Medicaid is the federally mandated, government-funded program that provides low-income seniors, children and some adults with no-cost health care coverage. Medicaid is jointly funded by state and federal governments and administered at the state level.
By law, every Medicaid plan must include specific mandatory benefits:
- Transportation to Medicaid-funded medical services
- X-rays and laboratory tests
- Primary physician services
- Long-term care in a nursing facility
- Inpatient and outpatient hospital services
Each state has the option to provide additional, state-specific benefits through Medicaid waivers and programs that may cover:
- Dental, optometry, chiropractic and podiatry services
- Dentures, eyeglasses and prosthetics
- Occupational, physical or speech therapy
- Hospice care
- Additional diagnostic and preventative health services
- Personal care and private-duty nursing services
- Prescription and over-the-counter medications
- Case management
The Texas Medicaid program is administered by the
Department of Health and Human Services and delivered through county-specific managed care organizations.
Qualify for Long-term Medicaid Coverage In order to qualify for
long-term Medicaid coverage that includes access to home care, nursing facility care and community-based nursing home diversion programs, seniors must meet income and asset criteria.
Seniors must also be permanent Texas residents; have a valid Social Security number; be U.S. citizens or qualified immigrants and require nursing home level care for at least 30 continuous days.
Income limits are set at $2,313 per person, per month and include income from most sources, such as wages, investments and alimony payments. Applicants must also own no more than $2,000 worth of countable assets, ($3,000 per couple), which includes all cash and investments, and all real estate except for an owner-occupied home worth up to $585,000.
Community Spouse Income and Asset Exemptions When only one spouse of a married couple needs long-term Medicaid services, special income and asset rules apply to ensure the non-applicant (community) spouse has sufficient resources to live on. The non-applicant doesn’t need to contribute financially towards their spouses’ care, therefore, their income isn’t considered for Medicaid qualification purposes.
The community spouse may qualify for up to $3,160.50 per month of income transferred from the applicant under the minimum monthly needs allowance rule. It allows the non-applicant to keep the lesser of 50% or $126,420 of the couple’s joint assets, excluding the owner-occupied home worth up to $585,000 and one vehicle.
STAR+PLUS Medicaid Managed Care Program Seniors who meet the criteria for long-term Medicaid coverage may qualify for home and community-based services through
STAR+PLUS, a Texas Medicaid nursing home diversion program. STAR+PLUS is also open to seniors who already live in a nursing facility who want to transition into an assisted living setting.
STAR+PLUS lets seniors aged 65 and older age in place in an assisted living setting by funding the medical and nonmedical services seniors need to remain safe and independent in the community. STAR+PLUS services and supports are assigned based on medical need and include skilled and intermittent nursing, medical supplies and adaptive aids, respite and personal care and rehab therapy.
Plano residents in Denton County can choose between the Superior Health Plan and the United Healthcare Community Plan. Collin County is covered under the STAR+PLUS Dallas Service Area where the plan providers are Amerigroup, Molina Healthcare of Texas and Superior Health Plan.
To learn more about Medicaid and the STAR+PLUS program, contact the nearest
Health and Human Services Commission office by calling (888) 337-6377.