Approximately 74% of Texas seniors have an income at or below the eligibility level for Medicaid. This federally mandated health protection plan provides low-income people of all ages with free access to basic medical services, such as long-term care in a nursing home, hospitalization, diagnostic imaging and primary care from a physician.
In Texas, Medicaid services also include special home and community-based programs, which prevent institutionalization among seniors who can live safely in an assisted living setting with appropriate supports. Most Texas Medicaid programs are delivered through managed care organizations at the county level.
In order to qualify for no-cost Medicaid coverage that includes access to long-term services, seniors aged 65 and older must:
- Have monthly earnings at or below $2,313 per person, or $4,626 per couple when both spouses are applying for coverage, and
- Be permanent residents of Texas, and
- Be a U.S. citizen or a qualified immigrant, and
- Have a valid social security number, and
- Require 30 or more days of continuous long-term care as assessed by a licensed physician, and
- Own no more than $2,000 in countable assets, or $3,000 per couple when both spouses are applying for coverage
Some assets are exempt from Medicaid limits, including an owner-occupied home worth up to $585,000, one vehicle, a prepaid burial contract and most life insurance policies worth up to $1,500. With regards to income,
almost all types are counted towards the eligibility limits except
VA Aid and Attendance Benefits and the VA Housebound Allowance.
Note: Texas is an income-cap state, therefore, seniors cannot spend-down excess income on medical expenses in order to reach Medicaid eligibility levels.
STAR+PLUS Home and Community-Based Services Medicaid-covered seniors aged 65 and older and adults with disabilities may qualify for supplemental home and community-based services through
STAR+PLUS. This Medicaid managed program reduces institutionalization rates among medically-fragile Medicaid participants by providing services and programs in an assisted living setting that are normally delivered in a nursing home.
STAR+PLUS plans are delivered through managed care providers, and there are at least two providers available in each county statewide. In
Dallas and Ellis counties, the STAR+PLUS medical plans are Molina and Superior. Participants must choose a provider within 15 days of joining STAR+PLUS, otherwise, a provider and primary care physician is assigned by the Department of Health and Human Services.
All STAR+PLUS plans include various long-term services, including adult day health programming and assisted living, help with activities of daily living, medical equipment and supplies, and access to an emergency response system. Plan services are provided based on the medical needs of each participant as identified through an individual plan of care.
For more information on Texas Medicaid and the STAR+PLUS program, contact the
Health and Human Services Commission at (214) 372-6370.