Texas Health and Human Services Commission v. Estate of Clyde L. Burt, Linda S. Wallace, and Linda S. Wallace

Supreme Court of Texas
══════════
No. 22-0437
══════════

Texas Health and Human Services Commission,
Petitioner,

v.

Estate of Clyde L. Burt, Linda S. Wallace, Executor, and
Linda S. Wallace,
Respondents

═══════════════════════════════════════
On Petition for Review from the
Court of Appeals for the Third District of Texas
═══════════════════════════════════════

Argued October 4, 2023

JUSTICE BLAND delivered the opinion of the Court, in which
Justice Lehrmann, Justice Blacklock, Justice Busby, Justice Huddle,
and Justice Young joined.

CHIEF JUSTICE HECHT filed a dissenting opinion, in which Justice
Boyd and Justice Devine joined.

To qualify for Medicaid assistance, an applicant’s resources, like
cash and assets, must fall below a threshold level. The calculation of
resources for this purpose excludes the applicant’s home. The issue
presented in this case is whether an interest in property purchased with
cash after a Medicaid applicant enters a skilled-nursing facility qualifies
as a “home” under federal law, excluding it from the calculation that
determines Medicaid eligibility.
The Texas Health and Human Services Commission concluded
that the property interest is not excluded, and thus it denied the claim
for assistance. The trial court reversed the agency’s determination, and
the court of appeals affirmed. The court of appeals held that a property
interest created after admission to a skilled-nursing facility can be
excluded from the resources used to determine Medicaid eligibility if the
applicant states an intent to live at the property in the future. In its
view, this is so even though the purchase took place after the Medicaid
claim arose, using funds that otherwise qualified as resources for
calculating Medicaid eligibility.1
We hold that a “home” is the applicant’s principal place of
residence before the claim for Medicaid assistance arises, coupled with
the intent to reside there in the future. A property interest purchased
with qualifying resources after the applicant moves to a skilled-nursing
facility is an available resource for determining Medicaid eligibility
under federal eligibility rules, as the property was not the applicant’s
principal place of residence at the time the claim for benefits arose. We
reverse and render judgment in favor of the Commission.
I
Clyde and Dorothy Burt purchased a house in Cleburne, Texas,
and lived there many years. In 2010, however, they sold the house to

1 644 S.W.3d 888, 895 (Tex. App.—Austin 2022).

2
their daughter and son-in-law, Linda and Robby Wallace. The Burts
moved to a rental property the Wallaces owned.
About seven years later, in August 2017, the Burts moved to a
skilled-nursing facility. At the time, the Burts had cash assets and cash
value in a life insurance policy; both count as available resources for
Medicaid eligibility.2 After moving into the facility, the Burts used these
assets to buy an undivided one-half interest in the Cleburne house from
the Wallaces.3 The Burts then executed a Lady Bird deed in favor of the
Wallaces.4 By executing the deed, the Burts granted their newly
acquired one-half interest back to the Wallaces, reserving an enhanced
life estate. As a result, the Burts’ undivided one-half interest in the
Cleburne house reverted to the Wallaces upon the Burts’ deaths. After
these transactions, the Burts were left with qualifying resources of

2 See 20 C.F.R. § 416.1201. The Burts also had railroad retirement
income.
3 The Burts represented in their Medicaid application that they
transferred cash and their interest in a life insurance policy to their daughter
to purchase their property interest in the Cleburne house for $54,379.18. The
parties agree that the Burts’ ownership interest had a market value of
$82,048.50, but the Commission does not challenge the purchase as a transfer
for less than fair market value. See id. § 416.1246(a), (e) (providing that
“[t]ransfer of a resource for less than fair market value is presumed to have
been made for the purpose of establishing . . . Medicaid eligibility” and may be
included in an applicant’s resources calculation).
4 A “Lady Bird deed,” also known as an “enhanced-life-estate deed,” is

“[a] deed that allows a property owner to transfer ownership of the property to
another while retaining the right to hold and occupy the property and use it as
if the transferor were still the sole owner.” Lady Bird deed, Black’s Law
Dictionary (11th ed. 2019).

