August 19, 2026
9:13 pm

Medicaid Spend-Down in Round Rock, Texas (2026)

Round Rock, Texas is in Williamson County, but the office that decides a long-term care Medicaid application is not a county office at all: it is the Texas Health and Human Services Commission, which runs eligibility through its Medicaid for the Elderly and People with Disabilities program. Applications are filed online through YourTexasBenefits.com, by mail, or in person at an HHSC benefits office serving Williamson County; confirm the current office location with HHSC before driving, because sites are consolidated periodically. The Williamson County seat is Georgetown, and county government does not administer Medicaid eligibility.

That structure surprises households that moved here from states where the county welfare office is the front door, and a large share of Round Rock’s older residents did move here. Williamson County is one of the fastest-growing counties in the United States, and much of that growth is adults who arrived for a child’s job, for the tax treatment, or for a retirement community in Georgetown. If you brought a Medicaid plan from another state, several parts of it do not survive the state line.

In This Article

Who Actually Decides, and Who Helps
What the Move to Texas Changed and What It Did Not
Community Property and a Texas Marriage
The Homestead You Think Is Untouchable
The $2,000 Line, the Look-Back, and STAR+PLUS
The Life Policy You Brought to Texas
Round Rock Costs Against the Texas Median
Frequently Asked Questions

Medicaid Spend-Down in Round Rock, Texas (2026)

Who Actually Decides, and Who Helps

Texas Health and Human Services Commission staff determine financial eligibility for nursing facility Medicaid and for the waiver services delivered through STAR+PLUS, which is Texas Medicaid’s managed long-term services and supports program. There is no Williamson County human services department in this chain. Once eligibility is established, an enrollment process assigns a managed care plan, and the plan rather than the state coordinates services.

For care planning, the entry point is the Area Agency on Aging of the Capital Area, a program of the Capital Area Council of Governments in Austin, which serves Williamson County along with the rest of the Austin region. That office handles benefits counseling, caregiver support, and referrals, and it is the right first call when you do not yet know which program you need. Free, unbiased Medicare and Medicaid counseling in Texas comes through HICAP, the Health Information, Counseling and Advocacy Program, which is the state’s federally designated health insurance assistance program and is delivered through the area agencies on aging. Life insurance contracts are regulated by the Texas Department of Insurance.

A practical sequencing note. Families frequently file for nursing facility Medicaid when what they actually want is community services through STAR+PLUS, or the reverse. Call the Area Agency on Aging of the Capital Area first and HHSC second, unless a facility admission is already scheduled.

What the Move to Texas Changed and What It Did Not

Three things did not change. The 60-month look-back on transfers is federal and applies here exactly as it applied where you came from. The requirement to document five years of financial history follows the applicant, not the address, so accounts held in your prior state are still in scope, including accounts closed during the move. And there is no waiting period based on how long you have lived in Texas; residency is proven with a Texas driver’s license or state ID, voter registration, the address used on tax filings, and where care is actually received.

Several things did change. Texas is a community property state, which alters how a married couple’s resources are characterized. Texas has an unusually strong constitutional homestead protection that does not do what most new arrivals assume it does in a Medicaid context. Texas runs its long-term care Medicaid through managed care rather than through a county-administered fee-for-service model. And Texas has no state income tax, which is why many of these households came, but which has no bearing at all on Medicaid eligibility.

The most common relocation error we see in this county is a household that sold a house in California, Illinois, or the Northeast, bought a less expensive home in Round Rock or Georgetown, and is sitting on the difference in a brokerage account. That difference is a fully countable resource. Protected home equity became countable cash the day the sale closed, and no amount of Texas homestead law reaches into a brokerage account. The nursing home Medicaid spend-down guide covers what can and cannot be done with proceeds.

Community Property and a Texas Marriage

Texas characterizes most property acquired during a marriage as community property, owned by the marital community rather than by one spouse. Separate property generally includes what each spouse owned before the marriage and what came to them individually by gift or inheritance.

For Medicaid, this matters because the spousal assessment counts resources rather than titles. The federal spousal impoverishment rules protect a share of the couple’s combined countable resources for the spouse who remains in the community, plus a minimum monthly income allowance, and those rules apply in Texas as elsewhere. But how a particular asset is characterized, whether a spouse’s separate inheritance stays separate, and how retirement accounts are treated in a community property state are genuinely technical questions with Texas-specific answers.

