Everything from here is publishable copy. Heading levels marked in the margin. Section order is unchanged from version 1; the voice is not.

Medicare does not pay for long-term nursing home care. Medicaid does. But Medicaid has strict limits on income and assets, and Texas can later make a claim against your estate to get its money back. Planning is how a family qualifies without leaving the healthy spouse with nothing, and how the home gets protected before that claim arrives.

What does a nursing home cost in Texas?

About $5,627 a month for a shared room. Closer to $7,604 for a private one. Those are the Texas median figures from the 2025 CareScout Cost of Care Survey. Houston runs at or above the state median.

Most people stay in a nursing home for more than a year. Many stay for several. Do the arithmetic on your own family's savings and you will see the problem in about ten seconds.

Won't Medicare pay for this?

No. This surprises almost everyone, so it is worth being clear.

Medicare pays for up to 100 days of skilled nursing care, and only after a qualifying hospital stay. You pay part of the cost yourself after day 20. And it stops as soon as you are no longer getting better.

What Medicare does not cover is custodial care. That is help with bathing, dressing, eating, and getting around. It is the care most people in a nursing home actually need, and it is the care that goes on for years.

That last line is the one families never hear until it is too late.

What if this is already happening to your family?

A daughter calls us on a Tuesday. Her mother fell three weeks ago. She has been in the hospital, then in rehab, and the rehab has just told the family that Medicare will stop paying on Friday. The facility wants to know how the family is paying from Saturday.

Her mother owns her home. She has about $90,000 in savings. The daughter has been told by two different people that the family will have to spend every dollar of it before Medicaid will help, and that the state will take the house afterwards.

Neither of those things is quite true. But the clock is real, and what the family does in the next two weeks will decide how much they keep.

Families reach us at three different moments. Find yourself here.

Everyone is still healthy

You have time. That means you have every option. The five-year look-back works for you instead of against you. The home can be protected cleanly. And planning now costs a fraction of what a crisis costs later. Most of what can be done well can only be done here.

There has been a diagnosis, or a decline

A dementia diagnosis. A bad fall. A parent who can no longer manage alone. Care is coming, but it is not here yet. This is a narrow window and a valuable one. The first question we ask is whether the powers of attorney will actually let anyone act.

The discharge date is already set

Like the daughter above. People assume it is too late to do anything. It is not. Crisis planning is ordinary work in this field, and families in this position routinely keep a meaningful share of what they have. There are fewer options than there would have been a year ago. There are still options.

Why is it so hard to qualify?

Because there are two separate gates, and most people only know about one.

The first gate is income. The second is assets. You have to get through both. Families who have heard about the asset limit often walk up confident, and then find out the income gate was there all along — or the other way round.

And there is a guard at the gate who looks back five years to see whether you moved anything just before you arrived. That is the look-back, and we will come to it.

None of these gates are locked. They each have a key. The keys are legal, they are well established, and most of them have to be cut before you walk up — which is the whole reason planning exists.

How does planning ahead actually help?

Four things, in the order families care about them.

• It protects the home. There are deeds and trusts that take the house out of reach of an estate recovery claim. Almost all of them have to be in place before the claim can arise.
• It provides for the healthy spouse. Texas already protects the spouse who stays at home. How much of that protection your family actually gets depends on decisions made before the application, not after.
• It protects what the children inherit. Not just getting it to them, but keeping it theirs — out of a divorce, away from a creditor.
• It provides for the person who needs care. Qualifying is not the goal. Qualifying while keeping enough for comfort, dignity and the things Medicaid does not pay for is the goal.

Can Texas take the house?

Not while you are living in it. The homestead is usually exempt while you are alive and receiving benefits.

After death is different. The Medicaid Estate Recovery Program can file a claim against the estate for what the state spent. The house is usually the biggest thing in the estate.

Two things about this are reported wrongly almost everywhere, and both matter:

• A transfer on death deed does not protect the house. Texas Estates Code §114.106 says that if the estate does not have enough to pay claims against it, property passing by transfer on death deed can be reached anyway — as if it were still part of the estate. That is exactly what an estate recovery claim does. A Lady Bird deed does not have that problem. The two deeds are described online as if they were the same thing. They are not.
• The rules changed on 27 August 2026. The state now has longer to give notice and longer to file. The amounts below which it will not bother to make a claim went up. A great deal of what is published about this, including the state's own guide for families, still shows the old numbers.

There is one more part that catches families off guard. If your parent was in a managed care plan like STAR+PLUS, the claim includes what the state paid that plan every month — not just what was spent on their care. Those can be very different numbers.

What is the five-year look-back?

When you apply, Texas looks at five years of your financial history to see what you gave away.

Anything you gave away in those five years creates a penalty period. During that period Medicaid will not pay. The length is worked out by dividing what you gave away by a daily rate the state sets.

Two things people get wrong. First, ordinary family generosity counts — the help with a grandchild's tuition, the money for a wedding, the house signed over to a son. Nobody was trying to cheat anyone, and it still counts. Second, a penalty is a delay, not a refusal. Delays can sometimes be planned around. What you cannot do is find out the number after you have applied.

What if you are married?

The spouse who stays at home is protected. They keep a share of the couple's savings, and if their own income is low, a share of the other spouse's income too.

How much they keep depends on choices made before the application goes in.

One trap is worth naming. A special trust to protect a surviving spouse has to be created in a will. It cannot be created in a living trust. Couples who moved everything into a living trust — because somebody told them to avoid probate — can lose the ability to protect the survivor. The one document that had to do that job is the one they thought they had replaced.

What papers should every older Texan have?

Five. And one of them almost never says what it needs to say.

• A durable power of attorney for money. This is the one. Texas Estates Code §751.031 requires that Medicaid planning powers be spelled out. A general power of attorney does not give your family the authority to do what Medicaid planning requires. If the paper is silent and you can no longer sign, the only route left is asking a court to appoint a guardian. That takes months. A hospital will not wait months.
• A medical power of attorney, with a HIPAA release so the person you chose can actually be told what is happening.
• A directive to physicians. Sometimes called a living will.
• A declaration of guardian. You name in advance who a court should appoint, if it ever comes to that.
• A will, a trust, or both. Which one depends on what you own and who it is going to.

How we work

Every matter here runs through the 4L Protection Framework — Life, Love, Liberty and Legacy. It is how we find what is missing before we decide what to draft. For long-term care that means we start with your gaps and your timeline. Documents are the last conversation, not the first.

The 4L Protection Framework →

Where should you start?

If you are not sure where your family stands, find out. The audit takes about twelve minutes. It is free and nothing is sold to you at the end. You get a score, your gaps in order of urgency, and a page you can print and take to any attorney you choose.

Phục vụ cộng đồng người Việt tại Houston

Chúng tôi tư vấn, tổ chức hội thảo và cung cấp tài liệu bằng tiếng Việt. Một số vấn đề trong lĩnh vực này không có từ tương đương rõ ràng trong tiếng Việt — việc tiểu bang đòi bồi hoàn, thời gian xét năm năm, sự khác biệt giữa di chúc và trust. Giải thích đúng cần nhiều hơn là dịch.

Consultations, workshops and written materials are available in Vietnamese as well as English.