Texas Skilled Nursing Medicaid Rates and Reimbursement (2026)

Skilled nursing Medicaid rates in Texas sit well below the national middle. Texas Medicaid publishes a daily rate of $225.64 for a nursing home stay under code PD079, effective September 1, 2025, compared with a national median of $282.59 among states with a comparable figure. Texas is not part of the 21-state ranking.

Texas nursing facility rates are driven by the state's two-year budget. The 2026-27 General Appropriations Act includes separate rate increases for nursing facilities and for intellectual and developmental disability nursing facilities, both effective on September 1, 2025, the start of the state fiscal year. Every rate here is compiled from official state Medicaid publications and linked to its source document.

Texas Medicaid nursing home rate per day: $225.64

The $225.64 per diem is the published Texas Medicaid payment for one nursing home resident day, listed under code PD079. It covers nursing at three licensure levels, room and board, dietary, housekeeping, activities, administration and capital.

Texas nursing facility rates are paid through Texas Medicaid and published alongside the fee schedules administered by TMHP. Texas also recognizes special reimbursement classes within nursing facility payment, so the PD079 figure is a statewide reference point rather than every facility's own rate. The Texas state page lists the full set of published Texas rates and links each to its source document.

The 2026-27 budget: Riders 25 and 31

Texas sets Medicaid rates on a two-year cycle through the General Appropriations Act (GAA). For the 2026-27 biennium, two riders in Article II, which covers the Health and Human Services Commission (HHSC), address nursing facilities directly:

• HHSC Rider 25, Rate Increase for Nursing Facilities: enacted with the GAA, effective September 1, 2025.
• HHSC Rider 31, Rate Increase for Intellectual Developmental Disability Nursing Facilities: a separate increase for facilities serving residents with intellectual and developmental disabilities, also effective September 1, 2025.

HHSC also held a public hearing on proposed Medicaid payment rate actions for nursing facilities and for a nursing facility special reimbursement class, effective September 1, 2025. Public rate hearings are how HHSC converts a legislative appropriation into specific published rates.

For operators, the biennial cycle has a clear implication: the appropriation behind the September 1, 2025 rate covers the full biennium, and larger changes usually follow the next General Appropriations Act rather than arriving mid-cycle. Budget planning in Texas therefore runs on a two-year horizon rather than an annual one.

Earlier add-ons and related programs

Texas has used temporary measures to supplement the base nursing facility rate. HHSC proposed temporary add-on rates for nursing facilities with an effective date of June 10, 2023. Facilities comparing current rates with that period should account for whether add-ons were included in what they received. A rate history that mixes base rates and temporary add-ons can make year-over-year growth look larger or smaller than the base per diem actually moved.

Two other proposed actions touch the edges of the industry. One, effective September 1, 2023, addressed attendant services in various programs and case management in the Deaf-Blind and Multiple Disabilities Waiver Program. The other, published July 3, 2026, is an amendment to the waiver application for the Medically Dependent Children Program (MDCP), which serves children who might otherwise need nursing facility care.

Labor costs in Texas

Texas's May 2025 wages show a mixed picture:

Registered nurse pay is close to the national median, while nursing assistants earn well below it. Because aides provide most direct-care hours, a below-median aide wage partly offsets a below-median per diem. The licensed nurse picture is less favorable: registered nurses cost almost as much as they do nationally, and those wages have to be paid out of a rate that sits well under the national median. Facilities in large metro areas, where hospitals compete for the same nurses, feel that pressure most.

Managed care and Texas nursing facilities

Texas Medicaid includes STAR+PLUS home and community-based services among its programs, and STAR Kids and STAR Health cover the Medically Dependent Children Program. Our data does not classify the nursing facility line under a specific managed care payment rule in Texas, so the published HHSC rate is the reference for what a nursing home day is worth under Texas Medicaid. We record 19 plans and related arrangements in Texas. The Texas managed care page details the rules for each service line that is classified.

Texas against the national range

Of the 44 states with a published nursing home rate, 21 are ranked on a single daily figure. New Mexico leads at $826.00, followed by Colorado ($419.22), Rhode Island ($381.06), Washington ($373.84) and Kentucky ($365.78). The lowest ranked figures are Connecticut ($107.21), Michigan ($99.90) and Arkansas ($70.00).

At $225.64, Texas sits below the national median and far below the top tier. For Texas operators, the most important comparison is less with other states than with the next biennial budget, which will decide how far the PD079 rate moves.

See the skilled nursing industry hub for every state and the methodology page for how rates are compared.