3
$2,016.10, which is under the $3,000 maximum resource threshold for
couples to be eligible for Medicaid assistance.5
On the day of the sale, Clyde Burt executed a Form H1245,
informing the Commission that he considered the Cleburne house to be
his home and principal place of residence, to which he intended to
return. Shortly thereafter, he submitted the form along with his and his
wife’s joint application for Medicaid nursing-facility assistance. While
their application was pending, the Burts died, having never left the
skilled-nursing facility. They incurred $23,479.35 in costs for their care.
The Commission denied the estate’s claim for Medicaid
assistance. It determined that the Burts’ interest in the Cleburne house
was not excludable as a resource for determining Medicaid eligibility. A
Commission hearing officer and reviewing attorney upheld the decision.
They reasoned that the property interest was not excludable as the
Burts’ home because the home had not been the Burts’ residence in the
years before they entered the nursing facility.6
Linda Wallace, as executor and beneficiary of her father’s estate,
petitioned for review in the district court, arguing that the Commission
should have excluded the Burts’ interest in the Cleburne house from the
Burts’ available resources.7 Agreeing, the trial court reversed the
Commission’s decision.

5 See 42 U.S.C. § 1382(a)(3)(A).

6 See 1 Tex. Admin. Code § 358.348; Tex. Health & Hum. Servs.
Comm’n, Medicaid for the Elderly and People with Disabilities Handbook
F-3000, Home (2021).
7 See Tex. Gov’t Code § 531.019. Dorothy Burt is not named as a party.

Neither party contends that this affects the disposition of this case.

4
The court of appeals affirmed, holding that an applicant’s
principal place of residence and home for Medicaid eligibility purposes
turns on the applicant’s subjective intent.8 The court of appeals reasoned
that “the purposes of Medicaid are better served by allowing an
applicant to claim the home exemption for a home he buys while in a
nursing facility,” because renters and homeowners “will be in the same
need of a home upon . . . discharge from the institution.”9
The Commission petitioned this Court for review, arguing that
the court of appeals’ expansive interpretation of “home” fails to comport
with “home” under state and federal law. We granted review.
II
We review the Commission’s denial of Medicaid assistance under
the substantial evidence rule.10 Under that standard, courts first
“determine whether the agency’s construction contradicts the statute’s
plain language.”11 Statutory interpretation is a question of law we
consider de novo.12 If the Commission’s construction comports with the
statute, then a reviewing court should uphold the Commission’s decision
“if the evidence is such that reasonable minds could have reached the

8 644 S.W.3d at 890, 893.

9 Id. at 894 (citing Est. of Seffer v. Tex. Health & Hum. Servs. Comm’n,

No. D-1-GN-08-000790 (419th Dist. Ct., Travis County, Tex. Dec. 16, 2008)).
10 See R.R. Comm’n of Tex. v. Cont’l Bus Sys., Inc., 616 S.W.2d 179, 181

(Tex. 1981); Tex. Gov’t Code § 531.019(g).
11 Sirius XM Radio, Inc. v. Hegar, 643 S.W.3d 402, 407 (Tex. 2022).

12 Aleman v. Tex. Med. Bd., 573 S.W.3d 796, 802 (Tex. 2019).

5
conclusion that the agency must have reached in order to justify its
action.”13
A
Medicaid is a federal and state assistance program that provides
medical and skilled-nursing care for qualifying persons.14 Federal law
sets Medicaid’s parameters, and the states enact legislation to
implement the program.15 In Texas, the Health and Human Services
Commission administers Medicaid.16
Texas’s methodology for determining income and resource
eligibility must be “no more restrictive[] than the methodology . . . under
the [federal] supplemental security income program.”17 Under that
standard, an applicant’s resources must not exceed $2,000 for an
individual or $3,000 for a couple.18 “Resources” includes “cash or other
liquid assets or any real or personal property that an individual (or
spouse, if any) owns and could convert to cash to be used for his or her
support and maintenance.”19 Under the statute, the Commission must

