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 Understanding How Texas Medicaid Works

Health Care Coverage: Medicaid for people ages 65 years or older and
people who have a disability

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A person who is 65 years or older, or a person who has a disability, may receive Medicaid assistance if he or she meets income and resource limits set by the program.

The amount of resources that a person owns is considered when deciding if he or she can receive Medicaid. Resources can include bank accounts, certificates of deposit, property, cash value of most life insurance, stocks and bonds. Resources do not usually include the value of a person’s home, vehicle, limited burial fund or personal belongings.

Also See: Spousal Impoverishment

Medicaid for Long-Term Care

A person who needs 30 or more days of continuous, long-term care may be able to receive Medicaid if income and resource limits set for the program are met. Medicaid may also pay for medical services that were received three months before the person applied for assistance.

A person who receives Medicaid for long-term care must pay a portion of the cost by using all of his or her income, except for a small monthly allowance for personal needs and certain deductions such as health insurance premiums.

Long-term care services can be provided through community programs while the person is living at home or while the person is living in a long-term care facility, such as a nursing facility, institution for mental diseases or facility for the mentally retarded.

The benefit period for long-term Medicaid services is usually one year. Before the end of the benefit period, a renewal application will be sent to that person, or his or her authorized representative.

Medicaid for people who receive Supplemental Security Income

A person who receives Supplemental Security Income (SSI) automatically receives Medicaid. HHSC sends information about Medicaid services to people receiving Supplemental Security Income.

If a person receiving Supplemental Security Income needs help paying for medical services that were received three months before applying for Supplemental Security Income, he or she must complete a Medicaid application to request this help. Income and resource limits set by this program must be met.

To learn more about how to apply for Supplemental Security Income, visit the U.S. Social Security Administration web site or call the toll-free number, 1-800-772-1213.

Medicare Savings Programs

Medicare Savings Programs are for people who receive Medicare and need help paying for Medicare premiums, co-insurance and deductibles. If a person meets income and resource requirements set by the program, Medicaid will help pay for some Medicare costs.

Income limits range from $867 to $1,734 for a person and $1,167 to $2,334 for a couple.  The amount of resources a person owns is also considered and can include bank accounts, certificates of deposit, property, cash value of most life insurance, stocks and bonds. Resources usually do not include the value of a person’s home, vehicle, limited burial funds or personal belongings.

People who receive Medicare and are interested in applying for a Medicare Savings Program must complete a HHSC Medicaid application.

The benefit period for Medicare Savings Programs is usually one year. Before the end of the benefit period, a renewal application will be sent to that person, or his or her authorized representative.

Medicaid Buy-In Program

With the Medicaid Buy-In program, people of any age who have a disability can have a job, earn money and still receive Medicaid if certain requirements are met. To participate in this program, most people must pay a monthly premium.

People enrolled in the Medicaid Buy-In program receive Medicaid health care services such as doctor visits, lab and X-ray services, hospital care, prescription drugs, eyeglasses, hearing aids and attendant care.

People with disabilities who want to participate in the Medicaid Buy-In program are allowed to have a higher income and more reources than allowed by other Medicaid programs. A person who earns as much as $4,320 each month may qualify. Some resources such as cash on hand and bank accounts are subject to limits. Retirement accounts and money set aside for health care and employment-related expenses are not counted when deciding if a person can participate in the Medicaid Buy-In program.

To take part in the Medicaid Buy-In program, a person must:

• Not permanently live in an institution (for example, a nursing facility or state hospital).
• Receive disability benefits through the Social Security Administration or meet Supplemental Security Income criteria without consideration of earned income.
• Work and pay federal income taxes based on earnings.
• Have earned more than $1,000 in the three months before applying for this program.

For additional information you can also visit The Texas Health and
Human Services Commission:

http://www.hhsc.state.tx.us/Help/HealthCare/65_and_Older/People_with_Disabilities.html

In the case of a couple where one spouse is entering a nursing home, his/her half of the assets must be legally preserved through Medicaid planning or be spent down in order to be qualified for Nursing Home Medicaid. It is important to know that there is a Spousal Impoverishment Law which provides income and asset protection for the well spouse of a Medicaid nursing home resident in an effort to prevent bankruptcy or financial hardship. This law states that the “community spouse” (well spouse) is entitled to a primary homestead, one car, all household goods, and many other assets.

The community spouse is also entitled to some asset protection up to a certain amount determined by Nursing Home Medicaid. The assets that the community spouse is allowed to keep is called the “Protected Resource Amount” (PRA). A qualified Medicaid Planning attorney may be able to help preserve assets even greater than the PRA amount. If you choose to seek an attorney for this purpose, it is important that they have experience in Medicaid Planning.

SOURCE: The Texas Health and Human Services Commission