Established in 1965 and jointly funded by federal and state governments, Medicaid provides limited health coverage to needy children, adults with disabilities and seniors. Every state-administered Medicaid plan must include certain mandatory benefits, such as hospital services, primary physician care, home care and nursing facility services. States may choose to offer additional Medicaid benefits that can include prescription drug coverage, rehabilitation therapies, personal care and adult day health programs.
In Texas, county-specific managed care organizations deliver most Medicaid services. To qualify for long-term coverage with access to home and community-based services, seniors must:
- Be permanent Texas residents
- Be a U.S. citizen or have a qualifying immigration status
- Require at least 30 days of continuous care at the level normally provided in a nursing facility, as verified by a licensed physician
- Have a monthly income of $2,313 or less or have a joint monthly income of $4,626 or less when applying with a spouse
- Own up to $2,000 in countable assets or up to $3,000 in joint countable assets when applying with a spouse
Countable assets include all cash and bank account balances, stocks and bonds, and investment properties. Exempt assets include one personal vehicle, a life insurance policy worth $1,500 or less, a prepaid burial contract and a home owned and occupied by the applicant worth up to $585,000.
Community Spouse Income and Asset Exemptions When only one spouse in a married couple needs long-term Medicaid coverage, the community spouse’s income is disregarded. If the community spouse is financially dependent on the Medicaid applicant, the applicant can transfer up to $3,160.50 per month from their income to the community spouse to cover shelter costs.
The community spouse is also entitled to all joint non-countable assets, such as an owner-occupied home, and half of the couple’s joint assets up to a $126,420 maximum.
Income Cap and Qualified Income Trust Texas is a Medicaid income-cap state, so residents can’t spend down their excess income on medical costs to achieve Medicaid eligibility.
Texas Medicaid rules do permit the use of a
Qualified Income Trust by seniors who are ineligible due to excess income. This irrevocable legal agreement lets seniors divert income that exceeds the $2,313 monthly limit into a trust. The State must be named the beneficiary of the QIT, and upon death, the State receives the funds in the QIT to cover Medicaid costs paid on behalf of the trustee. Note that a QIT can only be used for excess income, not excess assets.
STAR+PLUS Medicaid Managed Care Program Medicaid-enrolled seniors who meet the clinical requirements for nursing home placement may be eligible for
STAR+PLUS, a managed care program that prevents nursing home placement by funding home and community-based services. These services are assigned based on medical need, may be delivered in an assisted living setting and can include:
- Adult day activity and health services
- Personal care
- An emergency response system
- Medical supplies and mobility equipment
- Minor home adaptations to improve safety and accessibility
- Skilled and intermittent nursing care
- Occupational, physical and speech-language therapy
- Respite care
- Adaptive devices
- Home-delivered meals
Seniors who wish to move from a nursing facility into an assisted living setting may also receive transitional assistance. Some STAR+PLUS plans also offer value-added services, such as extended dental and vision benefits.
In Tarrant County, STAR+PLUS participants can choose to receive services through either the Superior HealthPlan or the UnitedHealthcare Community Plan. Upon acceptance into STAR+PLUS, seniors get an information packet describing the available managed care options. Participants must select a plan, or else one is automatically assigned.
For more information on Texas Medicaid, QITs and the STAR+PLUS program, contact
Texas Health and Human Services at (888) 337-6377 or the
Aging and Disability Resource Center of Tarrant County at (855) 937-2372.