Medicaid For Assisted Living In Texas


What Is Assisted Living

Do Medicare or Medicaid Pay for Assisted Living | Senior Living with Syed

It’s a supportive living option that includes housing, assistance with personal care needs, dining and a variety of convenient services and amenities. For individuals who value their independence but can benefit from help with personal care, dressing and taking medications assisted living can provide an ideal option.

More Ways To Pay For Memory Care In Texas

In addition to the state programs mentioned above, those looking for resources to finance memory care may consider:

  • Long-Term Care Insurance: Depending on the policy details, long-term care insurance may be used to pay for memory care services. It’s best to sign up for a policy early, as coverage will likely be denied if one already has long-term care needs. More information about the intricacies of long-term care insurance can be found at
  • Reverse Mortgages: Reverse mortgages allow some homeowners to take out a loan as an advance from the eventual sale of their primary residence. This can be a good way to fund memory care in the short-term, but the loans will need to be paid back after the sale of the home. The most commonly used type of reverse mortgages for seniors is the Home Equity Conversion Mortgage, which is the only reverse mortgage insured by the federal government.
  • Veterans Benefits: The Department of Veterans Affairs offers several programs that veterans and their spouses may use to cover health care needs such as memory care. More information about these programs can be found on the VA website.

Medicaids Coverage Of Assisted Living In Texas

Texas Medicaid coverage of assisted living costs is limited to expenses covered by the STAR+PLUS waiver plan. While this waiver doesnt offer assistance with room-and-board fees, it can be used to offset the cost of some long-term services and supports necessary for seniors who demonstrate a medical need for a nursing home level of care. Seniors who would prefer an alternative to nursing home living can access supportive services that make them eligible to live at home or in an assisted living facility.

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When A Nursing Home Is Medically Necessary

Medicaid will pay for a nursing home only when it is “medically necessary.” In Texas, for a nursing home to be considered medically necessary, you must have a medical condition that is so serious that you need the level of nursing care that is only available in an institution. Your doctor must document your medical condition and must prescribe skilled nursing services to be provided to you on a regular basis in an institutional setting. Nursing care includes things like giving shots, inserting a feeding tube or catheter, treating bed sores, and changing wound dressings.

For Medicaid to keep paying for your nursing home stay, a doctor has to certify at least every six months that you meet the standard for medical necessity.

If you need only custodial care , for instance, because you fall often or because you have dementia and tend to wander, then Medicaid may find that a nursing home stay is not medically necessary because you do not need a skilled nurse.

What Is A Qualified Income Trust

Medicaid for Assisted Living in Dallas

The Qualified Income Trust was designed to address the growing disparity between Medicaid caps and the high cost of long-term care for the elderly. It allows you to legally divert income into a Trust, reducing the amount of your income that gets counted against Medicaid caps.

A QIT is a special type of trust for seniors in need of long-term care whose income exceeds Medicaid caps. A trust allows a third party to hold assets on behalf of a beneficiary.

Here, you set up a special account for the Trust which will receive the income necessary to make sure the applicant falls under the income eligibility limit. You deposit income to the Trust, and the Trust then directs how funds are dispersed each monthcommon disbursements of Trust funds include:

  • A small personal needs allowance .
  • Medical expenses not reimbursed by Medicaid.
  • Minimum Monthly Need Amounts to a spouse, if applicable.
  • Lastly, a nursing home co-payment.

Once the QIT is established the State will determine how much of your remaining income will be used to contribute to your long-term care as a co-pay, or applied income amount.

Medicaid is considered a payor of last resort, so a Medicaid recipient is generally going to pay everything they have first and Medicaid will pay the difference. As with the fund, you are allowed a small personal needs allowance and a contribution toward a spouses MMNA. Upon death, the State becomes the beneficiary and uses any remaining funds to recover against Medicaid benefits paid out.

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Who Pays For Assisted Living Care In Texas

The state of Texas has Medicaid Waiver programs to help elderly and disabled people with their monthly expenses however, there are eligibility requirements for these waivers, both functional and financial.

First, lets discuss Medicaid eligibility criteria in Texas as well as the difference between Supplemental Security Income and Medicaid. SSI is a federally-funded program funded by general tax revenue, NOT by Social Security Taxes. It is designed to help people who are aged, blind, and/or disabled who have little or no income and it provides cash to people to meet their basic needs, including food, clothing, and shelter.

Medicaid, on the other hand, is a state-funded program and the financial eligibility requirements change yearly. You must be pregnant, a parent or relative caretaker of a dependent child who is under 19, blind, have a disability, or have a family member in your household with a disability, or be 65-years-old or older.

Other general requirements include:

  • A U.S. Citizen, national, permanent resident, or legal alien
  • In need of health care or insurance assistance and
  • Be considered low-income or very low-income.

