Medicaid is the nationwide health coverage program that pays for essential medical services for needy seniors, children and people with disabilities. It’s funded by the federal and state governments and administered by each state.
Every Medicaid plan must include mandatory benefits, such as physician services, X-rays and lab tests, hospital services and long-term care in a nursing facility. States may choose to fund additional benefits through Medicaid waivers and plans that may include rehabilitation therapy, case management, prescription medications, vision care and prosthetics.
In Texas, Medicaid plans are administered through a number of managed care organizations, and plan availability varies between counties. Medicaid members must be U.S. citizens or qualified immigrants, have a valid Social Security Number and live in Texas full time.
To qualify for long-term Medicaid coverage which includes home and community-based services, seniors must also need at least 30 days of non-stop care in a nursing facility and meet income and asset criteria.
Medicaid Income and Asset Limits
Each Medicaid applicant can earn up to $2,313 per month in income, and own up to $2,000 in assets ($3,000 per couple).
Income includes wages, investment dividends, alimony payments and money earned through most other sources, such as operating a small business. Some specific types of VA pension income is exempt, including VA Aid and Attendance and Housebound benefits.
Countable assets include all cash and bank account balances, stocks and real estate with the exception of a home that’s the principal residence of the applicant and/or their spouse valued at no more than $585,000.
If only one spouse in a married couple needs long-term Medicaid coverage, special income and asset rules apply to the non-applicant (community spouse). The income of the community spouse isn’t factored when calculating Medicaid eligibility, and the applicant may be able to reduce their declared income by transferring up to $3,160.50 per month to the community spouse under the minimum monthly needs allowance rule.
The community spouse may also keep up to $126,420 worth of the couple’s joint assets, in addition to the marital home and one vehicle, under the community spouse resource allowance rule.
STAR+PLUS Home and Community-Based Medicaid Waiver
STAR+PLUS is a Texas Medicaid managed care nursing-home diversion program for seniors who require the level of care normally provided in a nursing home setting. This home and community-based Medicaid waiver provides funding for community-based services and supports that are delivered in an assisted living environment and assigned based on the medical needs of each participant.
Every STAR+PLUS plan offers:
- Assisted living
- Personal care
- Access to a wearable emergency response system
- Skilled and intermittent nursing services
- Respite care
- Rehabilitation therapies, such as occupation, physical and speech therapy
- Minor home modifications to improve safety and accessibility
- Home delivered meals
- Medical supplies
- Transition support for seniors moving from a nursing facility into an assisted living setting
Some plans also offer
value-added services, such as enhanced dental and vision care.
League City is located in the STAR+PLUS Harris service area, which is served by three managed care plans — Amerigroup, United Healthcare Community Plan and Molina Healthcare of Texas. Upon receipt of the STAR+PLUS approval packet by mail, participants have 15 days to choose a managed care plan, otherwise, they’re assigned a plan and primary physician.
To learn more about Medicaid, STAR+PLUS and QITs, contact the
Health and Human Services Commission office at (888) 337-6377.