This is a place where relocated couples get bad results from good general advice. A plan built in a common-law property state and carried to Texas can misstate what belongs to whom. Take the characterization question to a Texas elder law attorney before the application rather than after a denial, and do not attempt to retitle assets on your own; retitling can look like a transfer, and transfers inside the look-back window create penalty periods.

Issue	What most states do	What Texas does, as of 2026
Who determines eligibility	County welfare or social services office	Texas HHSC, through Medicaid for the Elderly and People with Disabilities
Long-term care delivery	Fee-for-service or a waiver	STAR+PLUS managed long-term services and supports
Marital property	Common law title rules	Community property characterization
Income above the limit	Varies; some states allow a medically needy path	Income-cap state; a qualified income trust is generally required
Single applicant asset limit	Commonly $2,000	$2,000 (verify with HHSC)
Estate recovery	Varies by state	MERP, for services beginning on or after March 1, 2005, at age 55 or older

The Homestead You Think Is Untouchable

Texas homestead protection is famously strong against ordinary creditors. It is a state constitutional protection and it is real. It is also not a Medicaid shield, and confusing the two costs Texas families more than any other single misunderstanding on this page.

Two separate things are going on. During life, Medicaid generally excludes the primary residence as a countable resource within the federal home equity limit, so long as the applicant intends to return or a spouse remains. That exclusion comes from Medicaid rules, not from the Texas homestead provision, and the federal equity ceiling applies regardless of what state law says. After death, Texas runs the Medicaid Estate Recovery Program, known as MERP, which seeks reimbursement from the probate estates of people who were 55 or older when they began receiving certain long-term care services on or after March 1, 2005. MERP has meaningful exemptions and an undue hardship waiver process, and Texas heirship rules can affect whether a homestead ends up in the probate estate at all.

The result is neither the false comfort of unlimited protection nor the panic that the state automatically takes the house. It is a fact-specific question with a real process attached. Read what Medicaid estate recovery is for the general shape, then take the Texas application to your own elder law attorney. Do not rely on a Texas homestead argument to protect a house from MERP without advice.

The $2,000 Line, the Look-Back, and STAR+PLUS

As of 2026, a single applicant for Texas Medicaid long-term care may hold $2,000 in countable resources. Confirm the current figure with HHSC, since state figures are revised and a stale number is a real risk. Countable resources generally include bank and brokerage accounts, certificates of deposit, most retirement accounts depending on payout status, real property other than the homestead, and the cash surrender value of permanent life insurance above the exclusion threshold. Generally excluded are the homestead within the equity limit, one vehicle, household goods, and an irrevocable funeral trust within the state’s allowance.

Income is tested separately and Texas is an income-cap state for institutional Medicaid, which means applicants over the income limit generally use a qualified income trust, often called a Miller trust, to qualify. That is a mechanical, well-established device and it is not optional where income exceeds the cap; it is also not something to draft from a template. Ask HHSC or an elder law attorney whether your household needs one before the application, because timing matters.

Texas applies the federal 60-month look-back to transfers for less than fair market value, with the resulting penalty beginning when the applicant is otherwise eligible and already receiving institutional care. Our Texas Medicaid asset and income limits page keeps the state figures together.

The Life Policy You Brought to Texas

Permanent life insurance is evaluated under a face-value aggregation rule. The program adds the face amount of every policy on the same insured and compares that total to an exclusion threshold, commonly $1,500 as of 2026. At or below the threshold, cash value is excluded. Above it, the entire cash surrender value of those policies is countable. A $3,000 final expense policy therefore behaves very differently from a $1,200 one, and a $180,000 whole life contract with $27,000 of cash value is a $27,000 problem against a $2,000 limit. Term insurance with no cash value is generally not counted. See how life insurance counts as a Medicaid asset.

Surrender is the default and rarely the best-informed choice. A life settlement, in which a licensed institutional buyer purchases the contract from its owner, can exceed cash surrender value when the insured’s health has meaningfully declined. A reduced paid-up election converts the policy to a smaller fully paid death benefit with no further premiums. An irrevocable funeral trust converts countable cash into an excluded prepaid arrangement within the state’s allowance. Pine Lake Life Solutions does not purchase policies; we provide education and a free policy review so a family understands the contract before deciding. Texas life settlement licensing explains who is regulated to do what here, and the Round Rock life settlements page covers the commercial question.

