Texas Medicaid Definition
Medicaid is a wide-ranging, jointly funded state and federal health care program for low-income individuals of all ages. While there are several different Medicaid eligibility groups, this page is focused on Medicaid eligibility for elderly Texas residents, aged 65 and over. Specifically, long term care is covered. In addition to nursing home care, assisted living services, and adult foster care services, Texas Medicaid pays for many non-medical support services that help frail seniors remain living in their homes.
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 called 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 varying eligibility requirements and benefits. Further complicating eligibility is that the criteria vary with marital status and that Texas offers multiple pathways towards eligibility.
1) Institutional / Nursing Home Medicaid – This is an entitlement program; Anyone who is eligible will receive assistance. Benefits are provided only in nursing homes.
2) Medicaid Waivers / Home and Community Based Services – This is not an entitlement program; The number of participants are limited and wait lists may exist. Intended to delay and prevent nursing home care, benefits are provided at home, adult day care, adult foster care home, or in assisted living. More about Medicaid Waivers.
3) Regular Medicaid / Elderly and People with Disabilities (MEPD) – This is an entitlement program; Persons who meet the eligibility requirements are guaranteed program benefits. Various long-term care benefits, such as personal care assistance or adult day care, may be available.
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 does not mean one is ineligible or cannot become eligible for Medicaid. More.
|2022 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||$2,523 / month*||$2,000||Nursing Home||$5,046 / month*||$3,000||Nursing Home||$2,523 / month for applicant*||$2,000 for applicant & $137,400 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,523 / month||$2,000||Nursing Home||$5,046 / month||$3,000||Nursing Home||$2,523 / month for applicant||$2,000 for applicant & $137,400 for non-applicant||Nursing Home|
|Regular Medicaid / Elderly and People with Disabilities||$841 / month||$2,000||Help with ADLs||$1,261 / month||$3,000||Help with ADLs||$1,261 / month||$3,000||Help with ADLs|
What Defines “Income”
Any income that a Medicaid applicant receives is counted. 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. Covid-19 stimulus checks and Holocaust restitution payments do not count as income and have no impact on Medicaid eligibility.
When only one spouse of a married couple applies for Institutional Medicaid or a Medicaid Waiver, only the income of the applicant is counted. This means the income of the non-applicant spouse is disregarded and does not impact the income eligibility of the applicant spouse. The non-applicant spouse, however, may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) from the applicant spouse to prevent spousal impoverishment. In 2022, the MMMNA in TX is $3,435 / month. If a non-applicant spouse has monthly income under this amount, income can be transferred from the applicant spouse to the non-applicant spouse to bring their income up to this level. A non-applicant spouse who already has an income of $3,435 / month or more is not entitled to a MMMNA / spousal income allowance.
Income is counted differently when only one spouse applies for Regular Medicaid; The income of both the applicant spouse and non-applicant spouse is calculated towards the applicant’s income eligibility. More on how Medicaid counts income.
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. There are also many assets that Medicaid considers to be exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts, and generally one’s primary home. For home exemption, the Medicaid applicant must live in the home or have intent to return and have a home equity interest no greater than $636,000 (in 2022). Equity interest is the value of the home, minus any outstanding debt, in which the Medicaid applicant owns. If the applicant has a spouse living in the home, it is exempt regardless of where the applicant lives and their home equity interest.
All assets of a married couple are considered jointly owned regardless of the long-term care Medicaid program for which one is applying. However, the non-applicant spouse of an Institutional Medicaid or Medicaid Waiver applicant is permitted a Community Spouse Resource Allowance (CSRA). In 2022, the community spouse (the non-applicant spouse) can retain 50% of the couples’ assets, up to a maximum of $137,400, as the chart indicates above. If the non-applicant’s half of the assets is under $27,480, 100% of the assets, up to $27,480 can be retained by the that spouse.
Texas has a 5-year Medicaid Look-Back Period that immediately precedes one’s Medicaid application date. During this period, the state looks back on all asset transfers. If a Medicaid applicant has gifted assets or sold them under fair market value, a period of Medicaid ineligibility will be determined. This is because it is assumed assets were transferred to meet Medicaid’s asset limit. Some persons mistakenly think that the IRS gift tax exemption extends to Medicaid and unknowingly violate the look-back period.
Qualifying When Over the Limits
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) – Also called Miller Trusts, QITs are irrevocable trusts that allow Institutional Medicaid and Waiver applicants who are over the income limit to still become eligible for long-term care Medicaid. Irrevocable means that the terms of the trust cannot be altered or canceled. In a nutshell, a Medicaid applicant’s “excess” income (over the Medicaid limit) is deposited into the QIT and is no longer counted towards Medicaid eligibility. A designated trustee manages the trust and can only use funds for designated purposes, such as paying unreimbursed medical expenses of the Medicaid enrollee.
2) Asset Spend Down – Persons who have assets over the Medicaid limit can still become asset eligible by “spending down” excess assets on ones that are non-countable. Examples include making home modifications, like the addition of wheelchair ramps or stair lifts, prepaying funeral and burial expenses, and paying off debt. Remember that assets cannot be gifted or sold under fair market value, as it violates Medicaid’s look back rule. When “spending down”, it is best to keep documentation of how assets were spent as evidence the look back period was not violated.
3) 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 these individuals, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible, as well as to protect their home from Medicaid’s estate recovery program. Read more or connect with a Medicaid planner.
Specific Texas Medicaid Programs
1) STAR+PLUS Waiver – This 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) Community First Choice (CFC) Program – An entitlement program that, in addition to personal care, provides in-home support, such as meal preparation, medical alert services, and light housework. 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) – This is another program that provides for personal care in the home. Like Community First Choice, program participants can choose their caregivers, which includes the ability to select family members.
4) Day Activity and Health Services (DAHS) – This is an adult day care program that helps families care for their loved ones outside of nursing homes. Daytime supervision and health services are provided at community facilities during normal working hours.
5) Texas Community Attendant Services (CAS) – Provides non-medical personal care assistance, homemaker services, and transportation assistance to / from medical appointments.
6) Program of All-Inclusive Care for the Elderly (PACE) – The benefits of Medicaid, including long-term care, and Medicare are combined into a single program. Additional benefits, such as dental care and eye care, may be available.
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 mailed application, call Texas Health and Human Services at 1-877-541-7905. One’s local Area Agency on Aging office might also be helpful in answering program questions and providing application assistance.
Prior to applying for Medicaid benefits in Texas, it is imperative that seniors be 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.