What Are The Income Limits For Medicaid In Texas


Medicaid & Elder Law Ebook


Thinking Beyond Tomorrow reviews the law, provides understandable insights, and gives strategies to help you or your loved one qualify for Medicaid benefits.

Thinking Beyond Tomorrow answers your questions about:

Qualifying for Medicaid and VA benefits

Protecting Assets and the homestead from MERP

Planning for & managing medical care

Life Support & Death with Dignity

Wills, Living Trusts, Survivorship Rights and avoiding Probate

Pet Trusts and Gun Trusts

Managing finances during disability

Family and Marital Property Issues

Minimizing Federal Estate Taxes

Paul Premack is Certified as an Elder Law Attorney by the National Elder Law Foundation as accredited by the Texas Board of Legal Specialization and the ABA. He served as President of the Texas Chapter of the National Academy of Elder Law Attorneys and is a Member of the Washington and Texas Chapters of NAELA. He is licensed to practice law in the states of Texas and Washington and handles Estate Planning and Probate in Texas and Washington, including Bexar County and King County Probate, Wills, Living Trusts, Durable and Medical Powers of Attorney, and Elder Law. Since 1989 Premack has written the legal column for the San Antonio Express News, syndicated in other Hearst Newspapers around the USA.

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How Much Is The Federal Poverty Level

The federal poverty level in 2021 is equal to an income of $12,880 per year for an individual adult, plus $4,540 for each additional household member. Alaska and Hawaii have different benchmarks because of their differing costs of living.

2021 Federal Poverty Level by State

Number of people in home

48 states and Washington D.C.


Chip Income Guidelines For Texas

Texas takes care of childrens health for low-income families residing in the state. Childrens 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.

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How Much Money Can You Have In The Bank If You Are On Medicare

The asset limits are $8,400 for an individual and $12,600 for a couple.

Can Medicaid find bank accounts?

Medicaid has an asset verification system that uses the client or spouses Social Security number to pull information on any bank account they have had in the past five years, including the balance. Medicaid will request that the client verify the balance on each account.

Medicaid Eligibility In Texas

TEXAS Medicaid Eligibility and Using Your Texas Benefits

You may be eligible for Medicaid in Texas if you fit the following requirements.

  • You are a legal resident of Texas, i.e., a U.S citizen, legal alien or permanent resident, and need health insurance/care assistance.
  • Your financial situation falls under the low or very low-income bracket.
  • You are responsible for a child who is 18 or younger or blind
  • You are pregnant
  • You or a family member suffers from a disability
  • You are 65 years or older
  • If you live with an underage uninsured child. This includes your grandparents, parents or stepparents, legal guardians, adult brothers, and sisters.
  • If you are a young adult who is 19 years of age or younger and lives on your own.

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Apply For Medicaid In Texas

You can enroll through HealthCare.gov or the state Medicaid website. You can enroll by phone at 800-318-2596.

Eligibility: The aged, blind, and disabled. Also, parents with dependent children are eligible with household incomes up to 15% of FPL. Children are eligible for Medicaid or CHIP with household incomes up to 201% of FPL, and pregnant women are eligible with household incomes up to 198% of FPL.

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.

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Texas Has Not Accepted Federal Medicaid Expansion

  • 5,355,045 Number of Texans covered by Medicaid/CHIP as of March 2022
  • 1,748,000 Number of additional Texas residents who would be covered if the state accepted expansion
  • 771,000 Number of people who have NO realistic access to health insurance without Medicaid expansion
  • $6 billion Federal money Texas is leaving on the table in 2022 by not expanding Medicaid

Other Ways To Manage Assets

Medicaid changes could leave many Texas residents without coverage | KVUE

There are a number of ways to manage assets outside of the QIT that you can use along with the QIT. For example, a Ladybird deed, allows you to transfer ownership of real estate upon the death of the owners and protect this asset from Medicaid recovery efforts. Your attorney can help you with this and other ways of managing assets.

