Texas caregiver benefits guide
Last checked: May 18, 2026
If Texas Medicaid paid for long-term care, the state may ask for money back from the person’s estate after that person dies. This is called Medicaid Estate Recovery, or MERP.
This guide explains when a home may be at risk, which family protections may apply, what papers to gather, and who to call first in Texas.
Quick answer
Texas can seek repayment from the estate of some people who received Medicaid long-term services after age 55. The state cannot ask for more than Medicaid paid for covered services, and it does not seek recovery until after the Medicaid recipient dies.
The house may be at risk if it is part of the person’s probate estate and no protection, exemption, cost limit, deduction, or hardship waiver applies. Do not assume the state can take the house right away. Also do not assume the house is safe without checking the Texas MERP notice and probate rules.
Start here
- Find out what kind of Medicaid was used. Look for nursing facility care, STAR+PLUS long-term services and supports, Community First Choice, waiver services, or other long-term care.
- Check whether a protection may apply. Ask if there is a surviving spouse, a child under 21, a blind or disabled child of any age, or an adult child who lived in the home under Texas rules.
- Call before selling or transferring the house. If you have a MERP letter, call the Texas estate recovery contractor listed on the notice. If you do not have a letter yet, call your local Area Agency on Aging and ask where to get elder law or probate help.
Main Texas programs and where to start
| Program or route | Who it helps | Where to start |
|---|---|---|
| Texas Medicaid Estate Recovery Program (MERP) | Families handling the estate of someone who received Medicaid long-term services | Use the notice from MERP. For a case question, call the Texas MERP contractor number on the notice. Texas HHS lists HMS/Gainwell as the contractor and gives 800-641-9356 for specific cases. |
| STAR+PLUS | Adults age 65 or older and adults with disabilities who get Medicaid managed care and may need long-term services | Ask the STAR+PLUS health plan for the service coordinator and service plan. Ask if the services are long-term services and supports. |
| Community First Choice (CFC) | Medicaid members who live in the community and meet CFC rules, often needing help with daily tasks | Ask Texas HHS, the managed care plan, or the service coordinator whether CFC is part of the person’s Medicaid services. |
| Consumer Directed Services (CDS) | People who want more control over some Medicaid attendant services, including hiring and managing workers when the program allows it | Ask the service coordinator or case manager whether the person can choose CDS and what financial management services agency is used. |
| Area Agency on Aging (AAA) | People age 60 and older, family members, and caregivers who need local service help | Call 800-252-9240 and ask for the AAA that serves your county. Ask about benefits counseling, legal help, and caregiver support. |
| Probate or elder law help | Families who received a MERP notice, need to sell a house, or need to request a waiver | Ask the AAA for legal aid options. If the estate has property, get advice before signing, selling, paying, or transferring anything. |
What Medicaid estate recovery means
Medicaid estate recovery means the state asks for repayment after a Medicaid recipient dies. The claim is against the estate. The estate is the property left behind by the person who died.
Texas HHS says MERP applies to Medicaid long-term services and supports. These can include care in a nursing facility, certain home and community-based services, and related costs.
In plain English: Medicaid may pay for care now. Later, after the person dies, Texas may file a claim against the estate to recover some of those care costs.
This does not mean a living Medicaid recipient has to pay back benefits from monthly income. It also does not mean a family member must pay the state from personal money just because they are a child, spouse, or caregiver.
Rules can change
Texas rules, forms, contractors, and program names can change. Counties, managed care plans, waiver contractors, and agencies may use different names. Confirm details with Texas HHS, the MERP notice, the managed care plan, or a qualified Texas legal professional.
When estate recovery may apply in Texas
Texas MERP may apply when the person:
- was age 55 or older when covered Medicaid long-term care services were received;
- received covered long-term services and supports after Texas started MERP on March 1, 2005; and
- died leaving an estate that can be reached under Texas rules.