13 Tex. Health Facilities Comm’n v. Charter Med.–Dall., Inc., 665 S.W.2d

446, 453 (Tex. 1984) (citing Suburban Util. Corp. v. Pub. Util. Comm’n, 652
S.W.2d 358, 364 (Tex. 1983)).
14 El Paso Hosp. Dist. v. Tex. Health & Hum. Servs. Comm’n, 247 S.W.3d

709, 711 (Tex. 2008); see also 42 U.S.C. §§ 1396–1396w-8.
15 See El Paso Hosp. Dist., 247 S.W.3d at 711; 42 U.S.C. § 1396a; 42

C.F.R. § 430.0.
16 El Paso Hosp. Dist., 247 S.W.3d at 712; Tex. Gov’t Code § 531.021.

17 42 U.S.C. § 1396a(r)(2).

18 Id. § 1382(a)(3).

19 20 C.F.R. § 416.1201(a).

6
exclude an applicant’s “home (including the land that appertains
thereto)” from the applicant’s available resources.20
The Commission argues that the Burts’ interest does not qualify
as their “home” for Medicaid eligibility. Under the federal statute and
federal and state regulations, “home” must be understood as an “actual,
lived-in residence”; otherwise, an applicant could exclude any interest
acquired after the claim for assistance arises based on the applicant’s
declared intent to make it a future home. Because the Burts neither
lived in the Cleburne house when they applied for Medicaid assistance,
nor lived in it during the period before their entry into the
skilled-nursing facility, the value of their interest, acquired using
Medicaid-available resources after their admission to the
skilled-nursing facility, is not excluded.
Ms. Wallace responds that federal law permits an applicant to use
resources to purchase a property interest and designate it as a future
“home,” if the applicant states an intent to live there in the future. This
construction converts funds that qualify as “resources” at the time of the
claim into assets that do not, but Ms. Wallace argues that the definition
of “home” as a place of residence of the applicant at the time the claim
arose makes Texas’s Medicaid program more restrictive than the federal
supplemental security income program.
B
We begin by examining the applicable federal law. “In
determining the resources of an individual (and his eligible spouse, if

2042 U.S.C. § 1382b(a)(1); see also 20 C.F.R. § 416.1212(b); 1 Tex.
Admin. Code § 358.348(a).

7
any) there shall be excluded . . . the home (including the land that
appertains thereto).”21 The federal law does not define “the home.”
“When a term is left undefined in a statute, ‘we will use the plain and
ordinary meaning of the term and interpret it within the context of the
statute.’”22 “To determine a statutory term’s common, ordinary meaning,
we typically look first to [its] dictionary definitions . . . .”23
“[H]ome” is “one’s principal place of residence: domicile,”24 and
“[a] place where one lives; a residence.”25 Accordingly, a home is the
principal place in which one lives and resides, not merely a structure in
which one possesses a partial ownership stake. At the time the Burts
applied for Medicaid, they did not reside in the Cleburne house. Nor was
the Cleburne house their principal residence or domicile during the
preceding seven years. Under the plain language of the statute, the
Cleburne house was not their “home.” The Commission’s interpretation
is consistent with the plain meaning of the federal statute and no more
restrictive than the federal supplemental security income program.
In urging the contrary, Ms. Wallace first observes that the statute
does not explicitly require occupancy. To reside and live in a place,

21 42 U.S.C. § 1382b(a).

22 Hogan v. Zoanni, 627 S.W.3d 163, 169 (Tex. 2021) (quoting EBS Sols.,

Inc. v. Hegar, 601 S.W.3d 744, 758 (Tex. 2020)).
23 Tex. State Bd. of Exam’rs of Marriage & Fam. Therapists v. Tex. Med.

Ass’n, 511 S.W.3d 28, 35 (Tex. 2017) (citing Epps v. Fowler, 351 S.W.3d 862,
866 (Tex. 2011)).
24 Home, Webster’s Third New International Dictionary 1082 (2002).

