In Texas, Medicaid provides coverage for long-term care services, including nursing home care, for eligible individuals who meet certain income and asset requirements.
What is Medicaid?
Nursing home Medicaid is a joint federal and state government-funded program that provides assistance to individuals who require long-term care in nursing homes. In Texas, the program is administered by the Texas Health and Human Services Commission.
Who is Eligible for Texas Nursing Home Medicaid?
To be eligible for Medicaid long-term care benefits in Texas, an individual must be a United States citizen or an alien with qualified alien status and be a resident of the state of Texas
In addition, the applicant must reside in a Medicaid-licensed facility with an available Medicaid bed and meet certain medical and financial criteria.
In order to qualify for Medicaid in Texas, the applicant must meet “medical necessity” guidelines.
In order for “medical necessity” to exist, the applicant must demonstrate a medical condition that is of sufficient seriousness that the individual’s needs exceed the routine care.
This care may be given by an untrained person and requires licensed nurses’ supervision, assessment, planning, and intervention that are available only in an institution.
In addition, the applicant must require medical or nursing services that are ordered by a physician and dependent upon the individual’s documented medical conditions.
As well as require the skills of a registered or licensed vocational nurse, provided either directly by or under the supervision of a licensed nurse in an institutional setting, and required on a regular basis.
In order to qualify for Medicaid, the applicant must receive a monthly gross income below Medicaid’s defined income limits.
If the income limit (which changes slightly from year to year) is exceeded, a Qualified Income Trust (also known as a QIT or Miller Trust) can be used to overcome the income barrier to Medicaid eligibility.
“Resources” are cash, other liquid assets, or any real or personal property or other non-liquid assets that a person could convert to cash to be used for his or her support or maintenance.
Resource limits vary depending on the individual’s circumstances.
In order to qualify for Medicaid, an unmarried applicant must have less than $2,000 of countable resources.
The resource limit for a married applicant with an ineligible spouse is generally one-half of the couple’s combined countable resources as of the first day of the month in which the applicant began a period of continuous institutional care, subject to certain minimums and maximums.
However, not all resources are considered countable resources. Excluded resources may include:
- Your home,
- One vehicle of any value,
- Funds transferred to a 529 plan for the benefit of a child or grandchild under the age of 21,
- Prepaid burial contracts, and
- Your retirement accounts.
To ensure that people don’t try to cheat the system by giving away or selling their assets to family and friends for less than what they’re worth before applying for nursing home Medicaid, Texas has a five-year Medicaid look-back period.
If an applicant has made any transfers for less than fair market value within the five years prior to applying for Medicaid, a transfer penalty may be imposed.
During the penalty period, the duration of which is based upon the amount transferred, the applicant is not eligible for Medicaid coverage, even if they meet all other eligibility requirements.
Medicaid Estate Recovery Program (MERP)
The Texas Medicaid Estate Recovery Program (MERP) is a program that seeks to recover the costs of long-term care services provided by the state’s Medicaid program to individuals who are 55 years old or older and received Medicaid benefits.
When a Medicaid recipient passes away, MERP may seek to recover some or all of the expenses related to the care provided by filing a claim against the recipient’s probate estate.
It’s important to note that MERP does not take effect until after the Medicaid recipient’s death, and it does not impact the recipient’s eligibility for Medicaid while they are alive.
Additionally, MERP does not place liens on assets before or after the death of a Medicaid recipient and cannot collect more than the value of your probate estate.
Even if there are not enough assets in your probate estate to pay all or even some MERP claim, your family members will not be required to pay anything out of their own pockets.
How Can an Attorney Help with the Medicaid and Long-Term Care Planning Process?
While you are not required to have an attorney to apply for Medicaid in Texas, there are several reasons why hiring an attorney to help you apply for Medicaid can be beneficial.
A long-term care planning attorney can help you determine if you are eligible for benefits and assist you in completing the often complex application process.
Further, they can help put together a plan to protect your assets. If Medicaid denies your application, a lawyer can also file an appeal and advocate for your right to receive benefits.
An attorney can help determine whether you or your loved one is eligible for Medicaid benefits and can assist in addressing any potential issues during the eligibility determination process.
If you or a loved one is in need of skilled nursing care, you may be concerned about protecting assets and ensuring that they are not depleted by the cost of care.
A long-term care planning attorney can help you develop a plan to protect those assets while still qualifying for Medicaid benefits.
Complexity Of The Application Process
The Medicaid application process can be complex, particularly for those who are not familiar with the eligibility requirements and the various documents that are required.
An experienced elder law attorney can help you navigate the process, ensuring that all necessary paperwork is completed accurately and submitted on time.
Denials And Appeals
If Medicaid denies your application for benefits, an attorney can help with the appeals process, working to overturn the denial and ensure that you receive the benefits to which you are entitled.
If you or a loved one receives Medicaid benefits, you may be worried about assets being taken by MERP. An attorney can help you implement strategies such as the utilization of beneficiary designations and Lady Bird Deeds or Transfer or Death Deeds to avoid or help reduce the impact of MERP.
Get in Contact with a Central Texas Elder Law Attorney Today
Whether you should apply for Medicaid long-term care benefits depends on the financial situation, marital status, and health condition of you or your loved one.
Ultimately, the decision to apply for Medicaid long-term care benefits should be based on a thorough evaluation of your individual situation.
Long Term Care and Medicaid FAQs
Long-term care planning involves creating a plan to address the financial and medical needs of individuals who require long-term care, such as nursing home care, assisted living, or in-home care. This can include creating legal documents such as powers of attorney, lady bird deeds or transfer on death deeds, Wills, and trusts to protect assets and ensure that individuals receive the care they need.
To be eligible for nursing home Medicaid in Texas, you must be a resident of Texas, at least 65 years old or disabled, and meet certain income and asset requirements. Additionally, you must require nursing home care, as determined by a medical evaluation.
Transferring assets for the purpose of qualifying for nursing home Medicaid in Texas may be subject to penalties and may result in ineligibility for benefits.
MERP is a program that allows the state to recover the costs of certain Medicaid benefits from the estates of individuals who received those benefits.
No, Texas Medicaid and MERP do not place liens on assets before or after the death of a Medicaid recipient.