The waiver programs that will help pay for Assisted Living Services in Texas include:

Memory Care Made Personal

The Monarch at Richardson embraces a unique, more innovative approach to life for those with dementia, Alzheimers, and other memory impairments. The Valeo signature programs empower each individual to build on their personal strengths and life experiences, enabling true moments of joy and purpose.

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Which States Cover Assisted Living

Currently, 44 states will fund a portion of the cost of Assisted Living through Medicaid, but not all will do so in the same way.

Although your state might be on this list, bear in mind that each has its own set of rules and restrictions. The greatest thing you can do is call your local AAA or Area Agency on Aging for further information.

Furthermore, you may always call your Medicaid representative and ask them directly about anything that concerns you.

The 10 Best Assisted Living Facilities In Austin Tx

Medicaid Home and Community-Based Services (HCBS) Waivers in Assisted Living Communities

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Medicaid Options For Texas Seniors

According to, to be eligible for Texas Medicaid, you must be a resident of the state of Texas, a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income. You must also be one of the following:

  • Pregnant, or
  • Be responsible for a child 18 years of age or younger, or
  • Have a disability or a family member in your household with a disability, or
  • Be 65 years of age or older.

Texas’s Medicaid health care program is a State and Federal cooperative that pays for medical care for children and adults with limited income and resources. The program is supported by Federal and State taxes and designed to help a wide variety of families and individuals who need assistance.

Several Medicare programs can help Texas seniors get the care options they need, such as the Texas Health Information, Counseling and Advocacy Program, which provides seniors and their caregivers research and enroll in Medicaid and other health-related programs.

The Community First Choice Program

The Community First Choice program is a lot like the STAR+PLUS HCBS waiver in what it offers, except that CFC is a Medicaid entitlement program, meaning there are no maximum recipient caps and no waiting lists for enrollment. Community First Choice offers Medicaid reimbursement to low-income assisted living residents for the provision of assistance with activities of daily living, such as personal grooming tasks, mobility, and basic house chores. People already enrolled to receive other Medicaid waiver services may elect to switch to the Community First Choice Program.

Services provided under the CFC Program may include:

  • Personal assistance with activities of daily living
  • Skills education for self-care and independent living
  • Emergency response services
  • Training for support staff management
  • Consumer-directed service options

Who is Eligible?

Applicants for the Community First Choice program must qualify for Medicaid and must be assessed by a physician as nursing home-eligible. Coverage of personal care services through this program is provided based on an assessment of which services an individual requires.

How to Apply

Interested parties can apply online at, or call 2-1-1 for guidance and consultation. Your local Area Agency on Aging can also help with Medicaid and non-Medicaid applications. To initiate an assessment and determine your eligibility, consult the directory in this guide to find a nearby Area Agency on Aging.

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How Do You Pay For Assisted Living

Depending on location and income level, there are various programs that provide benefits and financial support.

Veterans Administration

For those who served in the military and their spouses, Aid & Attendance may be an option. This program, offered through the VA to veterans who served during a time of war, provides additional funding that can be used to help pay for the cost living at a community. There are eligibility requirements, such as serving during a particular time, income limits and individual health assessments, which must be met in order to get approved for Aid & Attendance.


Medicaid may provide some funding for assisted living. However, it depends upon which state you reside in. Texas provides coverage for assisted living through the STAR PLUS program. For qualifying residents, this program can cover services and amenities offered at an assisted living community such as The Monarch at Richardson. This program does not cover the cost of room and board. There are eligibility requirements that have to be met in order to qualify for Medicaid, such as income and property/savings.

How Much Does Adult Day Care Cost In Austin


Adult day care in Austin costs an average of $1,408 a month, $650 more than the state average of $758. The most affordable with a monthly average of less than $700 for adult day care in the state are Brownsville, El Paso, Abilene, Corpus Christi, and Laredo. The least expensive is Abilene with a monthly average of $618.

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The Question You May Not Have Asked

It is a well established technique for your Medicaid Attorney in The Woodlands to exempt your home as a resource for the purpose of establishing Texas Medicaid eligibility. This means that in many cases a you can keep your home during your lifetime without having to sell it. Your Medicaid attorney can also prevent the HHSC from counting the home against you as an asset in excess of the $2,000 limit. The question most people do not consider is this: what happens when you pass away after having received Texas Medicaid nursing home benefits?

The Aging & Disability Resource Center

This center was opened by the HHS as part of the national No Wrong Door initiative, and it is intended to streamline public access to resources and information concerning long-term services and supports. The Aging & Disability Resource Center helps to reduce confusion and facilitate access to care for long-term care recipients in all 254 counties of Texas.

