Established in1965 by the federal government, Medicaid provides limited health coverage to low-income people who have few assets. Medicaid is administered at the state level, and plans must include certain mandatory benefits such as inpatient and outpatient hospital care, nursing facility care and basic diagnostic tests. Optional services may be made available through state-specific waivers and programs.
The Department of Health and Human Services manages the Texas Medicaid program, and managed care organizations provide most Medicaid services. To be eligible for long-term coverage with access to home and community-based services for assisted living residents, seniors 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).
Some assets aren’t counted toward the Medicaid asset limit, including an owner-occupied home worth up to $585,000, prepaid burial contracts and personal effects.
Texas Medicaid applicants must also be permanent residents of the state, have either U.S. citizenship or qualifying immigration status and need 30 or more days of continuous care in a nursing facility as assessed by a physician.
Spousal Income and Asset Rules
If only one spouse in a married couple needs long-term Medicaid services, special income and asset rules are in place to prevent impoverishment of the non-applicant (community) spouse. The community spouse isn’t expected to pay for the care of the applicant spouse; therefore, the income of the community spouse isn’t considered when determining Medicaid eligibility.
Under the minimum monthly maintenance needs allowance clause, the non-applicant may collect up to $3,160.50 per month in income transferred from the applicant to cover living expenses such as rent and utilities. The non-applicant spouse can also keep the lesser of 50% of the couple’s joint assets or $126,420 under the community spouse resource allowance clause.
Income Cap and Qualified Income Trust
As a Medicaid income-cap state, Texas doesn’t have a Medicaid spend-down (also known as medically needy) program for seniors with incomes that exceed the $2,313 per month income cap.
Texas does permit the use of a Qualified Income Trust, also known as a Miller Trust, to reduce an applicant’s income to achieve Medicaid eligibility. A QIT is a non-revocable legal agreement that allows seniors to redirect their excess income into a trust that names the State as the beneficiary. Only income (not assets) can be diverted to the QIT, and money in the trust can be used for specific, preapproved medical expenses.
Upon death, the State receives any funds remaining in the QIT up to the amount paid for Medicaid services by the State on behalf of the trustee.
STAR+PLUS Medicaid Managed Care Program
Seniors with Medicaid coverage who require the level of long-term care normally offered in a nursing home may be eligible for STAR+PLUS, a Texas Medicaid managed care nursing-home diversion program.
STAR+PLUS funds home and community-based services for seniors 65 and older to delay or prevent institutionalization of medically fragile Medicaid participants. Services are assigned according to medical need as determined by a plan of care developed by participants, their family and designated health-care providers.
Services that may be delivered to STAR+PLUS participants who reside in an assisted living setting include skilled and intermittent nursing, medical supplies and adaptive aids, respite and personal care, and rehab therapy.
STAR+PLUS enrollment is also open to seniors currently residing in a nursing facility who want to move to an assisted living setting.
Carrollton residents who reside in Denton County receive STAR+PLUS services through either Amerigroup or Cigna-HealthSpring. The managed care providers in Dallas and Collin counties are Molina and Superior.
For more information on Medicaid, QITs and the STAR+PLUS program, contact the nearest Health and Human Services Commission office by calling (888) 337-6377.