Medicaid helps seniors in Texas cover the costs of medical expenses. If adults qualify for this insurance program, they receive a variety of health benefits, including doctor’s visits, hospital care, vision and hearing care, dental care, lab and X-ray services and prescription drugs.
Many seniors eligible for Medicaid receive coverage from the Medicaid for Long-Term Care program. To qualify for this program, seniors must meet certain requirements:
- 65 years of age or older
- Demonstrates a need for 30 or more days of long-term care
- Receive a monthly income of $2,313 or less (for individuals) or $4,626 or less (couples)
- Possess $2,000 (individual) or $3,000 (couple) or less in countable assets (primary homes, vehicles and certain types of life insurance are exempt from financial consideration)
Texas seniors who don’t meet the criteria for long-term care may qualify with the
Medicaid Buy-In for Adults program, which is available for seniors who meet the following requirements:
- Have a disability (physical, mental, intellectual or developmental)
- Are currently employed
- Don’t live full time in a nursing home, state hospital or intermediate care facility for people with intellectual disabilities
When enrolled in this program, seniors make monthly payments to “buy-in” to the health insurance program.
Seniors can apply for Medicaid via the
Your Texas Benefits website or call (512) 424-6500 for more information.
STAR+PLUS Home and Community Based Services Waiver Once seniors are accepted into the state’s Medicaid program, they receive care through
STAR+PLUS, a managed care system designed for aging adults. STAR+PLUS provides seniors with a variety of long-term services and supports, such as short-term care, assistance with activities of daily life and service coordination. Seniors in Marble Falls live in the Travis service area, which means they’ll receive medical plans from Amerigroup or United Healthcare Community Plan.
While the standard STAR+PLUS program doesn’t cover the costs of assisted living, there are Medicaid waivers that do. The most common is the
STAR+PLUS Home and Community Based Services Waiver. This waiver covers the costs of assisted living, adult foster care home services and respite care. It can also be used for personal assistance services, emergency response services, therapies and transitional assistance.
The Home and Community Based Services waiver is the
highest level of coverage within the STAR+PLUS program. To receive this coverage, recipients must demonstrate complex health care needs. Eligibility is usually determined by primary health providers and service coordinators and authorized by a Texas Health and Human Services (HHS) STAR+PLUS support unit.
To learn more about this waiver program, Marble Falls seniors should contact their designated service coordinator at (830) 693-5703.
Deaf Blind with Multiple Disabilities (DBMD) Waiver Seniors can also receive assisted living coverage via the state’s
Deaf Blind with Multiple Disabilities (DBMD) Waiver. This waiver provides home and community based services, including Assisted living (licensed up to six beds), dietary services, residential habilitation and adaptive aids and medical devices, to individuals who meet the following criteria:
- Have a diagnosis of deafblindness and one additional diagnosis
- Present the disability prior to the age of 22
- Demonstrate care needs proportionate with placement in an intermediate care facility
- Are not currently enrolled in a Medicaid waiver program
For more information about the DBMD waiver, call (877) 438-5658.