Covered services can include nursing facility services, ICF/IID services, home and community-based waiver services, Community Attendant Services, and related hospital or prescription drug costs. If the person was in STAR+PLUS, ask the health plan or service coordinator which long-term services were paid by Medicaid.
Texas HHS says the state will not ask for more than Medicaid paid for the person’s services. A MERP claim should list the claim amount and the dates or dates of covered Medicaid services.
If you get a notice, read the date on it. Texas hardship waiver requests are time sensitive.
Is the house at risk?
Maybe. The home is often the asset families worry about most. In Texas, the official MERP FAQ says an estate for estate recovery means real and personal property that is subject to probate. Real property can include a home and other land.
Probate is the court process used to handle property after a person dies. Some property passes through probate. Some property may pass outside probate. Deeds, beneficiary forms, wills, affidavits, and family facts can change the answer.
Do not guess. A deed that looks simple can still create legal or Medicaid problems. Talk with a Texas probate or elder law professional before selling, giving away, or moving title to a home.
How the house may become part of the issue
- The Medicaid recipient dies owning a home in their name.
- The home is part of the probate estate.
- Texas MERP sends a Notice of Intent to File a Claim.
- No listed exemption applies.
- No hardship waiver is granted.
- The estate has enough value for recovery to be cost-effective.
Even then, the state’s claim is part of the estate process. Other probate claims may have priority. The right step is to answer the notice, check for exemptions, and ask about waiver or deductions if they apply.
Common protections and exemptions
Texas rules list several situations where Medicaid estate recovery claims are not sought, plus other limits that may reduce or stop recovery. Families should confirm each item with the MERP notice, Texas HHS, or legal help.
| Possible protection | What it may mean in Texas | What to gather |
|---|---|---|
| Surviving spouse | Texas rules say recovery claims are sought only after death and if there is no surviving spouse. | Marriage record, death certificate, spouse’s address, and proof the spouse is living. |
| Child under 21 | Texas rules protect when there is a surviving child under age 21. | Birth certificate, adoption papers if any, proof of age, and contact information. |
| Blind or disabled child of any age | Texas rules protect a surviving child of any age who is blind or disabled under the Social Security law definition. | Social Security disability or SSI records, medical proof if requested, birth or adoption proof. |
| Adult child living in the homestead | Texas rules list an unmarried adult child who lived continuously in the decedent’s homestead for at least one year before death. | Driver license, mail, tax records, utility records, voter record, lease or other proof of residence. |
| Low estate value or low recovery amount | Texas rules say no claim is filed when recovery is not cost-effective. Current rule text lists a recoverable estate value of $10,000 or less, recoverable Medicaid costs of $3,000 or less, or sale costs that equal or exceed property value. | Tax appraisal, bank records, debt records, MERP claim amount, estimated sale costs. |
| Home maintenance and care cost deductions | Texas rules may allow deductions for necessary and reasonable home maintenance, taxes, and direct care costs that helped keep the person at home and delayed institutional care. | Receipts for taxes, utilities, insurance, repairs, lawn care, and direct care payments. |
| American Indian or Alaska Native property | Texas rules list certain protected American Indian and Alaska Native income, resources, and property. | Tribal, land, trust, income, or property records if this may apply. |
| Sibling or caregiver child | Texas MERP rules reviewed for this guide do not show a broad sibling exemption or broad caregiver-child exemption like families may hear about online. A sibling or direct descendant may matter for a homestead hardship waiver if the rule requirements are met. A caregiving adult child may also matter if the adult-child homestead rule or other Texas legal rules apply. | Do not rely on a general online rule. Get Texas-specific legal help and gather proof of residence, caregiving, income, and ownership. |
Hardship waivers
A hardship waiver asks Texas not to recover all or part of the MERP claim because recovery would cause hardship to an heir or person named in a will.
Texas rules say the hardship waiver request must be made within 60 days of the date on the MERP Notice of Intent to File a Claim. The form is Texas HHS Form 5006, Hardship Waiver Application.
