Texas Medicaid Definition
Medicaid is a wide-ranging, jointly funded state and federal health care program for low-income individuals of all ages. However, this page is focused on Medicaid eligibility, specifically for Texas residents, aged 65 and over, and specifically for long term care, whether that be at home, in a nursing home, in an adult foster care home, or in assisted living. Most Medicaid plans in the state of Texas are provided by Managed Care Organizations (MCOs). Texas managed Medicaid for the elderly and disabled is often referred to as STAR+PLUS.
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. More.
|2020 Texas Medicaid Long Term Care Eligibility for Seniors|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||$2,349 / month||$2,000||Nursing Home||$4,698 / month||$3,000||Nursing Home||$2,349 / month for applicant||$2,000 for applicant & $128,640 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,349 / month||$2,000||Nursing Home||$4,698 / month||$3,000||Nursing Home||$2,349 / month for applicant||$2,000 for applicant & $128,640 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$783 / month||$2,000||None||$1,175 / month||$3,000||None||$1,175 / month||$3,000||None|
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.
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 2020, a non-applicant spouse may receive as much as $3,216 / 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. This spousal allowance is not relevant for couples in which one spouse is applying for regular Medicaid.
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 $595,000 (in 2020).
For married couples, as of 2020, 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 $128,640, as the chart indicates above. However, if 50% of the couple’s joint assets is less than $25,728, the non-applicant spouse is entitled to 100% of the assets, up to $25,728. This, in Medicaid speak, is referred to as the Community Spouse Resource Allowance (CSRA). In order to avoid confusion, it is important to mention that this resource allowance does not extend to non-applicant spouses of those applying for regular Medicaid.
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. As a side note, some people mistakenly think that the IRS gift tax exemption extends to Medicaid. Unfortunately, it does not, which sometimes leads to people unknowingly violating the look-back period.
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 ones that are non-countable, 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. Read more or connect with a Medicaid planner.
Specific Texas Medicaid Programs
Texas offers its residents several Medicaid programs, some of which are entitlements and others which 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).
1) 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.
2) 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. This program allows for self-direction, meaning program participants can hire the caregiver of their choosing, including some relatives, to provide them with personal care assistance.
3) Primary Home Care (PHC) is another program that provides for personal care in the home. This program, like Community First Choice, allows participants to choose their caregivers, and select family members can be hired as caregivers.
4) 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 Texas Health and Human Services at 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. For additional information about applying for long-term care Medicaid, click here.