Medicaid is the jointly funded state and federal program that provides low-income individuals with access to essential health services, such as hospitalization, X-rays and long-term care. Medicaid is a nationwide entitlement program, therefore, enrollment is guaranteed for everyone who meets the eligibility criteria.
In Texas, Medicaid is administered through Health and Human Services and most programs are delivered through managed care organizations. To qualify for long-term coverage that includes access to home and community based services, seniors must:
- Be aged 65 or older
- Be permanent residents of Texas
- Be a U.S. citizen, permanent resident or legal alien
- Need continuous long-term care for 30 days or more
- Earn under $2,313 per month in income from all sources
- Have less than $2,000 in cash, investments and nonresidential real estate ($3,000 when applying with a spouse)
Applicants are allowed to keep a home in which they and/or their spouse live, as long as that home is worth no more than $585,000.
Community Spouse Income and Asset Limits Special income and asset rules apply when only one spouse in a married couple needs long-term Medicaid.
The non-applicant, called the community spouse, can receive up to $3,160.50 per month in income that’s transferred from the applicant spouse to ensure the community spouse has enough money to live on.
The community spouse is also entitled to up to 50% of the couple’s joint assets, worth up to $126,420 under the community spouse resource allowance.
Note: Texas is a Medicaid income cap state. This means that seniors with income that exceeds Medicaid eligibility limits cannot spend-down their excess income on medical expenses in order to qualify for Medicaid coverage.
STAR+PLUS Managed Care Program Seniors aged 65 or older who have Medicaid coverage and need the type of care normally provided in a nursing facility may qualify for home and community based services through
STAR+PLUS, a Texas Medicaid managed care program.
STAR+PLUS lets medically fragile seniors remain in a community setting, such as assisted living, by funding additional services and supports that would normally be provided in a nursing home.
Services available through STAR+PLUS include:
- Assisted living
- Cognitive therapy
- Dental care
- Emergency response service
- Home delivered meals
- Skilled and intermittent nursing services
- Medical supplies and adaptive aids
- Minor home modifications to improve safety and accessibility
- Personal care services to assist with bathing, dressing and eating
- In-home respite care
- Rehabilitation services, such as physiotherapy
- Transition assistance for seniors currently living in a nursing facility
- Financial management services
Allen is located within the STAR+PLUS Dallas Managed Care Service Area where the managed care organizations are Molina and Superior.
For more information on Texas Medicaid and the STAR+PLUS program, contact the local
Texas Health and Human Services benefits office at (214) 750-4619.