Gifting: If you want to gradually transfer your wealth to loved ones, gifting prior to the five-year look-back period is an effective way to do it without affecting your Medicaid eligibility. You can gift up to $15,000 a year per heir without involving gift taxes.

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Medicaid For The Elderly And People With Disabilities Handbook

  • Menu button for Chapter G, Eligibility Budgets”>
  • G-1000, Eligibility Budgets Overview

Revision 12-4 Effective December 1, 2012

The MEPD programs use income limits based on the Supplementary Security Income limit up to the 300% of the federal poverty level. For a detailed list of the various income limits for the different programs, see Appendix XXXI, Budget Reference Chart.

How Eligiblity Is Determined

Eligibility for Medicaid for adults aged 19 to 64 requires meeting an income limitthat is based on your household size.There is no asset test.

Your household size for Medicaid is typically the same as your tax filing household size:you + your spouse + your dependents. If you’re claimed as a dependent by someone else, or if yourpregnant, your household size may vary from your tax household size. If either of thosesituations apply to you,try using our Medicaid Eligibility Calculator for assistance calculating yourhousehold size.

A household’s Modified Adjusted Gross Income is used for eligibility decisionsfor many medical assistance programs. It’s similar to Adjusted Gross Income which is on your tax return, however some uncommon deductions are added back.For most people it shouldn’t be too much different than your total household income, so when readingthe charts below use the combined income from all household members from jobs and other sources,except for child support, Supplemental Security Income, and childrens’ non-taxable income.

Some pathways for Medicaid eligibilty may only be available if you’re a parent to a child 18 or youngeror are pregnant or were pregnant in the last 60 days.

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Prescription Drugs With Medicaid In Texas

Everything you Need to Know About Texas Medicaid

Most prescription drugs are covered. People 20 and under get unlimited medicines. All others are limited to three medicines per month. Prescriptions that help you quit smoking are not counted in that limit. Some medicines will need to be pre-approved. The pharmacist will take care of this, and will provide a 3-day supply pending approval.

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Whats The Highest Income To Qualify For Medicaid

Federal Poverty Level thresholds to qualify for Medicaid The Federal Poverty Level is determined by the size of a family for the lower 48 states and the District of Columbia. For example, in 2022 it is $13,590 for a single adult person, $27,750 for a family of four and $46,630 for a family of eight.

Is My Child With Disability Eligible To Apply For Chip

Is my child with disability eligible to apply for Chip?

If your child has a disability, you may be able to apply for long-term support and service through CHIP. These include the following:*Apply to have someone help you take care of the child and take them to the medical appointments. *Personal and home care such as helping monitor your childs health and assist them in performing daily activities. *Nursing home care*Hospital services for your childs mental illness*A place that provides care for children with intellectual disabilities.

Is there an Income Criteria to Qualify for CHIP?

Yes, there is an income limit for the parents of kids with disabilities to qualify for Texas Medicaid for children. Medicaid Eligibility in Texas is easy to figure out. The chart below gives you an overview of the maximum household income limit to help determine your eligibility. For any additional person, add $504 to the last figure, and that will be your maximum income limit per month. There is an enrollment fee that may cost you up to a maximum of $50. If you are a low-income family, your co-pay for each doctors visit and medication is around $3 to $5. This cost increases and costs between $20 and $35 for high-income families.

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Texas Medicaid Eligibility Household Income Limits

Texas Medicaid has an income limit policy to determine your eligibility to apply for healthcare coverage. The chart below explains the maximum income level.

Household Size i.e. Number of Person Maximum Annual Income
8 $88,427

If your income is lower than the above-mentioned maximum annual income levels , you may be eligible to apply for Medicaid in Texas.

The Minimum Spousal Share

Bill would change Medicaid eligibility requirements

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.

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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.

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.

