Texas has not expanded Medicaid under the Affordable Care Act, but that decision has no bearing on long-term-care Medicaid for seniors, which is a completely separate, decades-old eligibility pathway for people who are 65 or older, or blind or disabled.
The detail behind the program
These two things get conflated constantly, including by adult children who've read that Texas 'didn't expand Medicaid' and assume that means their aging parent has no Medicaid options at all. ACA expansion covers a different population entirely -- working-age adults under 65 whose income falls under a specific threshold, evaluated using MAGI (modified adjusted gross income) rules. Long-term-care Medicaid for seniors uses non-MAGI aged/blind/disabled eligibility rules that predate the ACA by decades and exist regardless of a state's expansion decision. If someone tells you Texas seniors can't get Medicaid help because the state didn't expand Medicaid, that's simply incorrect -- STAR+PLUS and nursing facility Medicaid have operated under separate rules the whole time.
