What Do I Need To Qualify For Medicaid In Texas


Are Ira Assets Protected From Medicaid

What Are The Texas Medicaid Eligibility Guidelines?

In the case of IRAs as it pertains to Texas, the circumstances are unique. You should consult professional legal advice before making any decisions.

As always, the only way to make sure you are taking the correct steps in your medicaid asset protection is by working together with a trusted legal expert. Reach out to us today to see how we can best keep your wealth in the family while also solving for your long-term health care needs.

Who Meets The Requirements For Medicaid In Texas

Are you eligible for Medicaid as a patient who resides in the state of Texas? Medicaid benefits eligibility apply to many different groups. However, note that Medicaid eligibility is a state-specific decision, so a petitioner must ensure that he or she meets all of the requirements determined by the Lone Star State.

You can explore the different Medicaid requirements by downloading our informative guide.

The following groups are able to qualify for Medicaid benefits in Texas:

  • Children Parents can opt into Childrens Medicaid, the Childrens Health Insurance Program or the Medicaid Buy-In for Children.
  • Women & pregnant women both low-income and those interested in CHIP perinatal coverage can qualify for Medicaid coverage in TX. In addition, women with cervical cancer or breast cancer can receive Medicaid benefits. Still, there is a program entitled Healthy Texas Women in which you may be able to enroll.
  • Young adults and families If the applicant is are an adult caring for a child, a former child of foster care or a transitioning foster care child, you are eligible for Medicaid in Texas.
  • The elderly and the disabled The Medicaid eligibility requirements for patients of this nature apply to programs for long-term care, those who receive Supplemental Security Income and both the Medicaid and Medicare Buy-In Programs.

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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If I Give Away My House And All My Money

Not anymore. There is a 5-year look-back law now. Uncle Sam government will find your money and make you pay it back. You should consult an Elderlaw attorney specializing in Medicaid to understand the acceptable ways to “spend-down” assets to qualify for Medicaid as a low-income senior.

You can gift away some assets within limits to a beneficiary, but you should remember that these assets will no longer be in your control. Also remember that the leading type of elder abuse is financial, many times by a family member. Spousal poverty protection laws have been passed to allow the spouse of a senior who needs long-term nursing home care to maintain usually up to 50% of the couples assets.

To qualify for Medicaid in Texas, any interested individual must be an American Citizen, or an immigrant with legal and permanent residency status, and who is currently residing in the State of Texas.

Coverage can possibly begin from 3-months prior to the applications approval. Applications sometimes take longer than expected. You should ask about the usual approval timeframe when you submit your initial application for Medicaid coverage.

Follow these guidelines on how you qualify for Medicaid in Texas:

  • Chose the sub-program of the Texas Medicaid as applicable to your health needs. CHIP for Children Medicaid, STAR Medicaid Managed Care Program, STAR Plus Program and Womens Health Program are among the many sub-programs you can choose from.

Learn About Medicaid Asset Limits And Eligibility Requirements

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Although Medicaid is federally funded, it is administered at the state level, and each state has its own set of rules and regulations of this program. The income and asset levels allowed differ from one state to another, so be sure to find out where your balance sheet falls in relation to the threshold.

If you are single, you generally cannot have more than $2,000 worth of cash or other assets outside of your residence, vehicle, and other necessary items unless your state has a higher limit.

If you are married and your spouse is still able to live independently, they are allowed to retain 50% of your joint assets up to a threshhold of $130,380 as of January 2021. Your single or joint income usually cannot exceed 138% of the federal poverty level, although several states have thresholds above this amount.

In nearly all cases, you will also have to prove via medical documents that you are disabled. However, certain exceptions apply . You must also be either a U.S. citizen or have a green card and prove your residency within the state.

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Medically Needy Medicaid Texas

If you dont meet Texas Medicaid eligibility requirements based on your income level, you can still qualify based on spend down. This means that if you spend enough money on health care to put you below the qualifying limit, you can still qualify. However, that money that puts you below the line has to be going towards your healthcare costs.

How Does Medicaid Work

Once you have applied for Medicaid for your child and received their benefits cards, you will need to:

  • Pick a managed care plan. You will receive a letter in the mail that will give you the options available in your area.
  • Pick a main doctor that is in network with the managed care plan you pick. You can find a doctor in the following ways:
  • Call the Medicaid enrollment broker for help at .
  • Use the provider directories that came in the mail with your enrollment packet.
  • Find a pharmacy that will take Medicaid benefits.
  • Your childs main doctor will then refer you to specialists and therapists who also take Medicaid and can help your child. All Medicaid programs encourage families to use the medical home model of care.

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    Medicaid And The Medical Home

    Texas Health Steps promotes the medical home as a patients primary point of contact when accessing health care. A medical home is a partnership between a child, the childs family or caregiver, and the childs primary health-care setting in which the health-care provider has responsibility for directing the patients care coordination in partnership with the patient and/or family. Maintaining medical homes for patients is a requirement for providers participating in Medicaid managed care plans, which will be covered in Section 3 of this training.

    Texas Health Steps providers should encourage patients to see their primary care provider as their medical home. If the patients PCP is not a Texas Health Steps medical provider, the checkup provider should send the PCP the records from all Texas Health Steps medical checkups performed for the client. All PCPs are encouraged to enroll as Texas Health Steps medical providers. This allows the patient to receive both acute care and preventive care services from the same provider.

    To learn more information about the medical home, enroll in the Texas Health Steps provider education module, Introduction to the Medical Home.

