Texas Medicaid Long Term Care Eligibility

Texas Long Term Care

texas-long-term-care Texas is an income cap state, meaning that in order to be eligible for Medicaid long term care benefits, there is a hard income limit. Non income cap states allow applicants to spend down money for their care, whereas income cap states require the amount to be no higher than their limit at time of application.

Eligibility:

1. Residency and Citizenship – the applicant must be a resident of Texas and a U.S. citizen or have proper immigration status.

2. Age/Disability – the applicant must be age 65 or older, or blind, or disabled. The applicant must meet certain medical requirements consistent with the level of care requested. Persons must need care for thirty (30) consecutive days.

3. Income Limitations – Texas allows applicants to place money into what’s known as a Miller Trust, which specifically designates any funds above the income limit for the payment of Medicaid services. Monthly income (wages, Social Security benefits, pensions, veteran’s benefits, annuities, SSI payments, IRAs, etc.) must be no higher than:

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  • There is a $60/month personal needs allowance that is not factored into the countable income.

4. Asset Limitations (Exempt vs. Available) – Medicaid divides assets into two categories: Exempt and Available. Exempt assets are specifically designated under the rules, and ownership of an exempt asset by the applicant will not result in a denial of benefits. If an asset is not listed as exempt then it needs to be liquidated and applied toward the costs of nursing home care before the applicant can receive Medicaid benefits. The state has a look back period of 5 years with a penalty for people who sell assets below fair market price, transfer assets to others, or give money and property away. Basically, all money and property, and any item that can be valued and turned into cash, is a countable asset unless it is listed as exempt.

Exempt Assets for an applicant in Texas include:

i. See chart above for allowances of cash/non-exempt assets.

ii. One home is exempt (equity limit $552,000) if planning to return, a spouse, a child under 21, or a disabled person resides in it. Whenever an institutionalized person sells a previously exempted residence, the money from the sale becomes a countable asset. The recipient may then lose eligibility for Medicaid until he/she has spent down the money and their countable resources are once again less than the maximum.

iii. One automobile, no equity amount specified.

iv. Irrevocable burial trust, no amount specified.

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v. Non-saleable property, household furnishings, furniture, clothing, jewelry, and other personal effects are not counted.

Spousal Rules:

Amount of assets community spouse may retain: The community spouse can keep one-half of countable assets with a maximum value of $119,220. If the community spouse’s assets do not equal the minimum of $23,844, the community spouse is able to retain assets from the institutionalized spouse until the minimum is reached.

Community spouse impoverishment protection: The community spouse can keep part of the institutionalized spouse’s income if the community spouse has an income of less than $2,980.50 per month. The maximum amount of income that can be retained is $2,980.50. Texas is an “income first” state, meaning the state limits the right to petition for an increased community spouse resource amount (CSRA) to couples whose combined income fails to meet the community spouse’s income needs. Basically, this means a community spouse can petition for an increased CSRA where there’s an income gap only after factoring in the nursing home spouse’s income first.

Texas long term care insurance partnership:

This is a program between the state and private insurance companies. Partnership policies protect assets by matching dollar for dollar what policy holders pay into their policies. For example, if you bought a Partnership Policy with a maximum benefit payout of $155,000 then you are able to protect $155,000 of your assets. For married couples each spouse needs to purchase their own policy. Once the $155,000 worth of long term care coverage is used, you may apply for Medicaid with $155,000 worth of assets exempted.

Further Reading:

Texas Health and Human Services STAR+PLUS handbook: http://www.dads.state.tx.us/handbooks/sph/3000/3000.htm

How to apply for Texas benefits: http://yourtexasbenefits.hhsc.texas.gov/sites/default/files/docs/1200-eng.pdf

Where to call to get Department of Aging and Disabilities Services (DADS): http://www.dads.state.tx.us/services/contact.cfm

Application Process: http://www.dads.state.tx.us/services/needtoknow.html