Texas Medicaid Estate Recovery (MERP) and the Family Home: A San Antonio Guide (2026)

By San Antonio Senior Advisor Care Team · September 15, 2026

What Texas Medicaid Estate Recovery Actually Is

Texas Medicaid estate recovery is the state's process for seeking repayment, after a Medicaid recipient dies, of what Medicaid spent on certain long-term care services during that person's life. The Texas Health and Human Services Commission runs it under the name MERP — the Medicaid Estate Recovery Program — and it is required by federal law, not an optional state policy. Nearly every San Antonio family that applies for STAR+PLUS HCBS waiver services or nursing facility Medicaid will see a MERP disclosure form somewhere in the application packet, usually signed in a hospital hallway at Methodist or Baptist Medical Center during a discharge that is already moving too fast for anyone to read carefully. Months or years later the family gets a letter from a state contractor referencing a number with a lot of digits in it, and nobody remembers signing anything.

The core rule is narrower than the panic it causes. MERP applies to people who were 55 or older when they received the covered services, and it applies only to specific categories of long-term services and supports — nursing facility care, services under the STAR+PLUS home and community based services waiver, intermediate care facility services, and the related hospital and prescription drug costs connected to those. Regular Medicare, a Medicare Advantage plan, private-pay assisted living, and ordinary doctor visits do not create a MERP claim. In Texas the claim also reaches only the probate estate — property that passes through a Texas probate proceeding — which is a meaningful limit that many states do not have. That single distinction shapes almost every conversation a Bexar County family will have about this.

Which San Antonio Families Are Exempt From a MERP Claim

Texas publishes a list of circumstances in which HHSC will not pursue recovery at all, and the exemptions are broader than most families expect. The state will not file a claim while there is a surviving spouse. It will not file while there is a surviving child under 21, or a surviving child of any age who is blind or has a disability. It also will not file when an unmarried adult child lived in the deceased parent's home continuously for at least one year immediately before the parent's death. That last one matters enormously in San Antonio, where multigenerational households on the West and South Sides are the norm rather than the exception, and where an adult daughter who moved back into the family house on Zarzamora to care for her mother may have unknowingly created a full exemption simply by living there.

There are also dollar thresholds and practical limits. HHSC does not pursue a claim when the value of the estate is at or below the published small-estate threshold, when the Medicaid claim itself falls below the minimum claim amount, or when the cost of recovery would exceed what could be recovered. Beyond the categorical exemptions, families can request an undue hardship waiver — for example, when the estate is the sole income-producing asset for surviving family, when the property is a homestead of modest value, or when recovery would leave heirs eligible for public assistance themselves. Deductions are also allowed against the claim for documented costs of maintaining the home during the recipient's time in care, including taxes, insurance, and necessary upkeep, and for the unpaid costs of certain care provided by family. Keep those receipts. In practice, documented maintenance deductions reduce more Bexar County MERP claims than any other single argument.

The 60-Day Deadline Families Miss

The sequence after death is where families lose ground. HHSC's contractor sends a Notice of Intent to File a Claim to the estate representative or to whoever the state can identify as responsible for the estate. From the date of that notice, the family generally has 60 days to respond with an application for an undue hardship waiver or with documentation establishing an exemption or a deduction. Sixty days is not long when a family is also arranging a funeral, closing accounts, and figuring out who has the house keys. The notice frequently goes to the address on file from the Medicaid application, which for a San Antonio family may be a facility that discharged the resident months earlier, or a relative who has since moved. Mail that nobody opens is still legally delivered mail.

The practical defense is to designate one family member as the point of contact before it matters, make sure the address HHSC has on file is a real mailbox somebody checks, and gather the documentation early: the deed, proof of who lived in the home and when, tax and insurance payment records for the care years, and any documentation of a disability for a surviving child. If a Notice arrives and the 60-day window is already running, call the number on the notice the same week and ask what form is required — do not wait to assemble a perfect file first. An incomplete timely response is recoverable. A complete late one often is not.

How This Changes the STAR+PLUS Decision in Bexar County

Because MERP attaches to STAR+PLUS HCBS waiver services and not to private-pay care, some San Antonio families conclude they should avoid Medicaid entirely to protect a house. That math is usually wrong, and it is worth doing out loud. The waiver exists precisely so a parent can receive attendant care, adult day services, respite, and in some cases assisted living services in the community rather than in a nursing facility. Paying privately to avoid a future claim typically spends down the same asset it was meant to protect — only faster, and with the family absorbing the caregiving in the meantime. The claim, when it comes, is capped at what Medicaid actually paid; private payment is capped at nothing.

