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Medicaid for Texas Seniors and the Elderly

Texas Medicaid Eligibility Requirements For Seniors & Elderly

Elderly man in nursing home with nurse aide. 

Can Senior Citizens Get Medicaid?

Yes. If a senior is financially and medically qualified, Medicaid will pay nearly all of his or her long term care costs. In Texas, long-term care is expensive, whether in a nursing home, assisted living facility, or home health care. Medicare coverage for long-term care is very limited, private health insurance policies generally do not cover long-term care, and few people have purchased private long-term care insurance policies.

For Texans needing long-term care, Medicaid is the most common source of funding. Medicaid is funded by both federal and state funds, and it provides health insurance to about 14% of Texans.

There are many different ways to become eligible for Medicaid in Texas, and Texas has specific eligibility rules for long-term care services like nursing homes, assisted living facilities, and home health care services. Assisted living facilities provide food, personal care services like help with bathing or dressing, and medication administration.

Historically, Medicaid did not pay for assisted living facilities. However, Texas has two programs that offer Medicaid payment for assisted living facilities, if you meet specific criteria.

If you are otherwise eligible for Medicaid and if you can show that a nursing home is medically necessary for you (also called “meeting the nursing home level of care”), then you may qualify for Community Based Alternative (CBA) Medicaid or for STAR PLUS Medicaid Waiver services.

Both programs pay for home and community based services, including assisted living facilities, for people who would otherwise have to be institutionalized in a nursing home. CBA and STAR PLUS have limited enrollment and are not available in all parts of the state. For more information, contact your local Texas Department of Aging and Disability Services office.

Texas has a particular kind of assisted living facility called a continuing care facility (CCF). CCFs provide custodial care through round-the-clock supervision, but not round-the-clock nursing care. CCFs are not covered by Medicaid.

Asset Limits in Texas for Medicaid

Individuals in Texas are allowed to keep $2,000 when they apply to Medicaid for long term care. If they are over this amount, they must spend down on care. It is important to note, that individuals are not allowed to give gifts of any amount for a period of 5 years (60 months) prior to applying to Medicaid. If an individual's assets are more than $2,000, they should learn about Medicaid Planning strategies. This asset limit only applies to assets that are considered countable assets.

Couples that both require Medicaid for long term care in Texas are allowed to keep $3,000 in assets. If there is one spouse that requires care, and one that does not, the spouse that does not receive care is referred to as the Community Spouse. The Community spouse is allowed to keep 50% of their assets up to $120,900 in countable assets. The Community Spouse is allowed to keep 100% of their marital assets up to $24,180.

The maximum amount of home equity allowed when applying to Medicaid is $560,000. Desipte the fact the home is not a countable asset, Medicaid, can look for repayment in probate court from the proceeds of a sale after it stops paying for care. It is important to understand if your home may be subject to the Medicaid repayment process.

Texas does not allow individuals to qualify for Medicaid by “spending down” their income on qualifying medical expenses until they reach Medicaid income limits. Texas does, however, allow individuals to place some extra monthly income in a trust that would let a person qualify financially for Medicaid. These trusts are called “Medicaid Trusts” or “Miller Trusts”.  If you meet the non-financial criteria for Medicaid but have been told that you are over-income for the program, you should consult an attorney to see whether a trust can help you qualify.

Income Limits in Texas for Medicaid

In Texas the individual receiving Medicaid cannot have income over $2,205. If their income is over that amount, they will need to do some Medicaid Planning to create eligibility. One strategy that works well is a Miller Trust (also known as a Qualified Income Trust). If an individual is married, the spouse's income does not typically count towards the income cap, but it is important to maximize income protection via the Monthly Needs Allowance rules. The maximum amount of income the Medicaid office allows a community spouse to keep in Texas is $3,022. All of an individual's income must go towards their cost of care, aside from $60 which is for a personal needs allowance.

Does Medicaid Pay for Long-term Care?

Yes, Medicaid pays for long-term care in a nursing home. In a few states it also pays for long-term senior care in the home. Medicare, on the other hand, does not pay for long-term care.

