Texas Medicaid Look-Back
Period Calculator

When you apply for long-term care Medicaid in Texas, the state will review all asset transfers made in the 60 months (5 years) immediately preceding your application date. This is the "look-back period" — a federal rule codified in the Deficit Reduction Act of 2005 (DRA) that applies uniformly in all 50 states and DC.

Any transfer of assets for less than fair market value made during this window is presumed to have been made to qualify for Medicaid, triggering a "penalty period" of ineligibility.

The look-back period in Texas is 60 months. This means transfers going back to approximately June 2021 are subject to scrutiny on an application submitted today.

The Texas Medicaid agency will request five years of financial records — bank statements, investment accounts, retirement accounts, real estate transactions, and any gifts — as part of the application process.

The look-back period does NOT prohibit asset transfers — it only penalizes transfers made for less than fair market value within the 60-month window, by creating a period during which Medicaid will not pay for nursing home care. Strategic planning completed more than 60 months before applying sidesteps the look-back entirely.

Key reference: 1 Tex. Admin.

Code § 358.417.

Texas Medicaid look-back reviews are conducted by the Texas Health and Human Services Commission (HHSC), Office of Eligibility Services. Texas's penalty divisor ($190/day) — one of the lowest in the country — reflects Texas's below-average nursing home costs in most markets.

Texas does not recognize 'spousal refusal.' Texas does not have a DAPT statute. Texas's STAR+PLUS managed care program delivers nursing facility and HCBS Medicaid through MCOs across the state.

Texas does not expand Medicaid under the ACA. Texas's 'half-a-loaf' strategy is widely used by Texas elder law practitioners due to the state's low penalty divisor — the math is favorable compared to higher-divisor states.

Texas's SB 1342 (2019) narrowed MERP to probate assets for deaths after September 1, 2019, making Texas's estate recovery more limited than pre-2019 law.

The penalty period is calculated by dividing the total amount of disqualifying transfers by the "penalty divisor" — the average daily cost of private-pay nursing home care in Texas. The Texas penalty divisor is approximately $190 per day (based on an average monthly private-pay rate of $5,700/month).

The formula is: Penalty Period (days) = Total Disqualifying Transfers ÷ $190/day.

Example calculation for Texas: If an applicant transferred $50,000 in gifts within the look-back period, the penalty period would be $50,000 ÷ $190/day = approximately 263 days (about 8.8 months) during which Medicaid will not pay for nursing home care. A $150,000 transfer would result in a penalty of approximately 789 days (about 26.3 months).

In Texas, the penalty period begins when the applicant is "otherwise eligible" — meaning they have met all other Medicaid eligibility requirements (income and assets) AND have entered a nursing facility. This means the penalty clock does not start until the applicant is otherwise qualified and in a nursing home, which creates the dangerous scenario of being in a facility, out of money, and still serving a penalty period with no Medicaid coverage.

Not all asset transfers trigger a penalty period in Texas. Federal law mandates several categories of exempt transfers: (1) transfers to the applicant's spouse or to a trust for the sole benefit of the spouse, (2) transfers to a blind or disabled child of any age, (3) transfers to a trust established for the sole benefit of a disabled individual under 65, and (4) transfers for fair market value — selling an asset at its actual market price is not a disqualifying transfer.

Additionally exempt in Texas: Transfer of home to sibling with equity interest; caretaker child. The caretaker child exemption is particularly important — if an adult child lived in the applicant's home and provided care that allowed the applicant to remain at home rather than enter a nursing facility for at least 2 years immediately before admission, the home can be transferred to that child without penalty.

Transfers made before the look-back period are also exempt — a gift made more than 60 months before the application date cannot trigger a penalty, regardless of amount. This is the foundation of proactive Medicaid planning.

Additionally, purchases for fair market value (paying off a mortgage, buying a prepaid funeral, making home improvements) are not transfers and do not trigger penalties — you receive an equivalent asset in return.

Texas allows applicants to apply for an undue hardship waiver to avoid a transfer penalty in cases where enforcing the penalty would deprive the individual of medical care that would endanger their health or life, or would deprive them of food, clothing, shelter, or other necessities of life. An undue hardship waiver is not automatic — it requires a written application to the Texas Medicaid agency and must demonstrate that the individual has exhausted all other means of paying for care.

Common undue hardship scenarios in Texas: the transferee (recipient of the gift) has already spent the funds and cannot return them; the applicant was the victim of financial exploitation or fraud; the applicant was incompetent at the time of the transfer; or the penalty period would leave the applicant without any source of payment for nursing home care and the facility would discharge them.

Undue hardship waivers must be applied for promptly — typically within 30 days of notification of the penalty period. An elder law attorney can help document and present the hardship claim effectively.

Even with a waiver application pending, the nursing home may require private-pay payment during the review period, creating serious financial stress.

If you discover a look-back problem after a Medicaid application is filed in Texas, there are several potential strategies. The most straightforward is "curing" the transfer — having the transferee return the gifted assets.

In Texas, returning all or part of a disqualifying transfer can eliminate or reduce the corresponding penalty period, though the returned funds must go directly back to the applicant (not spent on anything else) to be effective.

The "half-a-loaf" strategy involves making a partial return of transferred funds while preserving the other half, structuring the retained portion as a Medicaid-compliant loan or annuity to convert it into an income stream that pays the nursing home during the shortened penalty period. This strategy is complex, state-specific, and must be executed carefully to avoid creating additional problems.

Medicaid-compliant annuities can also address look-back issues in Texas by converting a lump sum of countable assets into a non-countable income stream — the annuity must be irrevocable, non-assignable, actuarially sound, and name the state as primary remainder beneficiary. These instruments are powerful but technical — only an experienced elder law attorney should structure them.

The most common mistake is making gifts to children or grandchildren — even small, regular gifts — within the 60-month look-back window without realizing they count as disqualifying transfers. Annual gifts under the IRS gift tax exclusion ($18,000 in 2024) are completely legal from a tax perspective but are not exempt from Medicaid's transfer rules.

A pattern of annual gifts totaling $100,000+ over five years can result in a significant penalty period.

• Other common triggers: adding a joint account owner (treated as a 50% gift unless the co-owner can prove their own contribution)
• transferring real estate for below market value to a child
• paying for a grandchild's education or a family member's expenses
• and making charitable contributions that exceed the applicant's normal giving history. Even paying for a child's wedding or a home down payment can become a look-back issue.

Joint account changes are a frequent source of problems in Texas. When an elderly parent adds an adult child to a bank account for convenience, Texas may treat this as a transfer of 50% of the account balance at the time the child's name was added.

Documenting that joint account funds were used exclusively for the parent's benefit can sometimes overcome this presumption.

The look-back penalty is one step in long-term care planning. The Texas Medicaid Eligibility Calculator covers income limits, asset limits, and community spouse protections for Texas applicants.

The Texas Long-Term Care Cost Calculator benchmarks nursing home and assisted living costs so you can estimate how long private resources will last before Medicaid becomes necessary. For estate planning context, the Texas Probate Cost Calculator shows administration costs the estate will face after the care recipient's death.

Connect with a Texas Medicaid planning attorney to review look-back exposure and planning options.