25 Home, The American Heritage Dictionary of the English Language

840 (5th ed. 2022).

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however, one must occupy it. The statute does not provide an exclusion
for real property or homes generally, but “the home.”26 The home
connotes a singular location commonly understood to be the place one
lives.
Ms. Wallace also counters that it is common for one to consider a
property to be a “home” despite being unable to immediately move into
it, as for example, when signing closing documents for a house or when
a service member purchases a house while on duty abroad. Those
examples feature two residences, one in which the person resides and
another that the person intends to occupy or has occupied during the
relevant time frame. Because the statute excludes “the home,” an
applicant must elect a principal residence to the exclusion of all others.
Which residence of two qualifying residences may turn on the
homeowner’s view of which is the principal one, but both are owned
before the applicant files a claim for Medicaid assistance. Absent
ownership of multiple residences, “the home” is commonly understood
to be the place one resides. The Burts’ principal and only home was their
rental house. It was not their daughter’s Cleburne house, in which they
purchased an interest using eligible Medicaid resources after their claim
for assistance arose, then immediately deeded that interest back to her
save a life estate.
Finally, Ms. Wallace argues that an occupancy requirement
denies renters the preservation of a home after nursing care. This, she
contends, contravenes Medicaid’s purpose of promoting a return to

26 42 U.S.C. § 1382b(a)(1) (emphasis added).

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independence.27 The court of appeals rested its holding on this
argument, noting that a renter needs a home upon discharge as much
as a homeowner.28
The statute, however, returns a Medicaid applicant to the type of
residence the applicant occupied before the claim for assistance arose.
The federal government appropriates Medicaid funds to enable states
“to furnish (1) medical assistance on behalf of . . . aged, blind, or disabled
individuals, whose income and resources are insufficient to meet the
costs of necessary medical services, and (2) rehabilitation and other
services to help such . . . individuals attain or retain capability for
independence or self-care.”29 The resources statute endeavors to
calculate the funds available for care based on an applicant’s living
situation before the claim for assistance arises; it does not permit the
applicant to change the nature of that residence (from renting to owning
or from a real property interest to a home) by converting assets that
otherwise are available to pay for the applicant’s care once the need for
that care arises.30

27 See id. § 1396-1.

28 644 S.W.3d at 894.

29 42 U.S.C. § 1396-1.

30 This is not the only Medicaid statute that requires residency. For

Medicaid applicants residing in an institution, the purchase of a life estate in
another’s property is considered an improper transfer of assets unless the
applicant “resides” at the life-estate property for at least one year after the
date of the purchase. Id. § 1396p(c)(1)(A), (J).

10
One way Congress has sought to limit improper asset transfer
and ensure recoverability of Medicaid funds31 is by imposing a
“look-back date,” which is tied to the date the applicant files for
Medicaid, to scrutinize eligibility.32 As the look-back period illustrates,
the period immediately preceding the applicant’s claim is the relevant
timeframe for determining eligibility.
Congress has sought to preclude artificial impoverishment,
repeatedly narrowing Medicaid eligibility to minimize abuse of the
program and to conserve government resources for those most in need.33
“As always, our mandate is to ascertain and give effect to the
Legislature’s intent as expressed in the statutory language.”34 The home
exemption prevents applicants from having to sell their homes to pay
for their care; it does not authorize the conversion of available resources

31 Federal law requires states to recover the costs of long-term care paid

through Medicaid for certain categories of applicants from the applicant’s
estate. See id. § 1396p(b); 1 Tex. Admin. Code § 373.101.
32 See 42 U.S.C. § 1396p(c)(1)(A), (B). The look-back period is 36 months

or 60 months, depending on the circumstances. Id. § 1396p(c)(1)(B)
33 Medicaid is for those “whose income and resources are insufficient to