Selling is the wrong answer when the face amount is too small to draw a competitive bid, when the policy already falls inside the burial exclusion so its cash value is not counted anyway, when the insured is relatively healthy and pricing will be poor, and when a surviving spouse’s own security depends on the death benefit. In a community property state there is a fifth caution: make sure you know who actually owns the policy and who has the right to sell it before anyone signs anything.

Round Rock Costs Against the Texas Median

As of 2026, cost-of-care surveys put a semi-private nursing home room in the Austin metropolitan area, which includes Round Rock, at roughly $8,500 to $10,000 per month, above a Texas statewide median generally reported in the $7,500 to $8,500 range. Assisted living in Round Rock and the surrounding Williamson County communities typically runs $5,000 to $6,000 per month for a one-bedroom with a moderate care package, against a Texas median of roughly $4,500 to $5,200. These are survey ranges, not quotes.

The local fact that drives those premiums is growth. Williamson County has been among the fastest-growing counties in the country for two decades, and it contains one of Texas’s largest age-restricted communities in Georgetown, which means the county’s population aged 65 and over has expanded far faster than its licensed long-term care capacity. The practical effects are tighter availability, firmer pricing, and less negotiating room than the statewide Texas median would suggest, particularly for memory care. A family that budgets from a Texas average will be short. Our Round Rock nursing home cost page runs the months-of-care arithmetic on local numbers.

Nothing on this page is legal, tax, or Medicaid-eligibility advice. Confirm program figures with the Texas Health and Human Services Commission, use HICAP through the Area Agency on Aging of the Capital Area for free counseling, and take community property, qualified income trust, and estate recovery questions to your own elder law attorney.

Frequently Asked Questions

Where does a Round Rock, Texas family apply for long-term care Medicaid?

With the Texas Health and Human Services Commission, through its Medicaid for the Elderly and People with Disabilities program, rather than with Williamson County. Applications can be filed at YourTexasBenefits.com, by mail, or in person at an HHSC benefits office serving Williamson County. Confirm the current office location with HHSC. The Area Agency on Aging of the Capital Area in Austin is the right first call for care planning.

What is the Texas Medicaid asset limit in 2026?

As of 2026 a single applicant for long-term care Medicaid is limited to $2,000 in countable resources. Married couples are protected by the federal spousal impoverishment rules, which preserve a share of combined resources and a minimum monthly income for the spouse remaining at home. Confirm the current figure with HHSC before planning around it, since Texas revises these numbers periodically.

Does the Texas homestead exemption protect our house from Medicaid?

Not in the way most people assume. During life, Medicaid generally excludes a primary residence within the federal home equity limit, which is a Medicaid rule rather than a product of Texas homestead law. After death, the Texas Medicaid Estate Recovery Program can seek reimbursement from probate estates for recipients aged 55 and older who began receiving covered long-term care services on or after March 1, 2005, subject to exemptions and a hardship waiver.

How does Texas community property affect a Medicaid application?

Texas characterizes most property acquired during a marriage as belonging to the marital community rather than to one spouse, and the spousal resource assessment counts resources rather than titles. Whether a particular inheritance, retirement account, or premarital asset is separate or community property is a Texas-specific technical question. A plan built in a common-law property state can misstate ownership, so have a Texas elder law attorney review it.

What is a qualified income trust and do we need one?

Texas is an income-cap state for institutional Medicaid, meaning an applicant whose monthly income exceeds the program limit cannot qualify on income alone. A qualified income trust, often called a Miller trust, is the established mechanism for handling that excess. It is not optional where income exceeds the cap and it is not a document to build from a generic template. Ask HHSC or an elder law attorney before applying, because timing matters.

Does my father’s whole life policy count against the $2,000 limit?

If the combined face amount of all policies on him exceeds the exclusion threshold, commonly $1,500 as of 2026, then the full cash surrender value of those policies counts as a resource. Below the threshold, cash value is excluded. Term insurance with no cash value is generally not counted. Confirm the current threshold with HHSC, and in a community property state confirm who actually owns the policy before considering any sale.

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