Nursing Home Care: Do You Meet the Texas State Medicaid Eligibility Requirements?

Last updated on: June 6, 2024

Addressing nursing home care and Medicaid eligibility is a critical issue for many families. As the population ages, the need for affordable and accessible long-term care facilities becomes increasingly pronounced. Medicaid can play a vital role in covering costs that would otherwise be unmanageable for most individuals and their families. However, understanding and complying with the eligibility requirements for Medicaid can be overwhelming due to its intricate rules and regulations.

For those facing the challenges of securing nursing home care while also managing the financial implications, a knowledgeable Houston Medicaid planning attorney can offer invaluable assistance. At The Law Office of Whitney L. Thompson, we can help you understand nursing home care and Medicaid eligibility, and provide personalized guidance in securing the necessary care without undue stress. Contact us today at (281) 214-0173 to schedule a consultation.

How Does Medicaid Help Me?

For older adults and persons with physical or intellectual disabilities, long-term care can become expensive. They or their caretakers may not have the means to access nursing homes or extended care, despite their needs.

Medicaid helps relieve that burden. It is a state and government program that provides free or low-cost health care services to individuals with need.

Do I Qualify?

Eligibility depends on a few factors, including income. Here is a brief overview of Texas state Medicaid eligibility requirements. You must:

  • Reside in the state of Texas
  • Be a U.S. citizen, national, permanent resident, or legal alien
  • Be in need of health care assistance
  • Be low income to very low income

You must also meet at least one of these conditions:

  • You are pregnant
  • You are responsible for a minor (younger than 18 years old)
  • You are blind
  • You have a disability or a relative in your household with a disability
  • You are 65 years old or older

To learn more about the requirements you need to meet, visit the Texas Medicaid website.

What if I Make Too Much Money or Have Too Many Assets?

Your best option is to contact a knowledgeable Elder Law Attorney. They can tell you more about the income and asset rules for Medicaid.

If you need help qualifying for Medicaid, a skilled Medicaid planning attorney can also help you with asset protection planning.

What Happens to Assets if You Go Into a Nursing Home in Texas?

When considering nursing home care in Texas, a common concern is what happens to your assets if you need to apply for Medicaid. It’s important to understand that Texas does not confiscate any assets from individuals applying for Medicaid. However, maintaining eligibility for Medicaid nursing home benefits involves meeting certain criteria related to your income and assets.

In Texas, the process is straightforward but strict. If your assets exceed the limits set by Medicaid, you may not qualify for benefits. Essentially, if you choose to keep your assets in a way that does not comply with these eligibility requirements, the Health and Human Services Commission (HHSC) will not approve Medicaid benefits for your nursing home care.

This means that asset management becomes crucial when planning for potential long-term care. Individuals must either appropriately spend down their assets or restructure them in accordance with legal guidelines to meet Medicaid’s eligibility requirements. This could involve strategies such as setting up a qualifying trust or converting countable assets into exempt assets.

For tailored and comprehensive assistance with requirement compliance and to assure that you or your loved ones can qualify for the necessary care without undue financial burden, it is vital to seek advice from a Houston Medicaid planning attorney who understands the intricacies of Medicaid’s regulations. At the Law Office of Whitney L. Thompson, we can help you plan effectively, aligning the management of your assets with Medicaid’s eligibility criteria while securing the care needed. Contact us today to learn more about how we can assist you.

Medicaid Eligibility Requirements in Texas

In Texas, there are certain requirements that one must fulfill in order to be eligible for Medicaid. These requirements are: 

  • Categorical requirements – A person can only become eligible for Medicaid if they are at least 65 years old, blind, pregnant, or otherwise disabled. They also need to be U.S. citizens. Some resident aliens might also be eligible. Undocumented aliens might be eligible for Medicaid only for emergency coverage.
  • Medical Necessity – The applicant must demonstrate a need for skilled nursing care in order to be eligible for Medicaid. In most cases, the doctor’s opinion that the applicant should be living in an assisted living or nursing facility is sufficient.
  • Income Eligibility – Medicaid regulations state that the applicant cannot receive more than $2,523 per month in direct income. Miller trusts can often solve problems if the monthly income of the applicant exceeds this cap. Medicaid applicants often face major hurdles in determining income eligibility. Poor decisions by applicants regarding their pensions and other income can block Medicaid eligibility. 
  • Asset Eligibility –  If one spouse enters a nursing facility, then the spouse who is institutionalized will have an asset cap of $2,000. If both spouses are going into a nursing facility, the asset limit for both spouses is $3,000. There are many exceptions to these asset caps. For example, a home worth up to $500,000 is not considered an asset. A home with a spouse still living in it is also not considered an asset. The most difficult aspect of Medicaid eligibility is asset eligibility. This is why speaking to an experienced lawyer for Medicaid planning is very important when it comes to Medicaid planning and eligibility.
Medicaid Eligibility Requirements in Texas Description
Categorical Eligibility based on age (at least 65), blindness, pregnancy, disability, and U.S. citizenship. Some resident aliens may also be eligible, while undocumented aliens may only qualify for emergency coverage.
Medical Necessity Applicants must demonstrate a need for skilled nursing care, often validated by a doctor’s recommendation for assisted living or nursing facility residency.
Income Eligibility Monthly income must not exceed $2,523. Miller trusts can help if income exceeds this limit, but poor financial decisions can complicate eligibility.
Asset Eligibility Asset limits include $2,000 for one spouse in a nursing facility and $3,000 if both spouses are residents. Exceptions include a home value up to $500,000, and a home with a living spouse is not considered an asset.

Secure Your Future Through Medicaid Planning Today

When you plan in advance for long-term care, you can raise the quality of life for yourself or the loved ones you care for while reducing stress. If you prefer an experienced lawyer to guide you through the Medicaid planning process, call Whitney L. Thompson, Esquire at (979) 318-5079.

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