August 19, 2026
9:13 pm

Medicaid Spend-Down in Plano, Texas (2026)

In Texas, more long-term care Medicaid applications fail on income than on assets — and a Plano, Texas family that does not know this loses months. Texas is a hard income-cap state. As of 2026 an applicant whose gross monthly income exceeds roughly $2,982 is over the limit, and Texas offers no medically needy spend-down pathway for long-term care to catch them. The fix is a Qualified Income Trust, often called a Miller Trust, and it has to be drafted, executed and funded correctly, in the right month, before eligibility can begin. A pension plus Social Security totaling $3,400 a month will stop a Plano application cold without one.

Plano sits in Collin County, with small western portions extending into Denton County. Eligibility is decided by the Texas Health and Human Services Commission, which operates benefits offices across Collin County and accepts applications through the state’s YourTexasBenefits system. The City of Plano does not determine eligibility. The program is Texas Medicaid STAR+PLUS, which covers both the nursing facility benefit and the STAR+PLUS Home and Community Based Services waiver — two doors, one managed care structure, very different asset and income consequences.

This page runs the at-home track against the facility track with Dallas–Fort Worth cost figures rather than Texas averages, and explains how a life insurance policy is counted.

In This Article

The income cap, the Miller Trust, and why timing matters
STAR+PLUS at home versus STAR+PLUS in a nursing facility
Community property: what Texas does with a married couple’s assets
Plano’s costs, and the unusually wide shared-versus-private spread
The Plano aging-in-place wave, and where the application goes
How Texas counts a life insurance policy
When selling is the wrong answer, and what MERP can reach
Frequently Asked Questions

Medicaid Spend-Down in Plano, Texas (2026)

The income cap, the Miller Trust, and why timing matters

Texas sets its long-term care income standard at 300% of the federal benefit rate — about $2,982 a month for 2026. Gross income above that figure, counted before Medicare premiums or anything else comes out, disqualifies an applicant outright unless a Qualified Income Trust is in place.

A QIT is not complicated in concept: income above the cap is deposited into a dedicated trust account each month, and the trust distributes it according to rules the state sets. It is unforgiving in execution. The trust must exist and be funded in the month for which eligibility is sought. Fund it late, fund the wrong dollars, or open the account at the wrong bank and the month is lost. HHSC will not backdate around a defective trust.

Two Plano-specific notes. First, a household with a corporate pension — and north Dallas has a great many retirees from telecommunications and technology employers — is far more likely to be over the cap than the Texas average household. Second, Texas caseloads mean the QIT question often surfaces weeks after the application, when it should have been settled before it. Ask the elder law attorney about the QIT in the first meeting, not the third.

The asset limit, by comparison, is the familiar one: $2,000 in countable resources for a single applicant as of 2026. Confirm the current figure with Texas HHSC.

STAR+PLUS at home versus STAR+PLUS in a nursing facility

Texas delivers long-term services through STAR+PLUS managed care plans, and the same program label covers two very different arrangements.

The at-home track is the STAR+PLUS Home and Community Based Services program. It funds personal attendant services, adult day, respite, home modifications, emergency response, and in some cases assisted living. It requires a medical necessity and level-of-care determination showing the applicant would otherwise need nursing facility care. Interest-list waits for the HCBS program have historically been long in Texas, and the length varies over time — ask your STAR+PLUS plan and HHSC what the current situation is rather than relying on what a neighbor experienced three years ago. Getting a name onto an interest list early costs nothing and is the single cheapest thing a Plano family can do.

The facility track is the nursing facility benefit, also administered through STAR+PLUS. Once a resident is on it, nearly all monthly income becomes applied income paid to the nursing home, less a small personal needs allowance and any spousal allowance. Texas applies a home equity ceiling of about $752,000 for 2026 to unmarried institutionalized applicants. In most of Texas that ceiling is academic. In Plano and the surrounding Collin County suburbs, a long-held home in an established neighborhood can approach it, and it is worth an actual valuation rather than an assumption.

Both tracks carry the 60-month look-back. Every uncompensated transfer in the five years before the application is reviewed, and a penalty period means Medicaid pays nothing while the facility keeps billing.

Community property: what Texas does with a married couple’s assets

Texas is a community property state, and that is a genuinely different starting point from the separate-property states most national Medicaid guidance is written for. Property acquired during the marriage is generally presumed to belong to the marital community rather than to one spouse, regardless of whose name is on the account.

For Medicaid purposes, the federal spousal impoverishment rules still govern: at the point one spouse is institutionalized, countable resources are assessed, and the community spouse is entitled to a community spouse resource allowance — running from roughly $32,532 to $162,660 for 2026. What community property changes is the underlying characterization and, in some cases, the planning options available to the well spouse afterward, including how a spousal refusal or a post-eligibility transfer between spouses is treated.

