The national health insurance program, Medicaid, provides vital coverage for low-income Americans, including families with dependant children, expectant mothers, adults with disabilities and senior citizens. The program is co-funded by the federal and individual state governments. Each state administers its own Medicaid program in accordance with federal guidelines.
In Texas, the Medicaid program administered by the Health and Human Services Commission provides primary, acute and long-term care coverage for more than a million disabled, blind and elderly state residents through managed care plans.
These plans provide a wide range of benefits, such as doctor and specialist care, emergency treatment, inpatient and outpatient hospital services, diagnostic tests (including lab work and X-rays), prescription drugs, ambulance and nonemergency medical transportation and institutional care in a nursing home.
Qualifying for Medicaid
Tomball residents aged 64 or younger and chronically disabled or aged 65 or older can qualify for Medicaid long-term care if they’re American citizens or legal immigrants and:
- Have no more than $2,313 in monthly income and countable assets of $2,000 or less as an individual
- Have no more than $4,626 in monthly income and combined assets worth $3,000 or less if married and both spouses apply
Seniors and disabled adults approved for
Supplemental Security Income benefits are enrolled in Texas Medicaid automatically by the Social Security Administration. When determining eligibility for other applicants, Medicaid looks at all sources of income, but disregards a number of assets, including:
- One automobile
- An owner-occupied home with a value up to $585,000
- Household and personal effects
- Prepaid irrevocable burial trusts
Qualified Income Trust Those who satisfy the eligibility requirements for Medicaid coverage except for income may be able to lower their monthly earnings to the $2,313 limit with a
Qualified Income Trust. Using this option, excess monthly income must be deposited into an irrevocable trust account and only be removed to pay for allowable medical and care-related expenses.
If a married applicant’s spouse doesn’t require Medicaid coverage, only the applicant’s income is counted. Per federal laws enacted to
provide spousal living and resource allowances, the non-applicant may be awarded up to $3,160.50 of their applicant spouse’s monthly income along with a maximum of $126,420 of the couple’s joint assets.
Seniors can
apply for Medicaid online or contact Your Texas Benefits helpline at (877) 541-7905.
STAR+PLUS Waiver Program Tomball residents eligible for the full benefits of Texas Medicaid and in need of long-term care can apply to the
STAR+PLUS waiver if they want to live in the community instead of an institutional nursing facility. To qualify for the waiver program, applicants must be assessed as requiring a nursing home level of care but functionally capable of living in a community setting. Approved applicants receive all-inclusive medical coverage and long-term care services that may include:
- Care coordination
- Transitional assistance to return to the community
- Assisted living and personal care
- Nursing services
- Adaptive aids
- Medical supplies
- Physical, occupational and speech therapy
- Personal emergency response systems
To learn more or apply for the STAR+PLUS waiver program, Tomball seniors and disabled adults can contact the
Houston-Galveston Area Agency on Aging at (713) 627-3200.