Texas Medicaid protects your at-home spouse's income. The federal minimum floor is $2,555 per month as of 2026. Harris County families applying through the Texas HHSC STAR+PLUS waiver program can often keep more depending on local housing costs. These rules are federal law. They apply directly to assisted living facilities in Houston that participate in the waiver program. The mechanics trip families up constantly. You must know which income counts. You need to take the asset snapshot at the right time. You also must divert income legally to a spouse who needs it. This guide explains exactly how spousal income protection works under Texas Medicaid and what Houston families must do before filing an application.
Yes, your spouse can keep their income. Texas applies federal spousal impoverishment rules. These set a guaranteed minimum monthly income floor for the spouse who stays home. Income belonging to the at-home spouse never counts against the institutionalized spouse's Medicaid eligibility.
Key Takeaways
- The Community Spouse keeps their own income. Texas uses the name-on-the-check rule. Income belongs to whoever receives the check.
- The MMMNA floor is $2,555 per month. If the Community Spouse earns less than that amount, they may receive a diversion of the institutionalized spouse's income.
- The CSRA protects up to $154,140 in assets. This federal cap protects the at-home spouse entirely separate from the Medicaid applicant's strict limit.
- Not all Houston-area facilities accept STAR+PLUS. Confirm Medicaid participation status before relying on coverage in Katy or Sugar Land.
Reviewed by the HALF Publishing Team. Houston Assisted Living Facilities maintains an independent directory of licensed senior care communities across Greater Houston, with facility data sourced from the Texas HHSC, CMS quality ratings, and Google Reviews, updated regularly.
Texas Medicaid Protects Your Spouse's Income
Federal spousal impoverishment law gives your at-home spouse two distinct financial shields. These are the Minimum Monthly Maintenance Needs Allowance (MMMNA) and the Community Spouse Resource Allowance (CSRA). The MMMNA operates as a guaranteed income floor. It is the absolute minimum the Community Spouse is allowed to keep each month without contributing to care costs. The 2026 federal floor sits at $2,555 per month. Texas applies this standard directly. The CSRA covers assets. The at-home spouse keeps up to $154,140 in countable assets. This allowance sits entirely separate from the Medicaid applicant's strict $2,000 resource limit. The Texas Health and Human Services Commission (HHSC) must apply these protections based on federal law.
STAR+PLUS is the specific Texas Medicaid waiver making assisted living coverage possible. It operates across Harris County, Fort Bend County, and Montgomery County. Type A and Type B assisted living facilities licensed by the state can elect to participate. Participation remains entirely voluntary for the facility operators. The coverage geography matters immensely. A family searching for The Woodlands senior care options will find a different range of participating facilities than someone looking near the Texas Medical Center. The table below summarizes the core numbers.
| Protection Type | 2026 Figure | What It Covers |
|---|---|---|
| MMMNA (income floor) | $2,555 per month | Minimum monthly income the Community Spouse keeps |
| CSRA (asset cap) | $154,140 | Maximum countable assets the Community Spouse retains |
| Personal Needs Allowance | $60 per month | Amount kept by the institutionalized spouse after cost-share |
| Medicaid resource limit | $2,000 | Maximum countable assets for the Medicaid applicant |
How Income Is Split Between You and Your Spouse
Texas Medicaid follows a strict name-on-the-check rule. Income belongs to the spouse whose name appears on the payment. If the Community Spouse receives $1,100 per month in Social Security, that money is theirs. It does not factor into the institutionalized spouse's eligibility calculation at all. The institutionalized spouse's own income goes toward their monthly patient liability. This is Medicaid's term for the cost-share. Texas allows them to keep a $60 Personal Needs Allowance for basic expenses.
If the Community Spouse's income falls below the MMMNA floor, the calculation changes. The gap can be filled by diverting a portion of the institutionalized spouse's income to the at-home spouse. This diversion happens before the cost-share calculation takes place. The diversion is perfectly legal and federally protected. It is officially called the Monthly Maintenance Needs Allowance transfer.
| Income Scenario | Monthly Amount |
|---|---|
| Institutionalized spouse Social Security | $1,400 |
| Community Spouse Social Security | $1,100 |
| MMMNA floor (2026) | $2,555 |
| Community Spouse income gap | $1,455 |
| Allowable income diversion to Community Spouse | $1,455 |
| Institutionalized spouse income remaining for cost-share | $0 (after $60 Personal Needs Allowance) |
Many Houston families assume income is automatically split evenly when one spouse enters a facility, but it is not. That misunderstanding causes families to hand over money they were legally entitled to keep. Housing costs in high-cost suburbs push the effective MMMNA higher. This happens through the shelter allowance. If the Community Spouse pays above a federal threshold in rent, mortgage, or utilities, HHSC calculates a higher allowance. This is very common in Sugar Land or Inner Loop neighborhoods. It requires proper documentation. The state does not apply this increase automatically.