Recommended Reading: Guidelines To Qualify For Medicaid

How To Apply For Medicaid In Texas

You can apply online for benefits. You will need to be prepared to answer questions about the following for each family member:

  • Social Security number and birth date
  • Citizenship or immigration status
  • Money from jobs and other sources
  • The value of cars and other property
  • Costs you pay for bills

You can also call 211 if you are in Texas. Alternatively, you can dial 1-877-541-7905 Monday to Friday, 8 a.m. to 6 p.m.

You can also visit a community partner in person. Printing and mailing a copy to HHS is also an option

Who Can Get Medicaid In Texas

Medical Insurance In Texas

You should apply for Medicaid if your income is low and you match one of the descriptions below:

  • You think you are pregnant
  • The parent or caretaker of a child and/or teenager under the age of 19.
  • You are a child or teenager age 18 or under.
  • An adult age 65 or older.
  • You are legally blind.
  • Living with a disability or disabled.
  • You are in need of nursing home care.

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Medicaid Breast Pumps Texas

Texas Medicaid offers special healthcare for new mothers. Let us look a little bit more into it.

Texas Medicaid eligibility plan offers breast pumps coverage for women, although they may not be hospital-grade or quality. Many plans may allow you to own or rent a double-electric breast pump, but this will require you to get a prescription from your attending doctor.

If you are an expecting or new mother, you may be eligible to apply for Medicaid breast pumps Texas on your Medicaid Insurance. However, Medicaid will only process your payment and ship the pump after the baby is born.

Income Limits For Long

To be able to get Texas’s Medicaid program to pay for long-term care in 2019, a single person’s monthly income cannot be higher than $2,313. If both spouses of a married couple need nursing home care, the couple’s monthly income cannot be higher than $4,326. The applicable income and resource limits, discussed below, may change each year.

Texas does not allow individuals to qualify for Medicaid by “spending down” their income on qualifying medical expenses until they reach Medicaid income limits. Texas does, however, allow individuals to place some extra monthly income in a trust to allow a person qualify financially for Medicaid. These trusts are called “Medicaid Trusts” or “Miller Trusts” you can read more about them in Nolo’s article on Medicaid income trusts. If you meet the non-financial criteria for Medicaid but have been told that you are over-income for the program, you should consult an attorney to see whether a trust can help you qualify.

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How Do I Spend Down Assets For Medicaid

Most of us will require nursing home or other long-term care at some point in our lives. Whats worrying is how expensive it is. Medicare coverage for long-term care is very limited private health insurance policies generally do not cover long-term care and few people have private long-term care insurance policies. While overall costs vary, Texans needing nursing care will quickly find their financial resources depleted unless they qualify for Medicaid.

To be eligible for Medicaid, you cannot have assets greater than a certain limit, and only those with a low income and limited financial resources will qualify for coverage. According to the American Council on Aging, when you apply for Medicaid long-term care coverage in Texas as a single person, your non-exempt assets in 2022 cannot exceed $2,523. For couples, the limit is $5,046 if both spouses are applying.

This is especially problematic in situations where there is a healthy spouse whose husband or wife needs long-term care. If the couple receives too much income to qualify for Medicaid, the remaining spouse worries that they will have to spend down all the assets they have for the spouses careleaving the healthy spouse penniless.

A consultation with an elder law attorney can help you determine the best way to handle your individual situation so you can qualify when the time comes.

What Services Does Texas Health And Human Services Provide

Missouri’s Medicaid expansion aims to benefit low-income workers, but sign-ups still lag

HHS works with federally qualified health clinics, medical associations, community partners and local governments to help clients find the health care they need. Aging and Disability Resource Centers can help Texans find personal care, nursing care, help at home and other long-term care services.

What is the highest income to qualify for Medicaid 2022?

Federal Poverty Level thresholds to qualify for Medicaid

The Federal Poverty Level is determined by the size of a family for the lower 48 states and the District of Columbia. For example, in 2022 it is $13,590 for a single adult person, $27,750 for a family of four and $46,630 for a family of eight.

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