Examples in Texas rules include:
- the estate property is the site of a family business, farm, or ranch that is the main income source for heirs or people named in a will;
- heirs or people named in a will would become eligible for public or medical help if recovery is made;
- allowing heirs to receive the estate would let them stop getting public or medical help;
- the Medicaid recipient received medical help because of a crime committed against the recipient; or
- other compelling reasons.
Texas also has a homestead hardship rule. It may protect all or part of a home when a sibling or direct descendant inherits the homestead, the tax appraisal value and income rules are met, and MERP agrees that the rule is satisfied.
HHSC has the authority to grant the waiver case by case. Texas rules say MERP makes a hardship waiver decision within 40 days after it receives the waiver request and all required supporting documents.
Do not miss the 60-day waiver window
If you received a Notice of Intent, count from the date on the notice. If you need more papers, call right away and ask what to send. Do not wait for probate to be finished.
Documents to gather
Put these in one folder before you call or ask for legal help:
- the MERP Notice of Intent to File a Claim;
- the death certificate;
- Medicaid approval letters and long-term care notices;
- STAR+PLUS service plans, waiver papers, or nursing facility bills if you have them;
- the will, trust papers, deed, transfer-on-death deed, or affidavit of heirship if any;
- probate court papers if a case has been opened;
- property tax appraisal and mortgage balance;
- bank statements and estate asset list;
- proof of surviving spouse, child under 21, or blind or disabled child if any;
- proof that an adult child lived in the home for at least one year before death if that may apply;
- receipts for property taxes, utilities, insurance, repairs, maintenance, and direct care payments;
- income proof for heirs if asking for a hardship waiver; and
- notes from every phone call, including date, name, phone number, and what was said.
For a simple printable planning aid, see caregiver checklists. For call preparation, see phone scripts for caregivers.
What families should not do
- Do not ignore a MERP notice. The hardship waiver deadline can be short.
- Do not sell the house without advice. Sale money may still belong to the estate and may affect claims.
- Do not pay from your own bank account unless a lawyer tells you to. A MERP claim is against the estate, not your personal money.
- Do not assume a home is safe because it was exempt during life. Medicaid eligibility home rules and estate recovery rules are not the same thing.
- Do not give away the home to avoid recovery without legal advice. Transfers can cause Medicaid problems, probate problems, tax problems, or family disputes.
- Do not rely on a rule from another state. Texas rules are not the same as California, New York, or Florida rules.
- Do not assume a family caregiver payment program changes MERP. Payment for caregiving and estate recovery are separate issues.
If you are still planning care and want to understand Medicaid home care routes, read Medicaid HCBS waivers explained. If the family is trying to meet Medicaid financial rules, read Medicaid spend-down and the Medicaid look-back period.
Who to contact in Texas
If you received a MERP letter
Call the number on the letter first. Texas HHS lists HMS/Gainwell as the contractor for Texas MERP and gives 800-641-9356 for specific case questions.
Ask for: Texas Medicaid Estate Recovery Program claim status, exemption review, hardship waiver, and the deadline on your notice.
If you need local help before a letter comes
Call the Texas Area Agency on Aging line at 800-252-9240. Ask for the AAA that serves your county.
Ask for: legal assistance, benefits counseling, caregiver support, and referrals for probate or elder law help.
If the person is still alive and getting care
Ask the STAR+PLUS health plan, Medicaid caseworker, or service coordinator which services are long-term services and supports. Ask for copies of the service plan and notices.
If the person wants home care options, ask about STAR+PLUS, Community First Choice, and Consumer Directed Services.
Phone script for a MERP notice
“Hello. I am calling about a Texas Medicaid Estate Recovery notice for [name], date of death [date]. I need to know whether a claim has been or will be filed, what services are included, and what deadline applies. I also need to know how to report a surviving spouse, minor child, disabled child, adult child living in the home, or hardship waiver request. Please tell me what documents to send and where to send them.”