The better question is not whether to use Medicaid but how the estate is structured and who survives. A surviving spouse, a disabled adult child, or a caregiving child who has lived in the home for the required period may make the claim a non-event. A house that passes outside probate may be outside the reach of a Texas claim entirely, though the mechanisms for that carry their own tax and eligibility consequences and are exactly the kind of decision that belongs with a Texas elder law attorney rather than a referral service, a facility marketer, or a blog post. San Antonio families can start with the Bexar County Probate Courts' self-help information and the State Bar of Texas lawyer referral service, and can bring questions about waiver eligibility itself to AACOG, the Alamo Area Council of Governments, at (210) 362-5200.

What to Verify Before You Sign Anything

Every Medicaid long-term care application in Texas includes a MERP notice, and a signature on it is an acknowledgment that the program was disclosed — not a waiver of any rights. Ask for a copy at the time of signing, and ask the facility's business office or the STAR+PLUS managed care plan's service coordinator which specific services in the care plan are MERP-covered. The plan will be Molina Healthcare, UnitedHealthcare, Superior HealthPlan, or Amerigroup in the Bexar service area, and service coordinators answer this question routinely. Get the answer in writing if you can, because the distinction between a waiver service and a plan-covered medical service determines what ends up on a claim years later.

Separately, verify the facility itself before any of this becomes relevant. Texas HHSC publishes licensing status, inspection history, and enforcement actions for every licensed assisted living and nursing facility in the state at apps.hhs.texas.gov/HSPubDisclosure, searchable by name or county. Confirm the license type — Type A for residents who can evacuate without assistance, Type B under Chapter 247 for residents who need evacuation assistance or have memory care needs — and confirm the facility is actually contracted for the waiver if the plan is to use STAR+PLUS there. A community that takes private pay only is a different financial path with a different estate outcome, and families deserve to know which one they are on before a deposit changes hands. General program information is at hhs.texas.gov.

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Common questions

Will Texas Medicaid estate recovery take my parent's San Antonio house?

Not automatically, and in many cases not at all. Texas recovery reaches only the probate estate, and HHSC will not pursue a claim if there is a surviving spouse, a surviving child under 21, a surviving child of any age who is blind or disabled, or an unmarried adult child who lived in the home continuously for at least one year immediately before the parent's death. Beyond those categorical exemptions, the state will not pursue claims below its published minimum amounts or where recovery costs exceed what could be recovered, and families may apply for an undue hardship waiver when the home is of modest value or is the family's only income-producing asset. Documented costs of maintaining the home during the parent's time in care — taxes, insurance, necessary repairs — are deductible against the claim. What actually forfeits a house is usually not the claim itself but a missed 60-day response window. Confirm current thresholds and forms directly with HHSC, because both are updated periodically.

Does MERP apply to assisted living in San Antonio?

It depends entirely on who is paying. Private-pay assisted living does not create a Medicaid estate recovery claim, because no Medicaid dollars were spent. If assisted living services are being paid through the STAR+PLUS HCBS waiver, those waiver services are MERP-covered for recipients who were 55 or older when they received them, along with related hospital and prescription costs. Many Bexar County families move between both arrangements over a few years — private pay at first, then waiver services after a spend-down — and only the waiver period is recoverable. This is the single most useful question to ask your STAR+PLUS service coordinator at Molina, UnitedHealthcare, Superior, or Amerigroup: which line items in this care plan are waiver services. Nursing facility Medicaid is covered regardless of where the resident lived before. Verify the facility's license type and waiver contract status at apps.hhs.texas.gov/HSPubDisclosure before assuming either arrangement applies.

How long does a Texas family have to respond to a MERP notice?

Generally 60 days from the date of the Notice of Intent to File a Claim. That window covers applying for an undue hardship waiver and submitting documentation of exemptions or deductions. The clock starts on the notice, not on the day someone in the family opens the envelope, which is why the mailing address on file matters so much — notices routinely go to a facility the resident left months earlier or to a relative who has moved. Designate one family member as the estate contact while the Medicaid case is still open and make sure HHSC has a mailbox that gets checked. If a notice arrives and time is already short, call the number on it immediately and ask which form is required rather than waiting to assemble complete documentation; a timely incomplete response can usually be supplemented, while a late complete one often cannot. Deadlines and forms are set by HHSC and should be confirmed against the notice itself.

Should we avoid STAR+PLUS in Bexar County to protect an inheritance?

That calculation usually costs families more than it saves. A MERP claim is limited to what Medicaid actually paid; paying privately for the same attendant care, adult day services, respite, or facility care has no such ceiling and typically spends the estate down faster than recovery would have reduced it. The STAR+PLUS HCBS waiver also exists specifically to keep people in the community rather than in a nursing facility, which is the outcome most San Antonio families say they want. The productive questions are about structure and survivors — who will survive the recipient, whether a caregiving adult child meets the one-year residency exemption, whether the home passes through probate at all — and those belong with a Texas elder law attorney, not with a facility marketer or a referral service. For help with waiver eligibility and interest list questions, AACOG can be reached at (210) 362-5200 or aacog.com.