The practical takeaway for a Plano couple: do not read a New Jersey or Ohio article about protecting the well spouse and assume it maps onto Texas. It frequently does not. The resource assessment is worth requesting from HHSC as a discrete step, and a Collin County elder law attorney should characterize the assets before anything is retitled.

2026 item	STAR+PLUS at home (HCBS)	STAR+PLUS nursing facility
Single-applicant asset limit	$2,000 — confirm with Texas HHSC	$2,000 — confirm with Texas HHSC
Income cap	About $2,982 per month; Qualified Income Trust required above it	About $2,982 per month; Qualified Income Trust required above it
What happens to monthly income	Retained, subject to program rules	Nearly all becomes applied income paid to the facility
Access	Interest list; timing varies — get on it early	Available on medical necessity, no interest list
Typical 2026 Plano-area cost	Waiver services; family still carries housing	About $6,000–$7,500 shared, $8,000–$10,000 private
Texas statewide median, 2026	Assisted living around $4,715 per month	$6,413 shared / $7,917 private per month
Home equity ceiling	Not applied while it is the residence	About $752,000 for an unmarried recipient

Community property: what Texas does with a married couple's assets

Plano’s costs, and the unusually wide shared-versus-private spread

Texas is among the least expensive states in the country for skilled nursing. The 2026 statewide medians run about $6,413 a month for a shared room and $7,917 for a private room. But the Dallas–Fort Worth market has an odd shape that matters for Plano families: metro figures for 2026 run roughly $5,931 shared and $8,380 private — that is, the shared room prices below the Texas median while the private room prices above it.

The spread between a shared and a private room in DFW is therefore around $2,400 a month, roughly $29,000 a year. Almost nowhere else in the country is the gap that wide relative to the base cost. For a family with a fixed pot of money, choosing a shared room in the DFW market buys substantially more months than the same decision does in most states. That is a real, specific planning lever and it belongs in the conversation before anyone signs an admission agreement.

Plano itself, as one of the more affluent north Dallas suburbs, prices at the top of the metro range. A realistic 2026 planning band for Plano-area skilled nursing is $6,000–$7,500 shared and $8,000–$10,000 private. Confirm the per-diem with each facility; these are survey ranges.

Assisted living: Texas’s statewide median is around $4,715 a month as of 2026 in state-level surveys, with national aggregators reporting higher figures for higher-acuity communities. Plano and the surrounding Collin County market runs above the state figure, in the neighborhood of $5,000–$6,500 monthly. Our companion page on nursing home costs in Plano works the runway math.

The Plano aging-in-place wave, and where the application goes

Plano’s demographic story explains its current squeeze. The city grew from a town of roughly 17,000 in 1970 to more than 128,000 by 1990 as corporate relocations pulled families into north Dallas. Those original buyers did not leave. They are now in their late seventies and eighties, in the same houses, and Plano’s 65-and-older population has been growing considerably faster than its total population. A city built for young families in the 1980s is now generating a substantial demand for post-acute and long-term care, and Collin County’s licensed bed supply has not expanded at the same rate.

What that means operationally: expect competition for well-rated beds, expect facilities to prefer private-pay admissions, and expect that a Medicaid-pending applicant is a less attractive admission than a private-pay one. Starting the application early is not administrative tidiness — it is what gets a parent into a good facility.

Where things go:

Texas Health and Human Services Commission — eligibility offices in Collin County, plus the statewide YourTexasBenefits application system. HHSC decides eligibility.
Area Agency on Aging of North Central Texas, operated by the North Central Texas Council of Governments, serves Collin County with benefits counseling, care coordination and the long-term care ombudsman program, at no charge.
Texas HICAP — the Health Information, Counseling and Advocacy Program, the state’s federally funded SHIP, delivered through area agencies on aging. Free, and selling nothing.
Texas Department of Insurance — the regulator for life insurance and life settlement licensing in Texas, and where you verify anyone who approaches your family about a policy.

How Texas counts a life insurance policy

The rule is the face-value aggregation rule. Every policy on one person’s life is totaled by face value. If the combined face value exceeds the burial-fund threshold — generally $1,500, though you should confirm the current Texas figure with HHSC — then the cash surrender value of those policies becomes a countable resource. Below the threshold, cash value is excluded entirely.

That threshold is low enough to catch essentially any permanent policy. A $150,000 universal life policy with $45,000 of accumulated cash value puts a single Plano applicant more than twenty times over the $2,000 asset limit on that asset alone. Term insurance has no surrender value to count, but its face amount still enters the aggregation calculation, which surprises people. How life insurance counts as a Medicaid asset covers the mechanics.