meet the costs of necessary medical services” and for “rehabilitation and other
services to help such . . . individuals.” Id. § 1396-1; see also Lewis v. Alexander,
685 F.3d 325, 333 (3d Cir. 2012) (“Individuals have gained access to
taxpayer-funded healthcare while retaining the benefit of their wealth and the
ability to pass that wealth to their heirs. Congress understandably viewed this
as an abuse and began addressing the problem with statutory standards
enacted in 1986.”); Ark. Dep’t of Health & Hum. Servs. v. Ahlborn, 547 U.S.
268, 291 (2006) (“Congress, in crafting the Medicaid legislation, intended that
Medicaid be a ‘payer of last resort.’” (quoting S. Rep. No. 99-146, at 313
(1985))).
34 Paxton v. City of Dallas, 509 S.W.3d 247, 256 (Tex. 2017) (citing TIC

Energy & Chem., Inc. v. Martin, 498 S.W.3d 68, 74 (Tex. 2016)).

11
to make them unavailable after the claim for assistance arises. The
resources calculation instead does the opposite, requiring liquidation of
nearly all assets except a home. If an applicant does not own a home
before entering care, then the exclusion does not apply.
C
The Social Security Administration and the Commission have
promulgated regulations designed to comport with the exclusion of the
home from an applicant’s resources.35 When a statute is unambiguous,
we apply its plain meaning and need not turn to an agency’s
interpretation.36 The federal and state regulations in this instance,
however, align with reading “home” to require residence before the claim
for assistance arises.
The Code of Federal Regulations defines a “home” as “any
property in which an individual . . . has an ownership interest and which
serves as the individual’s principal place of residence.”37 The federal

35 The Commission is authorized to adopt rules regarding Medicaid’s

operation in Texas. See Tex. Hum. Res. Code § 32.021(c). Pursuant to that
power, the Commission has promulgated regulations regarding the calculation
of resources that follow federal statutory and regulatory standards. See, e.g., 1
Tex. Admin. Code § 358.321(a), (b).
36 See Combs v. Roark Amusement & Vending, L.P., 422 S.W.3d 632,

635 (Tex. 2013) (“We give [unambiguous] statutes their plain meaning without
resort to rules of construction or extrinsic aids. On the other hand, ‘if a statute
is vague or ambiguous, we defer to the agency’s interpretation unless it is
plainly erroneous or inconsistent with the language of the statute.’” (quoting
Tex. Dep’t of Ins. v. Am. Nat’l Ins. Co., 410 S.W.3d 843, 853 (Tex. 2012))); see
also R.R. Comm’n of Tex. v. Tex. Citizens for a Safe Future & Clean Water, 336
S.W.3d 619, 634 (Tex. 2011) (Jefferson, C.J., concurring) (“We do not defer to
agency interpretations of unambiguous statutes.”).
37 20 C.F.R. § 416.1212(a) (emphasis added).

12
regulation thus contemplates current, not future, residency. Similarly,
the Texas Administrative Code provides that the Commission “follows
[the federal regulation] regarding the treatment of a home, except [the
Commission] does not count the equity value of a home that is the
principal place of residence of an applicant . . . if the home is in Texas,
and the applicant or recipient occupies or intends to return to the
home.”38 It requires that the home currently be the principal place of
residence, coupled with an intent to return.
Residence is “the act or fact of abiding or dwelling in a place for
some time.”39 The Burts did not principally abide or dwell in the
Cleburne house. Rather, their principal place of residence before their
claim for Medicaid assistance arose was a rental house; thereafter, it
was a skilled-nursing facility. Because the Burts did not reside in the
Cleburne house in the period before their claim for Medicaid assistance
arose, it was not their principal place of residence. Their ownership
interest was not concurrent with the Cleburne house serving as their
principal place of residence, and therefore it is not an excludable “home”
under the federal or state regulations.
Demonstrating this concept, the Code of Federal Regulations
provides that “[i]f an individual . . . moves out of his or her home without
the intent to return, the home becomes a countable resource because it

38 1 Tex. Admin. Code § 358.348(a) (emphases added).

39 Residence, Webster’s Third New International Dictionary 1931
(2002); see also Residence, Black’s Law Dictionary (11th ed. 2019) (“The act or
fact of living in a given place for some time.”).