Contact them by calling YES-ADRC, or 937-2372. Find out more online by visiting

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The Cost Of Assisted Living In Texas

Seniorly 2021 data shows that the average cost of assisted living in Texas is $3,745 per month. The national average monthly cost is $4,057. The average Texas cost is slightly less than the national average. Keep in mind as you start your senior living search that some areas will be more expensive than others. Explore our assisted living listings to start comparing properties, or get in touch with one of our local advisors to get expert advice on what you can afford in the areas in which youre interested.

Assisted living communities can provide the peace of mind that comes from not worrying about home maintenance, chores, or errands, as well as help with personal care like grooming, eating, and other activities of daily living seniors might have trouble with. However, if your loved one requires nursing care, or has diagnosed Alzheimer’s or dementia that has progressed to a certain point, they might need a skilled nursing facility/home health care, or memory care community instead. These types of care providers might cost more in Texas than assisted living facilities, but the important thing is that your loved ones needs are cared for in order to provide them with the best quality of life.

The Cost Of Assisted Living In Texas Top Cities

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One of the most impactful factors on the cost of assisted living in Texas is the facilitys location. Sitting close to the southern tip, McAllen is one of the more expensive areas, with an average cost of $4,850. Those who prefer to live at the north end of the state, in Amarillo, pay just slightly less at $4,600. Seniors can find a bargain by choosing a facility in Corpus Christi, averaging at just $3,388, or in San Antonio, which has assisted living costs about $3,413. El Paso in western Texas sits reasonably at $3,750, while Dallas and Houston come in a few hundred dollars more than the state average.

Nursing Home Care

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What Is An Estate

An estate is property, such as money, a house, or other things of value that a person leaves to family members or others when he or she dies. MERP does not apply to all property that a person may own.

Examples of property that the state will not collect on include:

  • Life insurance policies that name a person to receive the payment.
  • Bank accounts that are paid on death to another person.

Assisted Living Laws And Regulations In Texas

Assisted living communities in Texas must adhere to strict regulations and rules set by Texas Health and Human Services Commission . These regulations set out minimum requirements regarding staffing, care and amenities to ensure high standards of senior care.

Assisted Living Admission Requirements

There are two licensing types in Texas for assisted living communities: A and B. The license types are largely based on a residents physical and mental ability to evacuate the premises in an emergency situation. Residents must be appropriate for the license type when admitted. If a residents situation later changes and is not in accordance with the license, the community is not obliged to retain them. A community cannot admit anyone whose physical and mental needs cannot be met by the facility. A community can, however, secure services through third-party providers to meet resident needs, with written agreement of the resident, their physician or their legal representative.

Assisted Living Facility Requirements

Assisted Living Medicaid Policy

Texass Medicaid program covers assisted living services under the STAR+PLUS waiver. Assisted living facilities must have a contract with a residents managed care organization .

Assisted Living Scope of Care

Assisted Living Service Plan Requirements

Background Checks for Assisted Living

Medication Management Regulations

Requirements for Reporting Abuse

Staff Training Requirements

Staffing Requirements

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Are There Times When The State Will Not Ask For Money Back

Yes, the state will not ask for money when:

  • There is a spouse who is still alive.
  • There is a child under 21 years of age.
  • There is a child of any age who is blind or permanently and totally disabled under Social Security requirements.
  • The value of the estate is $10,000 or less.
  • The amount of Medicaid costs is $3,000 or less.
  • There is an unmarried adult child who lived full-time in the Medicaid person’s home for at least one year before this person died.
  • The cost of selling the property is more than the property is worth.

Also, the state will not ask for money when this would cause an undue hardship for the heirs.

Which Services Will Medicaid Cover


The restrictions will differ depending on the state you live in, which is why it is critical to check with your local Medicaid reps to ensure what is covered.

Medicaid will, in general, cover:

  • Personal Care Assistance Entails a variety of personal tasks such as dressing, eating, and bathing. However, it also includes a variety of other tasks.
  • Homemaker services Entail tasks around the house that the elderly may find difficult to complete, such as shopping, washing, food preparation, and so on.
  • Management of Cases
  • Transportation
  • Personal Emergency Response Systems

Remember that Medicaid will NOT pay the room and board portion of the charges. However, there are various methods to compensate for this, lowering the overall cost.

Given that the average monthly cost of Assisted Living is $4.300, any financial support and assistance are greatly appreciated.

With that in mind, you should be aware that most states will also provide Medicaid Waivers for Home and Community-Based Services. These Waivers can assist persons in receiving the assistance they require while remaining in the comfort of their own homes.

Furthermore, the income restrictions for the Waivers are often significantly higher, however, as is customary, each state sets its regulations and there are waiting lists included.

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