Background

Eligibility for Medicaid institutional or home and community-based waiver services in Texas includes a requirement that the person’s countable income not exceed the special income limit. The special income limit for a person is equal to or less than 300 percent of the full individual Supplemental Security Income (SSI) benefit rate. The special income limit for a couple is twice the special income limit for an individual. Effective Jan. 1, 2026, the monthly special income limit is $2,982 for an individual and $5,964 for a couple.

The current estimate of the average daily cost of a private pay nursing home stay in Texas is $262.37. This amount is more than the individual special income limit.

Texas residents who need nursing home care and have monthly income above the special income limit but below the private pay cost of the care may have insufficient funds to pay for the needed care. In 1993, Congress addressed this problem by amending Section 1917 of the Social Security Act which provides for an income diversion trust or QIT. Refer to 42 USC Section 1396p(d)(4)(B). The proper use of a QIT allows a person to legally divert income into a trust, after which the income is not counted to determine Medicaid eligibility for institutional or home and community-based waiver services.