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Please keep in mind that the following information does not substitute for the advice of an attorney. To discuss your specific situation, please contact an elder law attorney.
What is Meant by Nursing Home Medicaid Eligibility?
While Medicare covers some skilled nursing facility care, it will only cover this care for a limited amount of time (up to 100 days in a benefit period) if you meet certain criteria. ... Medicaid may also pay for some medical services that are not covered by Medicare, such as routine dental care.
Good nursing home care is not cheap. In Texas, the average cost of nursing home care is more than $60,000 per year.
Medicaid will pay for a nursing home only when it is "medically necessary." In Texas, for a nursing home to be considered medically necessary, you must have a medical condition that is so serious that you need the level of nursing care that is only available in an institution.
Your doctor must document your medical condition and must prescribe skilled nursing services to be provided to you on a regular basis in an institutional setting. Nursing care includes things like giving shots, inserting a feeding tube or catheter, treating bed sores, and changing wound dressings.
Medicaid can pay for care in a nursing home, once a person who qualifies has been in a Medicaid-certified bed for at least 30 days in a row. Medicaid may pay for your nursing home care if you have a low income, limited resources, and a medical need for nursing home care. You must also be a United States citizen or a qualifying alien, as well as a Texas resident.
Income: If you’re not married, you can make up to $2,205 per month
from all sources (or more, in some cases, as explained on page 7).
If you are married, and your spouse
also needs nursing home Medicaid, your combined income can be no more than $4,410 per month. Government checks, paychecks, interest and rental payments, annuities,
mineral rights, and gifts are considered income.
Resources: If you’re not married, you can
have no more than $2,000 in resources. If you are married, and your
spouse also needs Medicaid to pay for care in a nursing
home, your combined resources can be no more than $3,000. Resources include cash in checking and savings accounts, certificates of deposit, other liquid assets, and
property other than your homestead or burial plot.
However, not all resources are taken into consideration when you apply for Medicaid. Here are some resources that are exempt in most cases:
– A homestead with no more than $560,000
– One vehicle, regardless of value
– A life insurance policy with no more than $1,500 cash value
– A burial plot
Medical Need for Nursing Home Care: To qualify for nursing home Medicaid, you must have specific medical needs. How do you know, or prove, that you meet the
medical requirements? A nurse or other health care professional (often the director of nurses at the nursing home) assesses your health and then sends the assessment form to the Texas Medicare and Healthcare Partnership (TMHP) for review. TMHP decides whether you meet “medical necessity” requirements.
If your income, resources, and medical needs
are within the Medicaid guidelines, Medicaid will begin to pay for
your care in a nursing home. You’ll be expected to help pay for your
care in the nursing home, usually by turning over your monthly
income to the nursing home. In most cases, you will be allowed to
keep $60 per month for
A Texas elder law attorney can advise you about Medicaid assistance. Certified Elder Law Attorneys (CELAs) have years of accumulated knowledge covering a broad range of legal issues affecting seniors and persons with disabilities.
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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DISCLAIMER: Links to other websites or references to products, services or publications do not imply the endorsement or approval of such websites, products, services or publications by Elder Options of Texas. The determination of the need for senior care services and the choice of a facility is an extremely important decision. Please make your own independent investigation.