    Can I Qualify For Medicaid If I Have Savings

    How To Pass The Texas Medicaid Asset Test?

    In 2021, a single Medicaid applicant must have income less than $2,382 per month and may keep up to $2,000 in countable assets to qualify financially. Any cash, savings, investments or property that exceeds these limits is considered a countable asset and will count towards an applicants $2,000 resource limit.

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    Qualify With Texas Social Security

    You can meet Texas Medicaid eligibility requirements if you are on social security. There are two types of Social Security disability benefits: Social Security Disability Insurance and Supplemental Security Income . SSI beneficiaries are not automatically eligible for Medicare , but can receive Medicaid. Those qualified for SSDI will automatically be enrolled in Medicare after 24 months.

    Do You Reside Within The Community Health Choice Service Area

    • 20 counties in Southeast Texas
    • Only individuals living in our plans service area are eligible to enroll in Community Health Choices plan.

    If your category of Medicaid eligibility changes, your eligibility for this plan will change. You will have a 6-month grace period to achieve Medicaid redetermination and will continue to be covered under this plan. During this grace period, you will be responsible for the costs of your Medicare benefits, which will be the same as if you were on Original Medicare.

    Not sure if you qualify? One of our representatives can help you!

    H9826_IT_10045_092919_M Last updated October 4, 2021. ***Pending CMS Approval***

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    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.

    How To Apply For Medicaid And Chip

    How to Apply to Medicaid

    The new year is almost here. Will your health insurance needs change in 2021?

    You might be pregnant and need help with doctor bills. Maybe you lost your joband your health insuranceduring the pandemic. Your employer might be raising the amount you have to pitch in for insurance, doctor visits or medication next year.

    If you want help with health care costs, help is here. You and your family might be able to receive free or low-cost health care through the Texas Medicaid and Childrens Health Insurance Program .

    Ready to learn more? Here are the steps to follow.

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    What Is Texas Medicaid

    Texas Medicaid encompasses a variety of programs to provide financial health care coverage to eligible individuals throughout the state. Providing coverage for families, individuals and older adults, Texas Medicaid strives to preserve the well-being of Texans by providing quality health care services that can be accessed within beneficiaries’ communities.

    In Texas, there are five types of Medicaid coverage:

    • STAR
    • STAR Health
    • Traditional Medicaid

    Each of the STAR programs provides managed care for recipients. While STAR, STAR Kids and STAR Health offer services for families, kids and pregnant women, STAR+PLUS features managed care for those aged 65 and older and individuals who are living with disabilities. Traditional Medicaid covers individuals who aren’t eligible for managed 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?

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    Texas Medicaid Will Pay For A Nursing Home Assisted Living Or Home Health Care When A Patient Needs Skilled Nursing Care

    By Douglas Witten

    In Texas, long-term care is expensive, whether in a nursing home, assisted living facility, or home health care. Medicare coverage for long-term care is very limited, private health insurance policies generally do not cover long-term care, and few people have purchased private long-term care insurance policies. For Texans needing long-term care, Medicaid is the most common source of funding.

    Medicaid is funded by both federal and state resources, and it provides health coverage to over four million Texans. There are many different ways to become eligible for Medicaid in Texas, and Texas has specific eligibility rules for long-term care services like nursing homes, assisted living facilities, and home health care services.

    What Does Medicaid Offer Children With Disabilities Or Special Health Care Needs

    How To Mail A Texas Medicaid Application To Your Client In Less Than 1 Minute

    Medicaid Buy-In for Children, Medicaid Buy-In for working adults with disabilities, STAR Health, STAR+PLUS, and the STAR Kids program are all designed to make sure children and adults with disabilities or special health care needs have health care coverage. Medicaid health coverage includes acute care services , behavioral health services, pharmacy services, and some long-term services and supports .

    As we mentioned above, there are specific Medicaid programs, also known as waivers to help children with disabilities or special health care needs live and thrive in the community. These programs have long interest lists that might take many years. So, even if you dont think that your child would need the waiver services now, its a good idea to sign up as early as possible.

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    What Are My Next Steps

    If you would like to apply or reapply for Medicaid, your next step is to get a QIT.

    Medicaid may cover past medical expenses, schedule a consultation to see if you can have those expenses reimbursed. If you have all the documentation, we can prepare your application in a matter of days.

    If you need Medicaid for long-term care and dont want to be denied, Holman Law provides expert advice on Qualified Income Trusts and long-term care planning. Schedule a free consultation today.

    Holman Law is a top-rated estate planning and probate law firm serving clients in the Dallas-Fort Worth area. Our estate planning attorneys specialize in wills, trusts, and probate law. You can expect a quick response and excellent customer service suited to fit your individual or family needs.

    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.

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    Enjoy The Benefits Of Community

    As a Community Member, you can choose from a wide network of hospitals and doctors, including Memorial Hermann, Harris Health System, and many others.

    Great health care is just the start. Community Members also get lots of extras like:

    • Member events
    • Proof of identity – This could include Social Security numbers for children applying for coverage
    • Proof of citizenship or immigration status – U.S. birth certificate, U.S. passport, Certificate of Naturalization
    • Proof of money your family gets – Includes paycheck stubs, proof of self-employment income, child support check stub
    • Proof of what you pay to take care of others – Includes receipts or cancelled checks from the person you pay for child or adult care, child support or alimony

    Effective Date Of Coverage

    Income Qualifications For Medicaid Texas

    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.

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