SSI rate page for the underlying federal benefit rate.

The countable resource limit

What it is: the maximum in countable assets an individual applicant may hold. It has been a low fixed figure for many years and does not track inflation.

What is excluded: the homestead subject to the equity limit below, one vehicle, household goods and personal effects, irrevocable prepaid burial arrangements, limited burial funds, and certain small-face-value life insurance. The full treatment is on the eligibility page.

The home equity limit

What it is: a federal ceiling on the equity an applicant may hold in their home and still have it treated as exempt.

How it is set: a federal minimum and maximum, indexed annually, with states electing a figure within the range.

The exception that matters: the limit does not apply where the applicant's spouse, a minor child, or a child who is blind or disabled lawfully resides in the home. For couples this frequently removes the issue entirely.

The community spouse resource allowance

What it is: the portion of a couple's combined countable resources protected for the spouse who remains at home.

How it is set: a share of the couple's combined countable resources at the point of institutionalisation, subject to a federal floor and ceiling that are indexed each January.

Why timing matters: the calculation is made as at the date of institutionalisation. Spending resources before the assessment reduces the protected amount, so requesting the resource assessment early is one of the highest-value steps available — see the crisis planning page.

The minimum monthly maintenance needs allowance

What it is: the income floor for the community spouse. Where their own income falls below it, part of the institutionalised spouse's income is diverted to them rather than paid to the facility.

How it is set: a federal floor tied to the poverty guidelines and adjusted in July, with a separate maximum adjusted in January, plus a possible excess shelter allowance. It is one of the more intricate calculations in the programme and one of the most commonly under-claimed.

The personal needs allowance

What it is: the small monthly amount a nursing facility resident retains from their own income for personal expenses, everything else going to the cost of care.

Where to check: Texas Health and Human Services publishes the current figure; it is set by the state and has been adjusted only occasionally.

The penalty divisor

What it is: the average monthly cost of nursing facility care in Texas, used to convert an uncompensated transfer into a period of ineligibility. Divide the value transferred by the divisor and the result is the number of months of penalty.

Why it matters: the divisor is generally lower than what a private-pay resident actually spends, which means the penalty period tends to be longer than the transferred money would have funded. This is not an accident of drafting.

The look-back period

What it is: sixty months preceding the application, during which transfers for less than fair market value are examined.

What it is not: a limit on gifts. There is no permitted annual amount. The federal gift tax exclusion has no application here, a point laboured on the common mistakes page because it costs families more than any other single misunderstanding.

Official sources

• Texas Health and Human Services — long-term care: programme descriptions, application routes and the state-set figures.
• Medicaid.gov — eligibility: the federal framework and the spousal impoverishment standards.
• Social Security Administration — SSI benefit rates: the base figure the income cap tracks.
• Cornell LII — 42 U.S.C. § 1396p: transfers, trusts, liens and estate recovery, in the statutory text.

When an official figure and a secondary source disagree, the official figure is right. That includes this page.