Income & Asset Limits for Eligibility
There are several different Medicaid
long-term care programs for which elderly Texans may be eligible.
These programs have slightly different eligibility requirements and
benefits. Further complicating eligibility are the facts that the
criteria vary with marital status and that Texas offers multiple
pathways towards eligibility.
1) Institutional / Nursing Home
Medicaid - is an entitlement (anyone who is eligible will receive
assistance) & is provided only in nursing homes.
2) Medicaid
Waivers / Home and Community Based Services - Limited number of
participants. Provided at home, adult day care, adult foster care
home, or in assisted living.
3) Regular Medicaid / Aged Blind and
Disabled - is an entitlement (persons who meet the eligibility
requirements are guaranteed program benefits) and is provided at
home or adult day care.
The table below provides a quick
reference to allow seniors to determine if they might be immediately
eligible for long term care from a Texas Medicaid program.
Alternatively, one can take the Medicaid Eligibility Test.
IMPORTANT, not meeting all the criteria below does not mean one is
not eligible or cannot become eligible for Medicaid.
What Defines "Income"
For Medicaid eligibility purposes, any
income that a Medicaid applicant receives is counted. (Additional
information on how Medicaid counts income). To clarify, this income
can come from any source. Examples include employment wages, alimony
payments, pension payments, Social Security Disability Income,
Social Security Income, IRA withdrawals, and stock dividends.
However, when only one spouse of a married couple is applying for
institutional Medicaid or HCBS Medicaid waiver benefits, only the
income of the applicant is counted. Said another way, the income of
the non-applicant spouse is disregarded. However, to be clear,
income is counted differently in the case of just one spouse
applying for regular Medicaid. When this happens, the income of both
spouses is counted towards the applicant spouse's eligibility.
There is also a Minimum Monthly Maintenance Needs Allowance
(MMMNA), which is the minimum amount of monthly income to which the
non-applicant spouse of a nursing home Medicaid applicant of
Medicaid waiver applicant is entitled. As of January 2019, a
non-applicant spouse may receive as much as $3,160.50 / month from
his or her applicant spouse. This rule allows the Medicaid applicant
to transfer income to the non-applicant spouse to ensure he or she
has sufficient funds with which to live.
What Defines "Assets"
Countable assets include cash, stocks,
bonds, investments, credit union, savings, and checking accounts,
and real estate in which one does not reside. However, for the
purposes of Medicaid eligibility, there are many assets that are
considered exempt (non-countable). Exemptions include personal
belongings, household furnishings, an automobile, irrevocable burial
trusts, and one's primary home, given the Medicaid applicant or his
or her spouse lives in the home and the home is valued under
$585,000 (in 2019).
For married couples, as of 2019, the
community spouse (the non-applicant spouse of an institutional
Medicaid applicant or HCBS waiver applicant) can retain 50% of the
couple's joint assets, up to a maximum of $126,420, as the chart
indicates above. However, if 50% of the couple's joint assets is
less than $25,284, the non-applicant spouse is entitled to 100% of
the assets, up to $25,284. This, in Medicaid speak, is referred to
as the Community Spouse Resource Allowance (CSRA).
In Texas,
there is a 5-year Medicaid Look-Back Period, which is the period of
time that the state looks back on asset transfers. If during this
time frame, a Medicaid applicant has given away assets or sold them
under fair market value, a period of Medicaid ineligibility may
ensue.
Qualifying When Over the Limits
Texas has a Medicaid eligibility income cap,
and unlike many states, does not allow one to "spend down" excess
income on medical expenses in order to qualify for Medicaid.
However, for Texas residents, 65 and over who do not meet the
eligibility requirements in the table above, there are other ways to
qualify for Medicaid.
1) Qualified Income Trusts (QIT's) - A
QIT, also referred to as a Miller Trust, is an irrevocable trust,
which allows a way for one to become eligible for long-term Medicaid
services even if he or she is over the income limit. In a nutshell,
a Medicaid applicant's income over the Medicaid limit is deposited
into a QIT and is not counted towards Medicaid eligibility. A
designated trustee manages the account, and the trustee can use the
funds for only designated purposes, such as paying unreimbursed
medical expenses of the Medicaid enrollee.
Make note,
Qualified Income Trusts do not assist one who has assets over the
Medicaid qualification limit. Said another way, if one meets the
income requirements for Medicaid eligibility, but not the asset
requirement, Qualified Income Trusts have no impact on one's assets.
However, one can still meet the asset limit by "spending down"
excess assets on non-countable assets, such as home modifications,
like the addition of wheelchair ramps or stair lifts, prepaying
funeral and burial expenses, and paying off debt.
2) Medicaid
Planning - the majority of persons considering Medicaid are
"over-income" or "over-asset" or both, but still cannot afford their
cost of care. For persons in this situation, Medicaid planning
exists. By working with a Medicaid planning professional, families
can employ a variety of strategies to help them become Medicaid
eligible.
Specific Texas Medicaid Programs
Texas offers its residents several Medicaid
programs, some of which are entitlements and others have limited
enrollment. Nursing home care is an entitlement for all Texas
residents that require it and meet the program's financial criteria
(outlined in the table above).
The STAR+PLUS Waiver is a
limited enrollment, managed care program that covers assisted
living, adult foster care, and many in-home supports to help
beneficiaries avoid nursing home placement.
The Community
First Choice (CFC) Program is an entitlement program that, in
addition to personal care, provides in-home support, such as meal
preparation, medical alert services, and chore services.
Primary Home Care (PHC) is another program that provides for
personal care in the home. However, this program allows participants
to choose their caregivers, and select family members can be hired
as caregivers.
Day Activity and Health Services (DAHS) is an
adult day care program that helps families care for their loved ones
outside of nursing homes by paying for daytime supervision and
health services during normal working hours.
How to Apply for Texas Medicaid
Texas seniors can apply online for Medicaid
at Your Texas Benefits or submit a completed paper application,
which can be found here. For assistance with the application process
or to request a paper application be mailed to you, call
1-877-541-7905. Seniors might also find their local Area Agency on
Aging office helpful in regards to answering program questions and
providing application assistance.
Prior to submitting an
application for Medicaid benefits in Texas, it is imperative that
seniors are certain that all eligibility requirements (as discussed
above) for the program in which they are applying are met. Persons
who have income and / or assets over the limit(s), or are unsure if
they meet the eligibility criteria, should seriously consider
Medicaid planning.
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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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