Revision 19-1; Effective March 1, 2019

 

Note: The following information is effective Jan. 1, 2019.

 

Medicaid Eligibility for the Nursing Facility Program

Income — Maximum gross monthly income

  • $2,313 Individual
  • $4,626 Couple

What counts as income?

  • Social Security benefits
  • Certain veterans benefits
  • Private pensions
  • Interest or dividends
  • Royalty and rental payments
  • Federal employee annuities
  • Railroad benefits
  • State or local retirement benefits
  • Gifts or contributions
  • Earnings and wages

Resources — Maximum countable resources

  • $2,000 Individual
  • $3,000 Couple

What is a resource?

  • Bank accounts and certificates of deposit (CDs)
  • Real property
  • Life insurance policies
  • Burial funds
  • Individual retirement accounts (IRAs)
  • Stocks and bonds
  • Oil/gas/mineral rights
  • Jewelry and antiques
  • Cars and other vehicles
  • Boats and recreational vehicles

What can be excluded?

  • A homestead in Texas to which the person intends to return.
  • Life insurance, if the face value is $1,500 or less per insured person.
  • Separately identifiable burial funds of $1,500 (less any excluded life insurance) or more, if irrevocable, for the applicant and the applicant’s spouse.
  • One vehicle is excluded, regardless of value.

Protected resources amount for a spouse in the community

$25,284 minimum to $126,420 maximum (excludes value of homestead, household goods, personal goods, one car and burial funds)

Other

Medical Need — Must meet medical necessity criteria.

Residency — Must be a resident of Texas and a U.S. citizen or alien with approved status (for example, a legalized or permanent resident alien).

Living Arrangement — Must be a patient in a Medicaid-contracted long-term care facility for 30 consecutive days.

Co-payment

Individual — Total gross income, less $60 for personal needs.

Individual with a spouse in the community — Total gross couple income, less $60 for personal needs; less amount up to $3,160.50 for community spouse; less certain amount for dependents living with community spouse.

Couple — Total gross income, less $120 for personal needs.

Certain other expenses (such as health insurance premiums, guardianship fees and incurred medical expenses if the Medicaid program does not cover direct payment for the services) may be deducted if the person meets program policy requirements.

 

Texas Medicaid Home and Community-Based Services Waivers

Income — Maximum gross monthly income

  • $2,313 Individual, and individual with an ineligible spouse
  • $4,626 Couple
  • Note: Do not count income of a parent for a child.

What counts as income?

  • Social Security benefits
  • Certain veterans benefits
  • Private pensions
  • Interest or dividends
  • Royalty and rental payments
  • Federal employee annuities
  • Railroad benefits
  • State or local retirement benefits
  • Gifts or contributions
  • Earnings and wages

Resources — Maximum countable resources

  • $2,000 Individual
  • $3,000 Couple
  • Note: Do not count resources of a parent for a child.

What is a resource?

  • Bank accounts and CDs
  • Real property
  • Life insurance policies
  • Burial funds
  • IRAs
  • Stocks and bonds
  • Oil/gas/mineral rights
  • Jewelry and antiques
  • Cars and other vehicles
  • Boats and recreational vehicles

What can be excluded?

  • A homestead in Texas where the person lives or to which the person intends to return.
  • Life insurance, if the face value is $1,500 or less per insured person.
  • Separately identifiable burial funds of $1,500 (less any excluded life insurance) for the applicant and the applicant’s spouse.
  • One vehicle is excluded, regardless of value.
  • Burial spaces, unless used for investment.

Protected resources amount for a spouse in the community

$25,284 minimum to $126,420 maximum (excludes value of homestead, household goods, personal goods, one car and burial funds)

Other

Medical Necessity — Must meet nursing facility medical criteria or ICF/IID-RC level of care criteria.

Residency — Must be a resident of Texas and a U.S. citizen or alien with approved status (for example, a legalized or permanent resident alien).

Plan of Care — Must have an approved plan of care within the cost ceiling.

Age — May have specific age requirements. Examples:

  • STAR+PLUS — Must be age 21 or older; and
  • Medically Dependent Children Program (MDCP) — Must be younger than age 21.

Catchment Area — May require living in certain areas of the state.

Disability — Certain waivers have specific disability requirements.

Example: DBMD requires a person with a visual impairment and who is hard of hearing to have a third disability to be eligible.

Co-payment — In certain situations, individuals may be required to pay a co-payment based on income.