Paying for Assisted Living in Texas: Private Pay, Medicaid, VA and Insurance
The main ways Texas families pay for assisted living, what Medicare does and does not cover, and where to get free help sorting it out.
Assisted living is expensive, and the bill surprises many families because Medicare does not pay for it. Understanding the main payment routes before you tour will help you ask better questions and avoid being locked into a place you cannot afford for long.
Medicare does not cover assisted living
Medicare covers medically necessary care such as hospital stays, doctor visits and, in limited cases, short stays in a skilled nursing facility after a hospital stay. It does not generally cover custodial care, which is help with bathing, dressing, meals and supervision, and it does not pay room and board in assisted living. The federal Medicare long-term care page explains this. Medicare may still pay for doctor visits, therapy or home health services a resident receives while living in assisted living, as it would anywhere else.
Private pay
Most residents pay from savings, retirement income, the sale of a home or help from family. Typically a facility charges a monthly base rate that covers the apartment, meals and basic help, plus extra fees as care needs increase. Before you sign, ask for the admission agreement and the current fee schedule. Ask how often rates have risen in the past few years, how much notice you get before a change and what the refund rule is if your family member leaves.
Texas Medicaid
Texas Medicaid has long-term services programs that can pay for some care in assisted living for people who qualify financially and medically. In general, Medicaid in assisted living pays for care services, not for room and board, and not every assisted living facility has a contract with Medicaid. This site shows a "Medicaid provider number listed" fact when HHSC's directory lists a Medicaid provider number for the facility. That means the number is listed. It does not mean a bed is available or that a particular person will be accepted. Ask the facility whether it accepts Medicaid, whether it requires a period of private pay first and how many Medicaid residents it serves. For eligibility rules and how to apply, start with Texas HHSC Medicaid or call 2-1-1.
Veterans benefits
Veterans and surviving spouses with limited income and assets who need help with daily activities may qualify for the VA's Aid and Attendance benefit, a monthly addition to a VA pension. Eligibility and amounts are set by the VA; see va.gov for current rules. The application takes time, so start early, and use an accredited representative or a county veterans service officer, whose help is free.
Long-term care insurance
If your family member bought a long-term care policy, read it for the elimination period (the days you must pay before benefits start), the daily or monthly benefit and what counts as a qualifying need. Many policies cover assisted living, but they require paperwork from the facility. Ask the administrator whether the facility has helped with claims for your insurer.
Other help
- Your local Area Agency on Aging can explain options and may have programs that help. Find it through the Eldercare Locator.
- A certified elder law attorney can advise on Medicaid planning and the rules about transferring assets.
- Some community and faith-based nonprofits run assisted living with income-based rates.
Costs to watch
Compare the total monthly cost, not the advertised starting price. Ask about move-in or community fees, deposits, medication management, incontinence supplies, transportation and a second-person fee. Ask what level-of-care assessment sets the price and who performs it. A facility that is open about all of these costs in writing is easier to plan around.
We list state license records, not prices, and we do not recommend any facility. Use the listing to confirm the license, then call and ask for the numbers.
General information only, current as of the date above. The information on Texas Assisted Living & Memory Care Index is not medical advice and does not replace a doctor, nurse, discharge planner or other qualified professional. Do not use it to make decisions about diagnosis or treatment. If you have a medical emergency, call 911. Rules and programs change; check the official sources linked in this guide.