Medicaid Texas Income Limits 2020

Resource Limits For Texas Medicaid

To qualify for Medicaid, you must have few resources. Resources are assets, like money in the bank, retirement accounts, land, and personal property like cars.

The resource limit for a single person to qualify for Texas Medicaid is $2,000, and for a married couple who both want to qualify for Medicaid, it is $3,000.

Some property does not count toward the resource limit. In Texas, the home you live in is excluded from the resource calculation as long as it is worth less than $585,000 . There are other excluded resources, including one car.

Whats The Maximum Increase In Assessed Value In Texas

Technically, a Texas homesteads assessed value is limited to the lesser of either its market value or the sum of the market value of any new improvements and 110% of the appraised value of the preceding year. The 10% increase is cumulative. Therefore, the maximum increase is 10% times the number of years since the property was last appraised.

How Much Does It Cost

Children’s Medicaid is free.

If we find your child can get Children’s Medicaid, there is no cost to receive services.

CHIP fees vary based on your income.

If we find your child can get CHIP, your enrollment fee and co-pays will be based on your family’s income. Enrollment fees are $50 or less per family, per year.

Co-pays for doctor visits and medicine range from $3 to $5 for lower-income families and $20 to $35 for higher-income families.

Don’t Miss: How Do I Renew My Ohio Medicaid Benefits Online

Texas Requirements For Medicaid Qualification

Qualification for Medicaid in Texas is more of a formula than a series of check-boxes. You have to meet certain income requirements. But the income limit varies depending on the number of people in the household, and the variety of Medicare for which you are applying.

Here is an example from the Texas HHS website:

• If the monthly income is $1,784 or less, or the yearly income is $21,404 or less, you may qualify for Children’s Medicaid.
• If the monthly income is $2,663 or less, or the yearly income is $31,951 or less, you may qualify for CHIP.

Not to be confused with Childrens Medicaid, CHIP stands for Childrens Health Insurance Program. The above figures only apply to a family of two. For Childrens Medicaid, the limit increases to $4,558 for a family of eight. Even these are not hard limits as there are circumstances where the limits could be higher.

Eligibility groups include, but are not limited to the following:

• Women who are pregnant
• Individuals who receive Supplemental Security Income
• Anyone who currently receives adoptive assistance
• Low-income households that have kids under the age of 19

The only way to truly determine your eligibility is to apply.

The Minimum Spousal Share

The minimum Community Spousal Protected Amount is currently $25,728. This means the spouse can keep a minimum of $25,728 if the couples total combined resources exceed $25,728. If your total combined counted resources exceed $25,728 then your protected amount using the governments rules is 50% of your assets, but no less than $25,728. For exmaple, If you have $50,000 in resources, the spouse would keep $25,728 but the rest of your life savings would face the spend-down. If you want to avoid the spend-down and protect more than 50%, we can show you how.

You May Like: Does Medicaid Cover Medical Alert Systems

Does A Qit Make Sense For Me

A QIT can be a great solution for many people who are worried about long-term care costs for themselves, their spouse, or for other family members. Medicare and other health insurance do not cover the cost of long-term care. Even if you have special long-term care insurance, it may not cover the full cost of care. But even in these cases, where you cant afford the expense of long-term care, income may be a barrier to Medicaid eligibility.

In these circumstances, a QIT can ease the burden on you and your family by helping the patient qualify for the States Medicaid program.

If the patient has an income that is higher than Medicaid caps or has been turned down for Medicaid because of their income levels, you may worry that the only solution is to cover the cost of long-term care services out of your own pocket. But thats not the case.

Two Common Long Term Care Situations

Your Spouse Needs Long-Term Care

A situation we see frequently is a healthy spouse whose husband or wife needs long-term care. The healthy spouse is devastated to learn that they receive too much income to qualify for Medicaid. This person worries that if they cant get their spouse qualified for Medicaid they will have to spend down all the assets they have for the spouses careleaving the healthy spouse penniless.

Your Parent Needs Long Term Care

Common Questions And Answers About A Qualified Income Trust

Q: Do I have to deposit all of my income into the trust?

A: No, in Texas, you dont have to deposit your entire income. You can deposit a portion of your income thereby bringing your eligible income below the cap. However, you do have to deposit the entirety of income from any single source.

Q: What about any income I dont deposit into the trust?

A: If you put only a portion of your income into a QIT, you generally wont be keeping the remainder. As with the fund, you are allowed a small personal needs allowance and a contribution to your spouses MMNA, but the rest is going to go towards your nursing home bill.

Q: Do nursing homes and assisted living communities accept Medicaid?

A: Yes, most nursing homes and assisted living facilities accept Medicaid.

Q: Will a QIT help me protect my assets?

A: Not exactly. A QIT is a solution for income above Medicaid limits. Assets raise a separate issue. The QIT can help you avoid spending down your assets on care, but its not a way to shelter assets.

There are a number of ways to manage assets outside of the QIT. A Ladybird deed, for example, allows you to transfer ownership interests in real estate upon the death of the owners and protect this interest from Medicaid recovery efforts. You might want to use options like this in conjunction with a QIT.

Q: What can I do if my assets are too high for Medicaid?

