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Texas Nursing Home Medicaid

There are many misconceptions about Medicaid in Texas.  Here are answers to some of the questions we are asked most frequently.

What is Medicaid?

Medicaid is a joint federal and state assistance program that pays for necessary medical care and treatment for persons who qualify.  Each state determines its own qualification criteria and benefits, therefore Medicaid eligibility generally does not transfer from one state to another.

Who Qualifies in Texas?

In Texas, Medicaid benefits are available only to low income children, pregnant women, persons with a permanent disability and persons over age 65 with a medical need.

What does Medicaid Cover?

There are several Medicaid programs in the State of Texas. The Nursing Home Medicaid Program covers long term nursing home care for persons with a medical and financial need.

Persons over age 65 who have Medicare can qualify for Qualified Medicare Beneficiary (QMB) Medicaid if they meet the financial criteria.  With QMB, Medicaid acts as a supplemental insurance to Medicare, paying the premium, deductibles and any coinsurance.

A third relevant Medicaid program is the STAR+PLUS Home and Community Based Services waiver (HCBS).  This program replaced the CBA program.  HCBS covers the cost of in-home or assisted living care for persons who meet the medical and financial requirements of Nursing Home Medicaid, but who can safely live in a more independent setting.

What are the asset and income limits for Nursing Home Medicaid?

For a single applicant for Texas Nursing Home Medicaid in 2019:

Monthly income can not exceed $2,313.

Total assets can not exceed $2,000. (Excluding the home and one car)

For a married applicant with a “community” spouse (lives at home):

Monthly income can not exceed $2,313, but up to $3,160.50 of the combined income can be allocated for the community spouse.

Total assets can not exceed $2,000, however, half the couple’s assets (up to $126,420) can be protected for the community spouse.

For a married couple both applying for Medicaid:

Monthly income can not exceed $2,313 for each spouse.

Total assets can not exceed $3,000.

What is “spend down” and the “look-back period”?

Medicaid will look-back over the past five years of financial transactions to determine whether any assets were given away, sold below their value or otherwise disposed of.  Medicaid allows certain expenditures during this period, but other transactions will cause a penalty and delay approval for Medicaid benefits.  Applicants should consult with an attorney experienced with Elder Law and Estate Planning issues if their assets or income exceed the allowable amounts.

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