Eligible low-income seniors in New Braunfels may participate in Medicaid, a federal- and state-funded health insurance program. Medicaid provides coverage for numerous routine and emergency health services, including X-rays, laboratory tests, primary and specialty care physician appointments, prescription medications and emergency room visits. Participants may request transportation for nonemergency medical appointments and visits to a drug store to pick up prescriptions or other health-related necessities.
To qualify for Medicaid and maintain coverage, single Texas residents aged 65 and older must not have a monthly income higher than $771. The monthly income limit increases to a combined total of $1,057 for married applicants. The program typically caps asset limits, which include bank accounts and savings bonds, at $2,000 for individual applicants and $3,000 for married couples. Limits are higher for institutional and nursing home Medicaid recipients.
Some assets are excluded from the state-mandated limits. Seniors can typically remain in their primary home if its value is less than $585,000; they can also keep one automobile for transportation. However, rental property or secondary homes, such as a home or condo that’s not the primary residence, may count toward the asset limit for Medicaid.
Medicaid waivers for home and community-based services help limit out-of-pocket expenses for program participants. Seniors can also combine Medicaid coverage with Medicare. Assisted living facilities bill Medicare first because it’s considered the primary insurer, and then Medicaid, the secondary insurer, helps reduce any remaining expenses. However, Medicaid waivers are not available for room and board costs.
Eligibility for the following waiver programs is based on applicants’ age, income and medical necessity. Applicants must be 21 or older, require a nursing home level of care yet be able to successfully manage symptoms with in-home assistance and demonstrate Medicaid eligibility. Participants cannot enroll in multiple waiver programs at the same time. Monthly income limits are capped at $2,313 for individuals, while married couples can earn up to $4,626 per month. Regular Medicaid asset limits apply.
To apply for Medicaid in Texas, dial 2-1-1 for assistance. Seniors should visit a community partner, submit a paper application or apply online at YourTexasBenefits.com.
The STAR+PLUS Waiver
The STAR+PLUS waiver is a limited-enrollment Medicaid managed care program. It covers qualifying assisted living expenses, including personal care services, home nursing services, medical equipment and supplies, in-home and out-of-home respite care and cognitive rehabilitation. Various types of therapy, including speech, occupational and physical therapy, are also provided. This long-term care program helps recipients remain in their homes with support from program-approved caregivers and medical providers.
The Community First Choice Program
CFC, officially called the Community First Choice program, is an entitlement program, meaning all Medicaid-eligible applicants are guaranteed program enrollment and benefits. Benefits include services that help participants maintain independence, such as bathing assistance and housekeeping. Emergency response services are also available.
Day Activity and Health Services
Day Activity and Health Services is an adult day care program that helps members remain in the community rather than transitioning to a nursing home. This Medicaid program provides weekday services during traditional business hours, including medication management, ADL assistance, social activities and transportation services. Participants may receive services up to 10 hours per day, five days per week.
For more information concerning Medicaid and waiver benefits, seniors can apply online or call the hotline at (800) 252-8263.