By Beverly Law’s Texas-licensed attorneys, Joyce Ondich and John Efstathiou. Updated November 2026.
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The federal ban on making family guarantee the bill
Federal and Texas rules set admission terms for nursing homes in Medicare and Medicaid. None of them lets a facility make a relative or agent promise to pay as the price of a bed.
| Rule | Applies to | What it says |
|---|---|---|
| 42 U.S.C. 1395i-3(c)(5)(A)(ii) | Medicare skilled nursing facilities | No third-party guarantee as a condition of admission, expedited admission or continued stay. |
| 42 U.S.C. 1396r(c)(5)(A)(ii) | Medicaid nursing facilities | Same ban. |
| 42 CFR 483.15(a)(3) | Facilities in Medicare or Medicaid | May not even request a third-party guarantee as a condition of admission. |
| 26 Tex. Admin. Code 554.501 | Texas Medicaid-certified nursing facilities | State version of the same ban. |
Assisted living in Texas follows different rules, so an assisted living contract needs its own review.
What signing as the “responsible party” means
Admission packets often have a line for a “responsible party” or “resident representative.” The law allows one narrow request. A facility may require a person who has legal access to the resident’s income or resources to sign a contract to pay the facility from the resident’s income or resources, “without incurring personal financial liability” (42 U.S.C. 1396r(c)(5)(B)(ii); 42 CFR 483.15(a)(3)). You agree to use the resident’s Social Security, pension or savings for the bill. You do not agree to pay from your own pocket.
Look at how you sign. The Texas statutory power of attorney form tells agents to write the principal’s name and then sign “by (Your Signature) as Agent” (Texas Estates Code 752.051). If a page calls you a “guarantor,” or says you are “personally” or “jointly and severally” liable, ask the facility to strike it before you sign. Admission cannot depend on that page. If you already signed one, keep a copy and have it reviewed.
Your duties as agent under a Texas power of attorney
Under the Texas Durable Power of Attorney Act, an act by an agent binds the principal as if the principal had done it (Estates Code 751.051). A contract you sign as agent is the resident’s contract.
The job carries duties. An agent who accepts the appointment is a fiduciary (751.101), must timely inform the principal of each action (751.102), must keep records (751.103) and must give a full accounting if the principal demands one (751.104). The statutory form warns that an agent who violates the Act or acts beyond the authority granted may be liable for damages or prosecuted for misapplication of property by a fiduciary.
That is the agent’s real risk. If you agreed to pay the facility from the resident’s money and spent it on something else, the facility or the estate may claim you broke that promise or your duty. Pay from the resident’s account, keep that money apart from yours, and save receipts.
A medical power of attorney is outside the Act (751.0015) and covers health care decisions, not money. A durable power of attorney ends when the principal dies (751.131).
Adult children, spouses and the estate
Some states have filial responsibility laws that can make adult children support a parent in need. Texas does not appear to have one. A 2008 note in The Elder Law Journal lists Texas among the few states that never had one (Ross, 2008), and a 2023 count of 25 states with such laws does not include Texas (Erickson, 2023). Being the resident’s son or daughter does not, by itself, make you owe the bill.
Spouses are different. Each spouse has a duty to support the other, and a spouse who fails to do so is liable to anyone who provides necessaries to the other (Family Code 2.501). A person is personally liable for a spouse’s acts only if the spouse acted as their agent or incurred a debt for necessaries (Family Code 3.201). A spouse who gets a nursing home bill should get advice before paying or refusing.
| Who | Personal exposure | Law |
|---|---|---|
| Adult child who signed nothing | Legal surveys list no Texas filial support law | Elder Law Journal note |
| Responsible party with access to the resident’s funds | Pays from the resident’s money, without personal financial liability | 42 CFR 483.15(a)(3) |
| Agent under a durable power of attorney | Acts for the resident; exposed for misusing funds or acting beyond authority | Estates Code 751.051, 751.101 |
| Spouse | May be liable for necessaries if the duty of support is not met | Family Code 2.501, 3.201 |
| Estate after death | Unpaid bills become claims paid in the order set by statute | Estates Code 355.102 |
Arbitration agreements in the admission packet
Admission packets often include a binding arbitration agreement, which gives up the right to go to court over future disputes, including neglect claims. A facility must not require a resident or representative to sign one as a condition of admission or continued care, and must tell them they need not sign (42 CFR 483.70(m)). The agreement must allow the parties to rescind it within 30 calendar days of signing and must provide for a neutral arbitrator agreed upon by both sides. To cancel, send written notice inside the 30 days and keep proof.
After death: Medicaid estate recovery
If the resident received Medicaid long-term care after age 55 and began receiving those services after March 1, 2005, the Texas Health and Human Services Commission (HHSC) can seek repayment from the estate through its Medicaid Estate Recovery Program. HHSC does not collect on life insurance with a named beneficiary or on bank accounts payable on death to another person. It does not seek recovery when there is a surviving spouse, a child under 21 or a child who is blind or disabled, and heirs can ask for a hardship waiver (HHSC MERP guide). For the family home, see can a nursing home take your house.
