Medicaid vs Medicare: Which Pays for Nursing Home Care in Texas?
Understanding the difference between Medicaid and Medicare coverage for nursing home care is crucial for Texas families planning for long-term care. While both are government health programs, they cover very different types of nursing home stays.
Medicare Coverage for Nursing Homes
Medicare Part A covers short-term skilled nursing facility (SNF) care under specific conditions:
- You must have a qualifying 3-day inpatient hospital stay immediately before entering the SNF
- Coverage is limited to up to 100 days per benefit period
- Days 1-20: Full coverage (no copayment)
- Days 21-100: \$200/day copayment (2025)
- After 100 days: You pay all costs
Important: Medicare does NOT cover long-term custodial care. If you need help with activities of daily living (bathing, dressing, eating) but don’t require skilled nursing, Medicare will not pay.
Medicaid Coverage for Nursing Homes
Texas Medicaid covers long-term nursing home care for eligible low-income residents. Key points:
- No time limit — Medicaid covers ongoing care as long as you remain eligible
- Covers room, board, nursing care, therapies, and medications
- You must meet both financial and medical need criteria
- Income limit: Generally \$2,829/month (2025) for an individual
- Asset limit: \$2,000 for an individual (exempt assets include primary home, one vehicle, personal belongings)
Key Differences at a Glance
| Feature | Medicare | Medicaid |
|---|---|---|
| Care Type | Short-term skilled nursing | Long-term custodial care |
| Time Limit | Up to 100 days | No limit |
| Eligibility | Age 65+ or disability | Income & asset limits |
| Hospital Stay Required | Yes (3-day qualifying stay) | No |
| Covers Room & Board | During covered stay only | Yes, ongoing |
Can You Use Both Medicare and Medicaid?
Yes! Many Texas nursing home residents are “dual eligible” — they qualify for both programs. A common scenario:
- After a hospital stay, Medicare pays for the first 100 days of skilled nursing care
- If you still need long-term care after Medicare coverage ends, Medicaid takes over (if you qualify)
- During the Medicare-covered period, Medicaid may cover the copayment for days 21-100
Texas Medicaid Application Tips
Applying for Texas Medicaid long-term care can take 45-90 days. Start early and gather these documents:
- Proof of identity and citizenship (birth certificate, Social Security card)
- Bank statements for the past 60 months (for asset look-back)
- Tax returns and income documentation
- Insurance policies and property deeds
- Pre-admission screening and resident assessment
Contact Texas Health and Human Services at 2-1-1 or apply online at yourtexasbenefits.com.