Approximately 3.7 million – or 13% – of the population in Texas is at least 65 years of age, and that number is only growing every day. The projected growth of an aging population means that there is going to be an increase in the need for healthcare services and long-term care for the people of Texas.
One of the services that Texans will likely rely on will be Medicaid. This is a program that is different from Medicare (even though the two terms are often used interchangeably), and it will help seniors to pay for their healthcare needs to make sure they get the services as they need them.
Do you automatically get Medicaid? Do you need to apply for it? There are some differences between this program and Medicare, and here’s what you need to know about it.
What Is Medicaid?
This is a program that provides health coverage to low-income individuals, including children, pregnant women, people with disabilities and the elderly. The rules about this program will vary from state to state as they will determine their own coverage.
In Texas, Medicaid pays for a lot of non-medical services that will help to keep seniors in their homes and out of long-term care facilities.
The plans in Texas are administered by Managed Care Organizations, and they are usually called STAR+PLUS.
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Who Qualifies For Medicaid In Texas?
In the state of Texas there are various long-term care programs that seniors can apply for. Each program has different eligibility requirements, and they all have different benefits.
Institutional/Nursing Home Medicaid
This type of program is what’s known as an entitlement program and anyone who is eligible will receive this assistance. The stipulation, though, is that all care under this program is administered in a nursing home or long-term care facility.
The income limit for this type of benefit, for a single person, is $2,523 per month and they cannot have more than $2,000 in assets. If it’s a couple applying for the benefit their income cannot exceed $5,046 per month with $3,000 in assets.
Medicaid Waivers/Home And Community Based Services
The number of people in this program is limited, and there may even be wait lists to be enrolled in this program for Texans. The intention of this program is delay and prevent nursing home care.
The benefits here will be provided at the senior’s home or at an assisted living facility. In some cases, if the senior attends a day program then the benefits may be administered at the day program as well.
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Waiver programs receive help from the federal government to essentially “waive” the requirements of some of the state run healthcare so that they can give more healthcare to the people in their state.
This is why there may be a wait list for getting into these programs as each state will only receive so much funding from the federal government, which means their resources may be tapped out from time to time or they can only support a certain number of people at a time.
Prior to states having these waiver programs, it was often found that the only option for seniors was to go into a nursing home or other long-term care facility. Now with these programs they are able to stay in their homes and keep independence for as long as possible.
The income limits for this program are the same as what a person would need to qualify for Institutional or Nursing Home care.
Regular Medicaid
This is another entitlement program where anyone who qualifies for it automatically gets the benefits it offers. Additional benefits like personal care assistance or even adult day care programs may be available for people in this program.
The income limit for this program is much lower than the other two mentioned. The maximum income limit in order to qualify for this program, per month, is $841 per month for a single person or $1,261 per month for a couple applying.
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What Is Defined As Income?
When you are applying for Medicare and Medicaid benefits, one of the most important components that will be reviewed is your income. Income level is what qualifies or disqualifies a person, usually, for these benefits.
When it comes to applying for Medicaid, any income a person receives from any source is counted as income for this type of benefit. This included employment wages, alimony payments, pension payments, social security income or even investment dividend income.
If only one spouse in a couple is applying for these benefits then only that spouse’s income will be counted for the application. The spouse that is not applying may be able to get an allowance that will prevent spousal impoverishment from happening.
There are income limits in Texas on the non-applicant spouse, though. In order to determine if you are eligible for non-applicant spousal benefits or allowance, you will need to contact your Medicaid center to talk about your specific situation.
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Applying For Medicaid In Texas
If you’re living in Texas and need to apply for Medicaid benefits, you will need to apply online at the Your Texas Benefits website. You can also print off and fill in a paper application form, and then mail it to the center.
Before you apply for this program, seniors are encouraged to double check that they are truly eligible for the program they are applying for. If you need to meet certain requirements (income, assets or medical condition) then you will need to make sure all of that information is in order before applying.
If you have income or assets over the allowed limit for qualifying, it is encouraged that you consider something called Medicaid Planning. This is a program run by volunteers and professionals to help individuals to prepare for applying for Medicaid.
This could include getting all the right documents in order, or restructuring their finances so that they meet the eligibility requirements. Sometimes finances become complicated when it comes to Medicare and Medicaid (like what if one spouse needs long-term care and the other can live independently – how are their finances split?) so that is why professionals help individuals to financially plan and prepare for Medicare.
Other Programs Available For Senior Texans
Outside of Medicaid, there are other programs available to elderly Texans to help them get the healthcare services they require.
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Medicare
This is a program for Americans that are at least 65 years old, and it helps with the cost of healthcare so that people can see doctors and other healthcare specialists as they need them without the cost burden.
This program doesn’t always cover all the costs associated with receiving medical care, nor does it cover most long-term care costs. However, it can help to offset the cost of hospitalizations and recovery from surgeries.
Social Security
This is a monthly benefit paid to older Americans or workers who may have become disabled and cannot work anymore.
The amount that is paid out to each person is dependent on their average earnings when they retired. If the person is disabled, the amount of money they get each month will be based on the amount of income you have paid in Social Security taxes.
Supplemental Security Income
This is also a monthly benefit that is paid out to people who have a limited income or resources. There are some assets and income – like a house or a car – that are not counted for eligibility with social security income.
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Supplemental Nutrition Assistance Program (SNAP)
This program was known as food stamps previously, and it allows for Americans across the country buy nutritious foods at their local grocery store.
The program is open to both low-income single people and families who meet the income requirements.
For households where all people living there are over 60 years old, or there are people with disabilities, they can apply to participate in the Texas Simplified Application Process (TSAP). This makes the process for applying to the Supplemental Nutrition Assistance Program much easier and quicker, and it will give the recipient three years of benefits at a time (instead of the stands six months that the SNAP program hands out).
When you need to apply for medical benefit coverage, it can seem very overwhelming as to where to start and exactly how you go about getting coverage when you don’t have any,
Start with your local Medicare and Medicaid office, or their online website, to get the application process going. From here, you will be able to determine if you meet the eligibility criteria and get your benefits started.
If you need to restructure your finances in order to meet the financial requirement, you may want to first meet with a Medicaid Planner to see the best way to go about these changes.
There are also other additional benefits people in Texas can get to help them with medical costs and even making sure they are able to purchase nutritious foods. If you need assistance with your Medicare or Medicaid benefits, contact your local center for assistance to check on your coverage and benefits.