Don’t Miss: Dentist In Great Falls Mt That Take Medicaid

If Income Exceeds Income Limit And The Indicator Is Yes The Individual Or Family May Be Able To Be Eligible For Medicaid If They Can Meet A Deductible

Texas health benefits income chart. So far, hhsc has a total number of staff that is over 9,000. Federal laws and regulations require coverage of certain populations and services, allowing the states flexibility for additional coverage. Texas medicaid income limit charts.

These services help women plan their families, whether it is to achieve, postpone, or prevent pregnancy. The texas hhsc will send a packet to you. Look up the federal register for the current year.

The following chart gives a general idea of the amount of money most people or families can get and still be in this program. A familys gross income must be at or below 130% of the federal poverty level. Texas medicaid income limits 2020 chart.

Within 45 days, they will let you know if they have approved your application. Eligibility and benefits by federal poverty level using the eligibility and benefits chart to screen for potential eligibility a. Use the chart to find out if your children may be able to get chip or medicaid.

This packet will include facts about each health plan, and you will choose your health plan. Eligibility is based on total income and size of a participants household. Wait to hear from texas health and human services .

Health plans comparison chart effective september 1, 2020 t 1includes medical and prescription drug copays, coinsurance and deductibles. $395 × 14 = $5,530 Prior to 2004, the saww was based on the average.

11 Financial Statement Sample Format in 2020

What To Do If You Don’t Qualify For Medicaid

If you don’t qualify for Medicaid, you can possibly get subsidized health care through the Obamacare marketplaces during a special enrollment or open enrollment period. Americans who making more than 100% of the FPL qualify for a premium tax credit that can significantly lower the cost of a plan.

Federal open enrollment for 2022 health care plans runs until Jan. 15, 2022, though some state exchanges are open longer. Learn 2022 open enrollments dates by state. Healthcare.gov, the federal exchange, usually opens from November 1 to December 15 each year.

If you can’t find affordable health care on your marketplace during open enrollment, you have a few back-up options.

These include:

Short-term health insurance: Originally designed to prevent short-term health insurance gaps, these plans are cheaper, but much less comprehensive than traditional coverage. They don’t have to cover Obamacare’s 10 essential benefits or pre-existing conditions. Following changes by the Trump administration, short-term health plans can last from three months to potentially three years, though som estates have stricter limits.

Limited benefit plans: These plans cover a very small portion of the costs associated with certain “medical events,” like a doctor’s visit or ambulance ride. Both the number of events and dollar amounts covered are capped.

Recommended Reading: Do I Make Too Much For Medicaid

District Of Columbia Medicaid

Eligibility overview: Washington, D.C., has one of the most generous Medicaid programs in the U.S., covering adults with household incomes up to 215% of the FPL as part of its expansion program. It also has programs for pregnant, parent/caretaker, elderly, disabled and child residents.

Income requirements: The expansion covers adults without dependents who make up to $2,082 a month when applying on their own. Elderly, blind or disabled D.C. residents are eligible if they make up to 100% of the FPL, or $1,073.33 per month for one individual, and have resources below $4,000 for one person. D.C. also covers pregnant women with incomes up to 319% of the FPL, or $4,703.40 monthly for a two-person household, and parents/caretakers with incomes up to 216% of the FPL.

How to apply for Washington, D.C. Medicaid: You can apply online at DC Health Link or by visiting your closest Income Maintenance Administration Service Center.

Other notable programs: Long-term care and nursing home care services Spend Down, a Medicaid program for people who exceed income limits, but have high medical bills Emergency Medicaid for people who canât qualify for standard Medicaid due to citizenship/immigration status.

Chip Income Guidelines For Texas

Texas takes care of children’s health for low-income families residing in the state. Children’s Health Insurance Program or CHIP and Medicaid are the major programs available. CHIP provides health insurance for families who cannot qualify for Medicaid but who cannot afford other health insurance.

Family income is the basis for enrollment and copayment for the CHIP program. Qualifications in 2019 require that a child be under the age of 18, a U.S. citizen or permanent legal resident and a Texas resident. A pregnant woman qualifies at any age to apply for CHIP perinatal services.

Video of the Day

Recommended Reading: Is Neighborhood Health Plan Medicaid

Limitations Of A Qualified Income Trust

• Does not address assets: Assets are considered separately. A QIT only addressed the income eligibility requirement.
• Practical limit on funds deposited: In Texas, there is no rule limiting the amount of income you can place in a QIT but if your income is greater than the cost of care then a QIT probably wont be helpful for you.

The Maximum Spousal Share

The maximum Community Spousal Protected Amount increased from $126,420 to $128,640. Just as with the minimum, this does not mean that the spouse of a nursing home Medicaid applicant can keep $128,640. Remember it only means the spouse can keep $128,640 if the couples total combined counted resources are worth $257,280 or more. In that situation the spouse could keep $128,640, the spouse in the nursing home could keep $2,000, and the rest would have to be spent down in ways that do not result in a penalty.These are the default rules that the government uses when a family does not have a Woodlands Medicaid attorney to protect everything they can protect under the law. If you have a spouse or family member in a nursing home and would like to protect more than the default rules provide then get started today by giving me a call at 592-7913.

