Medicaid is the government-funded program that provides low-income seniors, adults with disabilities and families with children basic health care coverage. Medicaid is administered at the state level, and federal law dictates that the following Medicaid services must be provided:
- Inpatient and outpatient hospital services
- Nursing home care
- Physician services
- X-rays and lab services
- Home health services
- Transportation to medical care
Long-term Medicaid care services may be available through waivers and special state-specific programs.
In Texas, most Medicaid services are delivered through managed care organizations under contract with the Department of Health and Human Services. To qualify for enrollment, applicants must be permanent Texas residents, have a valid social security number and either a U.S. citizen or authorized immigrant. Seniors must also require at least 30 days of continuous care at a level normally provided in a nursing home.
Seniors
aged 65 and older can earn up to $2,313 per month ($4,626 per couple) and own up to $2,000 in assets ($3,000 per couple). Income from most sources is included, however, VA pensions are not.
Some assets are also excluded from Medicaid asset limits, such as a home worth up to $585,000 that the applicant and/or their spouse lives in, clothing, furniture, one vehicle and prepaid burial contracts.
Community Spouse Income and Asset Rules Special eligibility rules apply when one spouse requires long-term Medicaid services and the other spouse doesn’t. The income of the non-applicant spouse, called the community spouse, is not a factor in determining Medicaid eligibility for their spouse.
Medicaid has a minimum monthly maintenance needs allowance rule in order to prevent impoverishment of the community spouse and provide support for shelter costs. The applicant may transfer up to $3,160.50 of their income to their spouse and deduct that amount from their income on their Medicaid application.
The community spouse can also keep up to $126,420 worth of the couples’ joint assets, and up to 50% of the value of the joint assets (excluding the marital home and one vehicle), under the community spouse resource allowance rule.
STAR+PLUS Medicaid Managed Care Program Seniors with long-term Medicaid coverage may qualify for community-based services and supports through
STAR+PLUS, a Texas Medicaid managed care nursing-home diversion program.
STAR+PLUS lets medically-fragile seniors remain in their home or an assisted living facility by funding enhanced medical and nonmedical services and supplies, such as:
- Mobility devices and assistive aides
- Nursing care
- Occupational, physical and/or speech therapy
- Respite care
- A personal emergency response system
- Help with activities of daily living, such as bathing, getting dressed and eating
- Assisted living
- Transitional support for seniors who wish to move from a nursing facility into an assisted living setting
All STAR+PLUS plans include mandatory Medicaid benefits, such as basic health care services and hospitalization. Some STAR+PLUS plans include
value-added services, such as additional vision and dental care, exercise kits, gift programs and access to a 24-hour nurse line.
Brazoria County is in the STAR+PLUS Harris Service Area, and the plan providers are Amerigroup, Molina Healthcare of Texas, and United Healthcare Community Plan. Seniors must choose a plan within 15 days of receiving confirmation of their STAR+PLUS approval, otherwise, the Health and Human Services Commission can designate a plan provider and a primary care physician.
For more information on Medicaid and the STAR+PLUS program, contact the nearest
Health and Human Services Commission office by calling (888) 337-6377.