13
is no longer the individual’s principal place of residence.”40 Likewise, the
Texas Administrative Code provides that one’s principal place of
residence is excluded if “the applicant . . . occupies or intends to return
to the home.”41 In other words, if an applicant moves out of his principal
place of residence, he must intend to return to that home for it to remain
excludable. A later developed “intent to return” to the Cleburne house
does not bring the Burts within the exclusion because it was not their
residence in the years preceding their Medicaid claim. In other words,
the Burts’ ownership, occupancy, and intent to return never coincided in
the property before their claim for Medicaid assistance arose.
The regulations recognize exceptions that illustrate the statutory
rule. For example, an individual who moves out of a principal place of
residence with no intent to return because the individual is fleeing
domestic violence may exclude it until the individual establishes a new
principal place of residence.42 This subsection does not support the
notion that the Burts may maintain a home exclusion for a house they
sold years earlier.43

40 20 C.F.R. § 416.1212(c) (emphasis added).

41 1 Tex. Admin. Code § 358.348(a)(1) (emphasis added).

42 20 C.F.R. § 416.1212(d).

43 This is not a case about leaving a Medicaid applicant without a home.

Presumably the Burts’ daughter did not require her parents to transfer nearly
all their worldly possessions to her (including a life insurance policy naming
her as the beneficiary) to have a home, or to return to the property they
occupied during the years before their claim arose. This instead is a case of
generational wealth transfer without payment of medical debt—debt that
ordinary citizens owe against the estate’s assets before they inherit. The law
limits government assistance to the truly needy and imposes strict limits on

14
Still another section of the federal regulations lends support to a
construction requiring occupancy. Subsection (e)(1)—entitled
“[p]roceeds from the sale of an excluded home”—permits an applicant to
exclude the proceeds from the sale of an excluded residence if they are
used within three months to purchase another home.44 If one sells an
excluded home and purchases a new home within three months, it is
then “similarly excluded.”45 This allows Medicaid applicants to sell their
houses, irrespective of their Medicaid application, so long as the
proceeds are invested in a home within three months. This regulation
preserves an existing exclusion; it does not create a new exclusion based
on future occupancy. Rather, the regulation presumes occupancy of a
residence before the claim for assistance arises.
Finally, while the regulations count property “that an individual
(or spouse, if any) owns and could convert to cash to be used for his or
her support and maintenance” as available resources, they do not
conversely exclude available cash converted to purchase a home after
the claim arises.46 Collectively, the regulations align with the law that

eligibility. The dissent would saddle future generations with obligations to the
few who undertake elaborate estate planning to impoverish their elderly
parents, at least on paper, after the need for skilled-nursing care arises.
44 Id. § 416.1212(e)(1).

45 Id.

46 Id. § 416.1201. Our holding does not interfere with Texas’s ABLE

account program or ABLE account holders’ ability to purchase a home. ABLE
accounts are accounts for qualifying disabled individuals. Overview, Texasable,
https://www.texasable.org/about/#overview (last visited Apr. 29, 2024).
Contrary to the dissent’s discussion, a distribution from an ABLE account for
Qualified Disability Expenses, including housing, is not included as an asset

15
does not permit post-claim conversion of eligible resources absent a
recognized exception.
Ms. Wallace also relies on the Social Security Administration’s
Program Operations Manual System to support her argument that an
applicant’s subjective intent is all that matters. The Program
Operations Manual is “used by Social Security employees to process
claims for Social Security benefits.”47 It defines “[p]rincipal place of
residence” as “the dwelling the individual considers their established or
principal home and to which, if absent, they intend to return.”48
The Manual does not have the force and effect of law; it is the
statute that controls.49 Written employee guidance cannot be used to
contravene a statute. Even so, Ms. Wallace misapprehends the Manual.
While the Manual uses “considers” in defining principal place of
residence, it does not negate that one must reside in a house to include
it among properties that can qualify as an “established or principal”
home. As with absent service members, one may have more than one
“dwelling” or residence, but the principal place of residence is the one

for eligibility purposes for programs like Medicaid. See Frequently Asked
Questions, Texasable, https://www.texasable.org/faqs/ (last visited Apr. 29,
2024). If an individual with an ABLE account purchases and moves into a home
using those funds, it is an excludable principal place of residence.
47 POMS Home, Social Security Administration, https://secure.ssa.gov