When the cash value counts, families surrender by reflex. Price these three first:

Reduced paid-up. On a whole life policy this converts to a smaller, fully paid death benefit with no further premiums, often collapsing the countable cash value while keeping coverage.
An irrevocable funeral trust. Correctly drafted and irrevocable, it is generally an excluded resource, lawfully converting countable dollars into excluded ones. Texas has its own requirements — use an attorney.
A life settlement. Selling to a licensed institutional buyer commonly exceeds surrender value where the insured’s health has declined. Texas licenses providers and brokers; see Texas life settlement licensing.

When selling is the wrong answer, and what MERP can reach

Pine Lake Life Solutions provides education and a free policy review. We do not purchase policies, and the honest answer is often no. A settlement is the wrong tool when:

The face amount is small. A $10,000 final expense policy will not draw a competitive institutional offer, and if aggregate face value is already under the burial threshold, a sale turns an excluded asset into countable cash.
The policy is already inside the burial exclusion or irrevocably assigned to a funeral home.
The insured is in good health. Settlement pricing is driven by life expectancy underwriting.
A surviving spouse needs the death benefit. In a community property state where the well spouse can retain up to about $162,660 in 2026, converting a death benefit into countable cash can undercut the whole spousal plan.
A term conversion right is still open. Converting first can change value substantially. Find the deadline in the contract.

Estate recovery in Texas works differently from many states, and it is worth understanding before making irreversible moves. The Texas Medicaid Estate Recovery Program pursues claims against the probate estates of recipients who received long-term care services at 55 or older. Texas applies the federal exceptions — a surviving spouse, a child under 21, a blind or disabled child — plus an undue hardship process and cost-effectiveness limits that mean small estates are frequently not pursued.

Because Texas recovery is tied to probate, Texas-recognized deed mechanisms that move a homestead outside probate are a well-established part of Texas elder law planning. They are also easy to get wrong, they interact with the look-back, and they can affect property tax exemptions. This is a Collin County elder law attorney’s work, not a form from the internet.

Nothing on this page is legal, tax or Medicaid eligibility advice. Take it to your own attorney, to Texas HHSC, or to Texas HICAP. Every figure here is stamped as of 2026 and should be confirmed with the agency that administers it.

Frequently Asked Questions

What county is Plano in for Medicaid purposes?

Plano sits primarily in Collin County, with small western portions extending into Denton County. Eligibility is decided by the Texas Health and Human Services Commission, which operates benefits offices in Collin County and accepts applications through the YourTexasBenefits system. The City of Plano plays no role in eligibility. The Area Agency on Aging of North Central Texas serves Collin County residents.

What is a Miller Trust and does my parent need one?

A Qualified Income Trust, commonly called a Miller Trust, is required when gross monthly income exceeds the Texas long-term care income cap, roughly $2,982 for 2026. Texas offers no medically needy spend-down alternative for long-term care. The trust must exist and be funded in the month eligibility is sought, so raise it at the first attorney meeting.

Why is a private room in Dallas so much more than a shared one?

The Dallas-Fort Worth market has an unusually wide spread. For 2026 the metro runs roughly $5,931 monthly for a shared room and $8,380 for a private room, meaning shared prices below the Texas median while private prices above it. That roughly $2,400 monthly difference, about $29,000 a year, is a genuine planning lever for a family with fixed assets.

Does Texas being a community property state change Medicaid planning?

It changes the starting characterization of a married couple’s assets, which can affect planning options for the well spouse. The federal spousal impoverishment rules still apply, with a community spouse resource allowance running from about $32,532 to $162,660 for 2026. National guidance written for separate-property states often does not map onto Texas. Have a Collin County attorney characterize the assets first.

Will Texas take the house after my parent dies?

The Texas Medicaid Estate Recovery Program pursues claims against probate estates of recipients who received long-term care at age 55 or older. Federal exceptions apply for a surviving spouse and certain children, and Texas has hardship and cost-effectiveness limits that mean smaller estates often are not pursued. Because recovery is tied to probate, planning options exist. See an elder law attorney.

Is selling a life insurance policy a good way to spend down?

Sometimes, and often not. It can help where there is a sizeable permanent policy, the insured’s health has declined, premiums are becoming unaffordable, and the alternative is surrender or lapse. It is the wrong move for small final expense policies, policies already assigned to a funeral home, healthy insureds, or where a surviving spouse needs the benefit.

Find out what your policy is worth — free, confidential, no obligation.

A 15-minute educational review covers your eligibility, every alternative, and a realistic view of what each path would net you.

Call (305) 209-7183 · Request a review online →

Table of Contents