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Texas Medicaid Planners

Medicaid Nursing Home Eligibility

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Long term care is not cheap.
In Texas, the average cost for a semi-private room is $4,798 / mo. ($57,576 / yr.) and for a private room, $6,540 / mo. or $78,480 / yr. Medicaid Planners help clients structure their financial resources and prepare documentation to ensure the best possibility of being accepted into the Medicaid program.

They create trusts, manage asset transfers, and convert countable assets into exempt assets to ensure eligibility and preserve a family's resource

Medicaid will pay for a nursing home only when it is "medically necessary." In Texas, for a nursing home to be considered medically necessary, you must have a medical condition that is so serious that you need the level of nursing care that is only available in an institution.

Nursing Home Medicaid Eligibility

While Medicare covers some skilled nursing facility care, it will only cover this care for a limited amount of time (up to 100 days in a benefit period) if you meet certain criteria. Medicaid may also pay for some medical services that are not covered by Medicare, such as routine dental care.

 If you have questions or concern about Medicaid Eligibility, it's advised to only talk to a Medicaid Specialist regarding Medicaid and long-term care issues. What you don’t know about paying for nursing home care could cost you both your home and your life savings. Don’t let that happen! Medicaid pays for all or a part of the cost of care (depending on the facts).

To qualify for Medicaid, the person requiring care (who is the applicant for Medicaid purposes) must meet strict income and asset limits. With proper planning you may be able to substantially reduce the amount of money you spend out of pocket for care. Eligibility rules for single applicants are different from those who are married. Here are the basic guidelines:

Your doctor must document your medical condition and must prescribe skilled nursing services to be provided to you on a regular basis in an institutional setting.

Nursing care includes things like giving shots, inserting a feeding tube or catheter, treating bed sores, and changing wound dressings.

Find a Texas Medicaid Planner

Medicaid can pay for care in a nursing home, once a person who qualifies has been in a Medicaid-certified bed for at least 30 days in a row. Medicaid may pay for your nursing home care if you have a low income, limited resources, and a medical need for nursing home care. You must also be a United States citizen or a qualifying alien, as well as a Texas resident.

Income: If you’re not married, you can make up to $2,349 per month from all sources. If you are married, and your spouse also needs nursing home Medicaid, your combined income can be no more than $4,698 per month. Government checks, paychecks, interest and rental payments, annuities, mineral rights, and gifts are considered income.

 Resources: If you’re not married, you can have no more than $2,000 in resources. If you are married, and your spouse also needs Medicaid to pay for care in a nursing
home, your combined resources can be no more than $4,698. Resources include cash in checking and savings accounts, certificates of deposit, other liquid assets, and
property other than your homestead or burial plot.

However, not all resources are taken into consideration when you apply for Medicaid. Here are some resources that are exempt in most cases:

– A homestead with no more than $560,000 equity
– One vehicle, regardless of value
– A life insurance policy with no more than $1,500 cash value
– A burial plot

Medical Need for Nursing Home Care:

To qualify for nursing home Medicaid, you must have specific medical needs. How do you know, or prove, that you meet the medical requirements? A nurse or other health care professional (often the director of nurses at the nursing home) assesses your health and then sends the assessment form to the Texas Medicare and Healthcare Partnership (TMHP) for review. TMHP decides whether you meet “medical necessity” requirements.

If your income, resources, and medical needs are within the Medicaid guidelines, Medicaid will begin to pay for your care in a nursing home. You’ll be expected to help pay for your care in the nursing home, usually by turning over your monthly income to the nursing home. In most cases, you will be allowed to keep $60 per month for
incidental items.

Disclaimer: Elder Options of Texas is not rendering any legal or professional advice.  If legal advice is necessary your should consult a competent attorney.

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DISCLAIMER: Links to other websites or references to products, services or publications do not imply the endorsement or approval of such websites, products, services or publications by Elder Options of Texas. The determination of the need for senior care services and the choice of a facility is an extremely important decision. Please make your own independent investigation.