Phone script for the Area Agency on Aging
“Hello. I help care for a Texas resident who received Medicaid long-term care. I need local help with Medicaid estate recovery, probate questions, or legal aid. Can you connect me with the Area Agency on Aging legal assistance or benefits counseling program for my county?”
What to do if the first answer is no
- Ask for the answer in writing or ask where the rule appears on the notice.
- Ask whether the issue is an exemption, a hardship waiver, a deduction, or claim amount review.
- Ask for Form 5006 if hardship may apply.
- Ask how to request review if a hardship waiver is denied.
- Call the Area Agency on Aging and ask for legal aid or elder law referrals.
- Before selling property, ask a Texas probate attorney how the MERP claim affects the estate.
FAQ
Can Texas Medicaid take the house while my parent is alive?
Estate recovery is a claim after death. A home can still affect Medicaid eligibility, transfer rules, and planning while the person is alive. Get advice before changing the deed or selling the home.
Does Texas recover from every Medicaid recipient?
No. MERP is tied to covered Medicaid long-term care services for certain recipients. Texas also has exemptions, hardship waivers, deductions, and cost-effectiveness limits.
Does refusing to sign the MERP acknowledgement stop recovery?
No. Texas HHS says the acknowledgement form explains MERP. Refusing to sign does not make the estate exempt.
Can a family member be forced to pay Texas MERP from personal money?
The claim is against the estate. Family members should not pay from personal funds just because they received a letter. Ask for legal help if anyone says you personally owe the money.
What if there is a surviving spouse?
Texas rules list a surviving spouse as a protection. Report the surviving spouse to MERP and send proof if asked.
What if an adult child lived in the home and gave care?
Texas has a listed rule for an unmarried adult child who lived continuously in the homestead for at least one year before death. This is not the same as every caregiver-child rule you may see online. Gather proof of residence and get Texas-specific help.
What if the family farm or family business is at risk?
A hardship waiver may apply if the property is a family business, farm, or ranch that meets Texas rule details. Do not sell or transfer it before asking about a hardship waiver and legal help.
How fast do we need to act?
For a hardship waiver, Texas rules say the request must be made within 60 days of the date on the Notice of Intent to File a Claim. Read the notice and act fast.
Resumen en español
En Texas, Medicaid puede pedir pago de algunos costos de cuidado a largo plazo después de que la persona muere. Esto se llama Medicaid Estate Recovery, o MERP. La reclamación es contra el patrimonio, no contra el dinero personal de la familia.
Si recibe una carta de MERP, no la ignore. Pregunte por exenciones, una solicitud de dificultad económica, y la fecha límite. Llame al número en la carta o a la Agencia del Área sobre Envejecimiento al 800-252-9240 para pedir ayuda local.
About this guide
This guide was written for family caregivers in Texas who need a plain answer about Medicaid estate recovery and the family home. It focuses on official Texas routes, deadlines, documents, and first calls.
Rules can change. Confirm your facts with Texas HHS, the MERP notice, the managed care plan, the Area Agency on Aging, or a qualified Texas professional.
Disclaimer
This is general information, not legal, tax, medical, or financial advice. For legal or tax questions, talk with a qualified professional in your state.
Official sources used
- Texas Health and Human Services: Your Guide to the Medicaid Estate Recovery Program
- Texas Health and Human Services: Medicaid Estate Recovery Program FAQs
- Texas Health and Human Services: Form 5006, Hardship Waiver Application
- Texas Health and Human Services: Medicaid for the Elderly and People with Disabilities Handbook, D-7800 Medicaid Estate Recovery Program
- Texas Secretary of State: Texas Administrative Code portal
- Texas Health and Human Services: Texas Administrative Code information for HHS rules
- Medicaid.gov: Estate Recovery
- Texas Health and Human Services: STAR+PLUS
- Texas Health and Human Services: Community First Choice
- Texas Health and Human Services: Consumer Directed Services
- Texas Health and Human Services: Care for People 60+
- Texas Health and Human Services: Area Agencies on Aging directory