If the nursing home or a collector bills you personally
- Ask for copies of everything you signed and an itemized bill.
- Reply in writing that you signed only for the resident and that a third-party guarantee cannot be a condition of admission under 42 CFR 483.15(a)(3).
- A collection agency must send a written notice of the amount and creditor. Dispute it in writing within 30 days and the agency must stop collecting until it mails verification (15 U.S.C. 1692g). It may not misstate the character, amount or legal status of a debt (15 U.S.C. 1692e(2)(A)).
- Texas law also bars misrepresenting the character, extent or amount of a consumer debt (Finance Code 392.304(a)(8)) and allows suits for an injunction and actual damages (392.403).
- The free Texas Long-Term Care Ombudsman advocates for residents and can help families learn how to pay for nursing home care. Care complaints go to HHSC Complaint and Incident Intake. HHSC’s long-term care page explains ways to pay.
What this means for your case
A bill and an injury are separate problems that can arrive at the same time. If you face both:
- Keep the full admission packet, including any arbitration agreement and the date you signed it.
- Keep the resident’s money in the resident’s own account and pay the facility only from it.
- Answer collection letters in writing. Never ignore court papers.
- Note signs of neglect, such as falls, bedsores or weight loss, with dates and photos, and see how to report nursing home abuse.
If your loved one was hurt in a Texas nursing home, Beverly Law’s Texas-licensed attorneys can review the injury side. Read more on our Texas personal injury attorneys page, or call Beverly Law at (310) 552-6959 for a free review in English or Spanish. You owe no fees or costs unless we win.
Common questions
Can a Texas nursing home refuse to admit my mother unless I co-sign?
Not if it takes Medicare or Medicaid. Federal law and 42 CFR 483.15(a)(3) bar the facility from requesting or requiring a third-party guarantee as a condition of admission or continued stay.
I signed as my father’s agent. Do I owe the bill if his money runs out?
Signing as agent binds him under Texas Estates Code 751.051, and a nursing home in Medicare or Medicaid cannot make you guarantee payment as a condition of admission. Your personal exposure comes mainly from misusing his funds or acting beyond your authority, so keep records of every payment.
Does my power of attorney still work after my parent dies?
No. A Texas durable power of attorney ends at the principal’s death under Estates Code 751.131. After that, unpaid bills are claims against the estate.
Can I cancel an arbitration agreement I signed at admission?
Under 42 CFR 483.70(m), the agreement must give you 30 calendar days from signing to rescind it. Send the cancellation in writing and keep proof.
Is my husband or wife responsible for my nursing home bill in Texas?
Possibly. Texas Family Code 2.501 makes each spouse owe the other support and makes a spouse who fails to provide it liable to whoever supplies necessaries. Get advice before paying or refusing.
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Related pages
Texas personal injury attorneys · Can a nursing home take your house? · Nursing home residents’ rights · How to report nursing home abuse · Can a nursing home take your Social Security check? · Nursing home abuse lawyers
Sources
- 42 U.S.C. § 1395i-3(c)(5), Medicare skilled nursing facility admissions policy
- 42 U.S.C. § 1396r(c)(5), Medicaid nursing facility admissions policy and legal-access exception
- 42 CFR § 483.15(a)(3), ban on requesting or requiring a third-party guarantee
- 42 CFR § 483.70(m), binding arbitration agreements
- 26 Tex. Admin. Code § 554.501, admissions policy for Medicaid-certified facilities
- Tex. Estates Code § 751.0015, applicability (medical power of attorney excluded)
- Tex. Estates Code § 751.051, effect of acts performed by agent
- Tex. Estates Code § 751.101, fiduciary duties
- Tex. Estates Code § 751.102, duty to timely inform principal
- Tex. Estates Code § 751.103, maintenance of records
- Tex. Estates Code § 751.104, accounting
- Tex. Estates Code § 751.131, termination of durable power of attorney
- Tex. Estates Code § 752.051, statutory durable power of attorney form and agent’s duties
- Tex. Estates Code § 355.102, classification and priority of claims against an estate
- Tex. Family Code § 2.501, spousal duty to support
- Tex. Family Code § 3.201, spousal liability
- Tex. Finance Code § 392.304, fraudulent, deceptive or misleading representations
- Tex. Finance Code § 392.403, civil remedies
- 15 U.S.C. § 1692g, validation of debts
- 15 U.S.C. § 1692e, false or misleading representations
- Allison E. Ross, Taking Care of Our Caretakers: Using Filial Responsibility Laws to Support the Elderly Beyond the Government’s Assistance, 16 Elder L.J. 167 (2008)
- Danielle Erickson, Filial Responsibility Laws: Codifying a Qualified Quid Pro Quo of Care, Connecticut Public Interest Law Journal, vol. 22.2 (2023)
- Texas HHSC, Your guide to the Medicaid Estate Recovery Program
- Texas HHSC, Long-Term Care Ombudsman
- Texas HHSC, Complaint and Incident Intake
- Texas HHSC, Long-term care
Important: This page is general information, not legal or medical advice, and reading it does not create an attorney-client relationship. Every case is different; talk to a lawyer about yours. Last reviewed: November 11, 2026.