Read Also: Benefits Ohio Gov Renew Medicaid

Effective Date Of Coverage

Once an individual is determined eligible for Medicaid, coverage is effective either on the date of application or the first day of the month of application. Benefits also may be covered retroactively for up to three months prior to the month of application, if the individual would have been eligible during that period had he or she applied. Coverage generally stops at the end of the month in which a person no longer meets the requirements for eligibility.

Texas Medicaid Application And Qualifications

It is easy to confuse Medicaid with Medicare. The two programs are not without their similarities. One key difference is that Medicare is a federal program, whereas Medicaid is a state program with rules that vary depending on where you are. The other major difference is that Medicare is based largely on age and disability, while Medicaid is based largely on income.

Depending on your circumstances, you can be on both at the same time. Circumstances is the key word. Medicare tends to be long-term, if not permanent. Medicaid is often a shorter-term solution. There are other programs that are generally associated with Medicaid such as financial and grocery assistance. It is possible that if you have qualified for these other forms of assistance, Medicaid will be included.

Also Check: Medicaid Data Warehouse New York

How To Apply / Learn More

The STAR+PLUS program is available statewide. One can learn more about this program on the STAR+PLUS website or by contacting your local Area Agency on Aging. To apply for this Waiver or Texas Medicaid , one should visit the Your Texas Benefits website.

A wait-list for STAR+PLUS may exist or specifically for services provided at-home. Waiting times can be as long as a year and current nursing home Medicaid participants are prioritized over at-home applicants. If your loved one is in a Medicaid-funded nursing home on Medicaid and wants to return home or move to assisted living, you should contact a STAR+PLUS caseworker to discuss the options.

How To Apply For Medicaid

If youâre eligible for Medicaid, you can apply all year round through your state’s Medicaid website or HealthCare.gov, the federal health insurance marketplace. If you apply for Medicaid through Healthcare.gov and it looks like you qualify, the federal government will notify your state agency, which will contact you about enrollment. States also generally let you print out paper applications you can mail, fax or return directly to your local government office.

To complete your Medicaid application, you will likely need to provide documentation that you meet your state’s requirements. This documentation may include:

• Your birth certificate or driver’s license to serve as proof of age and citizenship

• Recent pay stubs or tax returns to serve as proof of income

• Copies of bank statements

• Proof of address, which could include a lease, utility bill statements or a copy of your mortgage

• Medical records to serve as proof of disability

States have 45 days to process your Medicaid application. They have 90 days if eligibility is tied to a disability . Processing can take longer if applicants do not supply all of the required documentation. If you don’t qualify for Medicaid, you might be able to get subsidized health insurance through Healthcare.gov. However, only certain life events allow you to apply for a marketplace health care plan outside of open enrollment, which takes place from Nov. 1 to Jan. 15.

Free in your inbox each Friday.

Sign up now

Recommended Reading: How To Qualify For Medicaid In Nevada

How Do I Apply For Medicaid For My Child

In Texas, Medicaid programs are managed by the Health and Human Services Commission . You can apply for any program for your child by visiting your local HHSC office. You can find that office by calling 2-1-1 or visiting 2-1-1 Texas online. You can also get free help applying for Medicaid services for your child from a community partner organization. When you apply for Medicaid, you may need to show or send:

• Proof of money you and each family member who lives with you earns from a job or other sources. Pay stubs or earning statements are most common, but there are other documents that can be used too.
• Social Security numbers or immigration document numbers.
• Details about current health insurance or any job-related health insurance that might be available to you.

If you and your child dont want to go apply in person, there are other choices:

• Apply for Medicaid online on the Your Texas Benefits website. You will have a chance to show proof of income, Social Security numbers, and insurance after you apply.
• Apply by phone by calling 2-1-1. They will start the application over the phone and mail it to you to sign.
• and fill it out.

Once you have filled out the application and gathered your other proof, you can:

• Take it to an HHSC benefits office. Call 2-1-1 to find an office near you.
• Fax it to 1-877-447-2839. If your form is 2-sided, dont forget to fax both sides separately.
• Mail it to the state office at:
• Health and Human Services CommissionP.O. Box 149024

Texas Medicaid Income Limit Charts

The Texas Medicaid eligibility income limit charts are divided by groups.

For example, the first chart is focused on income limits for children who qualify for Medicaid.

Similarly, the second chart below focuses on the Medicaid income limits for adults in Texas who qualify for Medicaid.

Texas Medicaid Income Limit for Children

Below is the income limit for children by age category. Find the age category your child falls into and you will see the income limit by household size.

How to Read the Texas Medicaid Income Limits Charts Above

You cannot have an income higher than the Federal Poverty Level percentage described for your group to be eligible for Medicaid.

Similarly, when you identify the income group that applies to you, the income limit you see refers to the maximum level of income you can earn to qualify for benefits.

For example, if you are pregnant, to qualify for Medicaid, you cannot have an income higher than 198% of the Federal Poverty Level which for a family of two is $34,492 as shown in the chart above.

Don’t Miss: Pediatric Dentist St Louis Medicaid