/apps10/poms.nsf/Home?readform (last visited Apr. 29, 2024).
48 Social Security Administration, Program Operations Manual
System SI 01130.100.A.2 (2023), https://secure.ssa.gov/apps10/poms.nsf/lnx/
0501130100.
49 Combs, 422 S.W.3d at 635 (noting that this Court does not defer to an

agency interpretation that is “plainly erroneous or inconsistent with the
language of the statute”).

16
the individual considers his “established or principal” home.50
Recognizing as much, the Manual acknowledges that “‘intent to
return’ . . . applies only to the continued exclusion of property which met
the definition of the individual’s home prior to the time the individual
left the property.”51 In other words, the property must be the applicant’s
principal place of residence before the applicant’s departure with an
intent to return to it for it to remain excludable. The Manual also
provides that “[p]roperty ceases to be the principal place of residence as
of the date that the individual left it with no intention of returning.”52
The Burts left the Cleburne house with no intention to return when they
sold it to the Wallaces, living elsewhere for seven years. Accordingly,
under the Manual, it had ceased to be their principal place of residence
long before the claim for Medicaid assistance arose.
D
Residency is a familiar concept in other areas of the law. While
not controlling in the interpretation of a federal statute, we note that
requiring physical presence, and not merely future intent, coheres with
this Court’s interpretation of residence in areas such as election law and

50 In the section entitled “How to develop the principal place of
residence,” the Manual provides that “[a]bsent ownership in more than one
residence or evidence that raises a question about the matter, assume that the
alleged home is the individual’s principal place of residence.” Social Security
Administration, Program Operations Manual System SI 01130.100.C.5.a
(2023), https://secure.ssa.gov/apps10/poms.nsf/lnx/0501130100 (emphasis
added). Here, the Burts did not reside in the Cleburne house, which raises a
question about whether it was, in fact, their principal place of residence.
51 Id. at SI 01130.100.C.7.c. (emphasis omitted).

52 Id. at SI 01130.100.B.5.

17
civil procedure. For example, in Mills v. Bartlett, an election law case,
we held that “residence cannot be determined by intention alone.”53
While subjective intent plays a role in determining primary residence,
“action” is also a factor.54 Ultimately, “[n]either bodily presence alone
nor intention alone will suffice to create the residence, but when the two
coincide[,] at that moment the residence is fixed and determined.”55
Similarly, in Owens Corning v. Carter, a case regarding a statute that
mandated dismissal of certain asbestos lawsuits brought by non-Texas
residents, we held that “although intent is necessary to establish a
permanent residence, it alone is not sufficient to establish a permanent
residence.”56 The same holds true here. Intent is a necessary element of
establishing a home, but intention alone is insufficient. It must coincide
with presence at some point. The Burts declared their intent to
principally reside in the Cleburne house, but their intent failed to
coincide with their physical presence.
* * *
We hold that a Medicaid applicant’s “home,” for purposes of 42
U.S.C. § 1382b, is the applicant’s principal place of residence before the
claim for assistance arises, coupled with the applicant’s intent to return
to that residence in the future. The purchase of a property interest with
Medicaid-available funds after the claim arises does not exclude that
interest from the calculation of available resources. Because the

53 377 S.W.2d 636, 637 (Tex. 1964).

54 Id.

55 Id.

56 997 S.W.2d 560, 571 (Tex. 1999) (citing Mills, 377 S.W.2d at 637).

18
Commission did not err in calculating the Burts’ eligibility for Medicaid,
we reverse the judgment of the court of appeals and render judgment for
the Commission.

Jane N. Bland
Justice

OPINION DELIVERED: May 3, 2024

19