What are the Basic Eligibility Requirements for Long-Term Care Medicaid in Texas?

What is Medicaid?

The government established an assistance program to serve those in low-income situations with their long-term healthcare needs if they could not work due to age or physical condition. All states adopted this program, and they called it Medicaid. The name is short for “medical aid.” While Medicaid is run by guidelines set forth by the federal government, the program is run by state and local governments and can vary from state to state.

Patients with Medicaid benefits typically do not pay costs for covered medical expenses or may rarely pay a small copay.

For What Long-Term Care Would Someone Need Medicaid?

A person may require long-term care for a multitude of reasons.

• Age – As we get older, we require help with basic tasks.
• Disability – Accidents or chronic illnesses may cause difficulty in performing basic tasks or cause health reasons why a person would need constant long-term care.
• Health Status – While not disabled, someone with a chronic condition such as diabetes or high blood pressure may be more likely to need long-term care.
• Living Arrangements – If someone lives alone, they are more likely to need paid care than if they are married or living with a partner or relative.

Any of the above reasons could cause someone to need help with basic tasks of living – bathing, dressing, personal hygiene, housekeeping, meal preparation, or eating. As many as 70% of people over 65 will use some form of long-term care during their lives. Many more may need it but not be able to afford it. For these reasons, many people find it important and of high priority to be able to qualify for Medicaid.

What Are the Basic Requirements for Long-Term Care Medicaid Eligibility in Texas?

The basic eligibility requirements for long-term care Medicaid in Texas are:

• Income:
  • Medicaid income limit for an unmarried Medicaid applicant is $2,163 per month.
  • For a married couple, the limit is $4,326 per month
  • If both spouses live in a nursing facility, the income limit is doubled
• Resources:
  • Resources accessible to the applicant may be ‘countable’ or ‘excluded.’
• Medicaid Facility or Medicaid Bed:
  • Applicant must be in a Medicaid-certified facility in a Medicaid bed for at least. 30 days
• Nationality and Residency:
  • Applicants must be U.S. citizens or qualified aliens
  • Applicant must also be a resident of Texas and intend to remain in Texas or return if not currently in Texas
• Medical Necessity:
  • Applicants must have a “medical necessity” for nursing home care, meaning their condition must be considered serious enough that it requires licensed nurses in an instituional setting.

What Next?

If you’re concerned you may not qualify for Medicaid but will need its benefits; there may still be options. Call (254) 457-5083 today and speak with an attorney from Rainey & Rainey, Attorneys at Law, LP, to discuss your options.