Learn about paying for Texas nursing home care using Medicaid benefits.

Medicaid is a joint federal and state program. The Texas Medicaid program is a unique combination of federally-mandated minimum coverage and state-determined optional coverage that help pay for medical care and supportive services for eligible individuals based on income and resources.

Medicaid may pay all or part of nursing home costs for eligible clients through the Medicaid Nursing Facility Program; however, clients contribute toward their care, based on income and other considerations.

Medical necessity is a prerequisite for participation in the Long-Term Care Medicaid program, and the individual applying for benefits must demonstrate a medical condition that’s of such seriousness that his or her needs exceed the routine care that may be provided by an untrained person, and therefore requires licensed nurses’ supervision, assessment, planning and intervention available only in an institution.

Additionally, the individual must require medical or nursing services that:

1. are ordered by a physician

2. are dependent upon the individual’s documented medical conditions

3. require the skills of a registered or licensed vocational nurse

4. are provided either directly by or under the supervision of a licensed nurse in an institution, and

5. are required on a regular basis.

Texas Medicaid Income Limits for 2015

Additionally, there are differences between income allowances for single individuals and for spouses qualifying for the waiver program. As of Jan. 1, 2015, an individual may have up to $2,199 in monthly direct gross income and own a total of $2,000 in assets, excluding a homestead, primary vehicle, irrevocable prepaid funeral plan and burial plots. If the applicant is married (and the spouse is not also applying for Medicaid), the asset and income limits increase significantly to allow the healthy spouse to continue paying their bills.

If you are concerned about what needs to be done to meet the eligibility criteria (income and resource limitations), call me to ensure that you qualify in advance of starting the process.