Houston Estate Planning and Elder Law Attorney Blog
Texas Medicaid planning is the process of legally structuring your income and assets so you can qualify for long-term care coverage without spending down everything you have saved. Nursing home care in Texas can cost thousands of dollars a month, and Medicaid is the primary program that helps families pay for it. With advance planning, many families are able to preserve significant assets while still meeting Medicaid’s strict financial limits.
McCulloch & Miller, PLLC helps families across Houston, Harris County, and the greater Houston metro area with Texas Medicaid crisis planning. Founding partner Thomas McCulloch is a member of the National Academy of Elder Law Attorneys, and his commitment to elder law grew from his own experience caring for his aging mother — perspective that shapes how the firm approaches these deeply personal decisions.
What Are the Medicaid Asset Limits in Texas?
To qualify for long-term care Medicaid in Texas, a single applicant generally must have no more than $2,000 in countable assets (as of 2026). Not everything counts, though: a primary home within the equity limit, one vehicle, personal belongings, and certain other resources are typically exempt. Because these figures are adjusted periodically, families should confirm the current limits with Texas Health and Human Services before relying on them.
When one spouse needs care and the other does not, federal “spousal impoverishment” rules protect the spouse who remains at home. Through the Community Spouse Resource Allowance, that spouse can keep roughly half of the couple’s countable assets, between about $32,532 and $162,660 in 2026, so they are not left without resources. Understanding which assets count and which are exempt is the foundation of any Medicaid plan.
What Is the Medicaid Look-Back Period in Texas?
Texas Medicaid uses a 60-month look-back period, meaning the state reviews the five years of financial transactions before an application to identify assets that were given away or sold below value. Gifts or transfers made during that window can trigger a penalty period during which the applicant is ineligible for Medicaid, even if they otherwise qualify.
The look-back rule is the single biggest reason planning ahead matters. Strategies that are perfectly legal when done early can backfire if attempted during the look-back window or after a crisis has already begun. This is also why well-intentioned do-it-yourself gifting — such as simply transferring a home to the children — so often causes more harm than good.
How Can a Trust Help With Medicaid Planning?
Certain irrevocable trusts can hold assets so that, after the look-back period passes, those assets are no longer counted toward the Medicaid limit while still being preserved for the family. Because the person who creates the trust gives up control of the assets, this is a significant decision that has to be weighed carefully against other goals.
A separate tool, a Qualified Income Trust — sometimes called a Miller trust — addresses a different problem: applicants whose monthly income exceeds the program limit can use one to still qualify. McCulloch & Miller, PLLC guides families through the trust options that fit their circumstances, including which type, if any, makes sense given the family’s timeline and goals.
What Is the Difference Between Medicaid Crisis Planning and Advance Planning?
Advance planning takes place years before care is needed, when the full range of strategies — including trusts that depend on the look-back period — remains available. Crisis planning happens when a loved one needs care now or in the near future, often after an unexpected health event, when time is short and fewer options remain.
Both are legitimate, and a great deal can still be done even in a crisis. Texas law permits a number of last-minute strategies, such as certain spend-downs on exempt items and the use of Medicaid-compliant annuities, that an experienced Texas elder law attorney can apply even after a family has run out of time to plan ahead. The key is acting quickly and with guidance, because mistakes made under pressure are hard to undo.
Who Should Consider Medicaid Planning?
Medicaid planning is worth considering for anyone who may eventually need long-term care and wants to preserve assets for a spouse or children, particularly families with a home and modest savings that would otherwise be consumed by care costs. It is especially important for married couples, where the goal is to provide for the spouse who remains at home, and for families supporting a loved one with a disability.
Because Medicaid rules intersect with tax, estate, and family considerations, planning is most effective when it is part of a broader strategy rather than a single isolated step. The firm’s holistic approach — combining legal, tax, and long-term care planning — is designed to address all of these at once.
Talk to a Houston Elder Law Attorney
If you or a family member may need long-term care, the attorneys at McCulloch & Miller, PLLC can explain your options and help you protect what you have worked to build. The firm has advocated for aging Texans and their families for over 35 years and brings a rare combination of legal, tax, and elder care experience to every plan. Call (713) 333-8900 or request a consultation online to discuss your situation. Flat fees available.