"The name-on-the-check rule is the single most misunderstood piece of Texas Medicaid spousal income law, and getting it wrong at application time can cost a Community Spouse hundreds of dollars per month."
HALF Publishing Team
Understanding STAR+PLUS Waitlists in Harris County
The STAR+PLUS waiver program utilizes an interest list. Families do not receive immediate funding upon meeting financial requirements. Texas manages a massive statewide queue for this waiver. Wait times in the Houston region can span several months. Some applicants bypass the list under specific circumstances. If your spouse already resides in a nursing home and wishes to transition to an assisted living facility, they might secure expedited approval. Medical necessity strictly dictates your eligibility. The state uses the Medical Necessity and Level of Care assessment for every applicant.
A registered nurse evaluates the applicant directly. They must require substantial support with activities of daily living to qualify. You need to gather detailed medical records from Houston-area physicians. Have these documents ready before the nurse evaluation occurs. The medical assessment proves just as vital as the financial paperwork.
Property taxes in Harris County and Fort Bend County run notoriously high. This directly impacts the Community Spouse's income protection strategy. The federal government sets a base shelter standard. When local housing expenses exceed this base standard, the state increases the MMMNA limit. Mortgage payments, property insurance, and utility bills all count toward this total. Families in high-tax areas like West University Place often qualify for the maximum allowable income diversion. You have to prove every single expense. Gather every property tax bill and utility receipt. Submit them with your application to the regional HHSC office.
The Houston Medicaid Application Timeline and Common Pitfalls
The Medicaid application process in Greater Houston involves highly specific timelines. Families routinely misjudge the required documentation steps. The first major hurdle involves the asset snapshot date. HHSC evaluates the couple's combined countable assets on the exact day the institutionalized spouse first enters a care facility. It does not use the application filing date. You must request the Community Spouse Resource Assessment early. You want to lock in the correct asset snapshot immediately.
HHSC processing times in Harris County routinely run 45 to 90 days. Starting late creates a massive coverage gap. Your family will have to pay out of pocket during that entire delay. Applications go through the Texas Health and Human Services Commission directly. You can file at local HHSC offices or online at the state portal.
Locating STAR+PLUS facilities in Houston presents another massive challenge. Greater Houston spans thousands of square miles. It includes 32 distinct senior care markets. Participating facilities are not evenly distributed across these zones. A building in Katy might accept the waiver while a competitor two miles away rejects it. You must confirm participation status directly with any facility. Check carefully with Medicaid-accepting facilities in Katy or assisted living in Sugar Land before setting up a tour.
Avoid moving assets without professional legal guidance. Texas Medicaid uses a strict five-year look-back period. Any improper transfers trigger severe penalty periods. Consult a Texas-licensed elder law attorney who handles Medicaid spend-down planning. Local attorneys understand the exact regional HHSC office procedures. The state offers absolutely zero grace period for innocent mistakes.
What to do next:
- Contact HHSC as soon as one spouse enters a care facility. Request the Community Spouse Resource Assessment immediately to lock in the correct asset snapshot date.
- Call any assisted living facility under consideration and ask directly. Do not assume they accept STAR+PLUS Medicaid.
- Consult a Texas-licensed elder law attorney before moving or transferring any assets. Medicaid's five-year look-back applies strictly.
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About This Guide
Houston Assisted Living Facilities is a free, independent directory helping families find licensed assisted living, memory care, nursing, and residential care homes across the Greater Houston metro area. Our data is sourced from the Texas Health and Human Services Commission (HHSC) and updated regularly. We combine verified licensing data with neighborhood-level detail — the kind of local context that national directories cannot provide. Whether you're evaluating options in the Inner Loop or comparing suburbs, Houston Assisted Living Facilities exists to make that search faster and more informed.