How to Apply for Medicaid Long-Term Care in Texas: HHSC Application Process

Your parent needs ongoing nursing home care, Medicare is not going to cover it, and you need to start the Medicaid application. The Texas Health and Human Services Commission (HHSC) administers Medicaid in Texas, and the long-term care application is a separate process from standard Medicaid — with stricter financial requirements, more documentation, and a longer timeline.

Here is what to expect and how to get through it.

Where to Apply

Long-term care Medicaid applications in Texas are submitted to the local HHSC office or through a caseworker at the nursing facility. You can also apply by:

• Calling 2-1-1 (Texas Health and Human Services helpline) to request an application packet
• Visiting your local HHSC office in person
• Applying online through YourTexasBenefits.com (limited for long-term care — the online system handles regular Medicaid but may redirect you to an in-person or phone interview for nursing home applications)

The application date matters. Medicaid coverage, if approved, is retroactive to the first day of the month in which the application was filed. Filing on January 28th means coverage can start January 1st — but only if your parent was already in the facility and met all eligibility criteria on that date.

Eligibility Requirements

Financial criteria:

• Income: Gross monthly income must be at or below $2,982 (2026 limit). Texas is an income-cap state — there is no income spend-down. If your parent's income exceeds the cap, they must establish a Qualified Income Trust (Miller Trust) before the application can be approved.
• Assets: Countable assets must be at or below $2,000 (single) or $3,000 (married couple, both applying). The primary home (up to $752,000 equity), one vehicle, household goods, and prepaid burial plans are exempt.
• Spousal protections: If one spouse applies while the other remains in the community, the community spouse can retain up to $162,660 in assets (CSRA) and receive a monthly income allowance (MMNA) of up to $4,066.50.

Medical criteria:

• The applicant must require a nursing facility level of care, typically defined as needing assistance with at least two activities of daily living (bathing, dressing, eating, transferring, toileting, continence)
• A physician must certify the medical necessity of nursing facility placement
• HHSC conducts a functional assessment to confirm the level of care required

Documents You Will Need

Start gathering these immediately — missing documentation is the most common cause of application delays and denials:

• Identification: Social Security card, photo ID, birth certificate
• Income verification: Social Security award letters, pension statements, annuity documentation, bank statements showing direct deposits
• Asset documentation: Bank statements (all accounts, last 60 months), investment account statements, life insurance policies, vehicle titles, property deeds
• Medical documentation: Physician certification of need for nursing facility care, hospital discharge summary, current medications list
• Insurance cards: Medicare card, Medicare Supplement (Medigap), Medicare Advantage, any other health insurance
• Miller Trust documentation: If income exceeds $2,982, the executed trust document and QIT bank account statements
• Five-year financial history: HHSC reviews all financial transactions from the past 60 months to identify any transfers of assets for less than fair market value

The Application Timeline

Expect 45 to 90 days from the date of filing to a determination. During this period:

• HHSC may request additional documentation — respond within the stated deadline or the application will be denied
• A caseworker may schedule a phone or in-person interview
• The nursing facility bills accumulate at the private-pay rate during the pending period
• If approved, Medicaid reimburses the facility retroactively to the coverage start date

Common Reasons for Denial

• Income over the cap without a Miller Trust. The trust must be established and funded before HHSC will approve the application.
• Missing bank statements. HHSC requires statements from every financial account for the past five years. A single missing month can hold up the entire application.
• Unreported asset transfers. Any gift, donation, or below-market-value transfer in the look-back period triggers a penalty. Disclose everything proactively.
• Incomplete application forms. Every field must be completed. Leave nothing blank — write "N/A" for sections that do not apply.

If the Application Is Denied

You have the right to request a fair hearing within 90 days of the denial notice. HHSC must provide a hearing before an administrative law judge, where you can present additional evidence and testimony. Many denials based on missing documentation can be reversed at this stage by providing the requested records.

The Hospital-to-Home Texas toolkit includes a Medicaid application document checklist, a Miller Trust setup guide, and a timeline tracker — built for families managing this process during an active care crisis.

See more Texas guides →