If I Give Away My House and All My Money Will I Qualify?
Not anymore. There is a 5-year look-back law now. Uncle Sam can find your money and make you pay. You should consult an Elder-law attorney to understand the acceptable ways to "spend-down" assets to qualify for Medicaid as a low-income senior. You can gift some assets, within limits, to a beneficiary, but you should remember that these assets will no longer be in your control. Also, remember that the leading type of elder abuse is financial, many times by a family member. Spousal poverty protection laws have been passed to allow the spouse of a senior who needs long-term nursing home care to maintain usually up to 50% of the couple’s assets.

How do I apply?

Applications are available through your state Medicaid program.

How soon will coverage start?
Coverage can possibly begin from 3-months prior to the application’s approval. Applications sometimes take longer than expected. You should ask about the usual approval timeframe when you submit your initial application for Medicaid coverage.

What is the minimum asset requirement to qualify?
Asset requirements are usually limited at $2,000.00.

Does Medicaid long-term care have a limit?
No, Medicaid will pay for long-term care in a nursing home for as long as a senior qualifies for needing the care, even if this means multiple years of care until death.


What are the basic eligibility requirements for long-term care Medicaid in Texas?

There are five basic requirements that must be satisfied in order to receive nursing home Medicaid services. The requirements are as follows:

1. Nationality and Residency. The Medicaid applicant must be either a U.S. citizen or an alien with qualified alien status. Additionally, the applicant must be a resident of Texas. There is no length of residence requirement. The applicant merely needs to reside in Texas and intend to remain or return to Texas.

2. Medicaid Facility, Medicaid Bed. To receive long-term care Medicaid, the applicant must be in a Medicaid certified facility and in a Medicaid bed for at least 30 consecutive days.

3. Medical Necessity. The Medicaid applicant must have “medical necessity” for nursing home care. The individual’s medical condition must be sufficiently serious that it requires the services of licensed nurses in an institutional setting. The medical services must be ordered by a physician and the conditions requiring regular skilled nursing care must be documented.

4. Income. The Medicaid income limit for an unmarried Medicaid applicant is $2,163 per month (in 2014). The income cap for a married applicant with an ineligible spouse is also $2,163 per month (in 2014). Importantly, this income cap is only applied to the income apportioned to the Medicaid eligible spouse using “the name on the check rule.” In other words, income received in the name of the ineligible spouse is not counted as income to the Medicaid eligible spouse. If both spouses live in the nursing home and apply for Medicaid, the income limit is doubled. The Medicaid income cap for a married couple, both of whom apply for or are receiving Medicaid is $4,326 per month (in 2014). If the above income caps are exceeded, a Qualified Income Trust (also known as a QIT or Miller Trust) can be used to overcome the income barrier to Medicaid eligibility.

5. Resources. Resources are categorized as “countable” and “excluded” for eligibility purposes. The resource eligibility limits, like the income limits, depend on whether the Medicaid applicant is married, married with an ineligible spouse, or has a spouse who is also applying for Medicaid benefits. Countable resources are counted as of 12:01 a.m. on the first day of the month.

  • Unmarried applicant.

The countable resources limit for an unmarried applicant is $2,000.

  • Married applicant with ineligible spouse.

The countable resource limit for a married applicant with an ineligible spouse is one half of the couple’s combined countable resources as of 12:01 a.m. of the first day of the month in which the eligible spouse began a period of continuous institutional care (i.e. first day of the month in which the eligible spouse was admitted to the nursing home or hospital, known as the “snapshot date”), subject to a minimum of $23,448 and a maximum of $117,240 (in 2014), known as the “spousal protected resource amount” or SPRA. The SPRA can be “expanded” if the married couple’s combined income is less than $2,931 per month (in 2014).

  • Married couple both of whom live in the nursing home and are applying.

The countable resource limit for a married couple, both of whom are applying for Medicaid nursing home benefits is $3,000.

  • Married couple both of whom live in the nursing home and only one is applying for Medicaid.

If both spouses live in the nursing home and only one spouse is applying for Medicaid, the countable resource limit for the applying spouse is $2,000. The countable resource limit for the spouse that is not applying for Medicaid is unlimited.

 

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Disclaimer: Elder Options of Texas is not rendering any legal or professional advice.  If legal advice is necessary the reader should consult a competent attorney.

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