Holman Law specializes in helping families in Texas with Medicaid application and eligibility. Medicaid can provide up to $2,000 per individual every month for nursing home care. If you or a loved one needs immediate assistance qualifying for Medicaid in Texas, especially if you do not have time to be denied – schedule a free consultation with us. We will provide guidance and support to prepare and submit the application to HHS.
How To Qualify For Medicaid Assistance
Applying for Medicaid can be tedious and most people in Texas are denied due to having the lowest income thresholds in the United State. Holman Law can help navigate through the lengthy application process and advise you on planning for your future. Not only will we apply for Medicaid on your behalf, but we’ll also make sure you’re eligible to receive assistance and financial support for long-term care. Hiring an Elder Care Attorney will save you time in the long run. If you’ve already applied and been denied Medicaid assistance, we can help you re-apply and qualify using financial strategies and estate planning services:
5 Facts About Medicaid in Texas
Fact 1 Medicaid can cover and pay for all your long term care costs
Fact 2 Texas is one of the most difficult states to get Medicaid coverage.
Fact 3 Many Texas residents are denied Medicaid, even if they are living below the poverty line.
Fact 4 Medicaid coverage can help cover long-term care costs, such as nursing homes and in-home care, and medical bills.
Fact 5 If you are over the income limit, a Qualified Income Trust (QIT) will help resolve this eligibility requirement so you can be approved for Medicaid.
For those who are in a crisis and need to address medical care for an elderly family member or spouse, you may not have the time to wait and see. It is our mission to help families with immediate needs in Elder Care: Medicaid application, long-term care, incapacity planning, and Estate Planning.
For those who are starting out seeking Medicaid assistance check out the government website for program description and requirements, as well as the Texas Medicaid Eligibility Checker at the bottom of the page. Keep in mind that even if the Eligibility Checker states that you are not eligible, you may still be able to qualify. Contact us to find out more.
- Nationality and Residency Requirements – The applicant must be either a U.S. citizen or an alien lawfully admitted for permanent residence, or otherwise permanently living in the U.S. The applicant must also be a resident of Texas.
- Age, Blindness, or Disability – An applicant for nursing home care must be either over 65, blind, or disabled as defined by Social Security.
- Income – For a single individual or married individual with a healthy spouse, in the state of Texas the income cap for countable income attributable to the applicant is $2,349 in 2020. This amount changes annually with inflation. If both spouses reside in the same nursing home, the incomes are combined and the income cap for the combined income is twice the cap for an individual.
- Assets – Asset limits, also known as resources depend on the applicant’s marital status and whether both spouses are applying for Medicaid. The countable resource limit for unmarried applicants is $2,000. If both spouses are applying for Medicaid the limit is $3,000. The resource limit for countable resources for a couple with one healthy spouse is half the couple’s combined resources, subject to a minimum and maximum spousal resource allowance. These amounts change annually with inflation and can be expanded under special circumstances.
- Medicaid Facility – Applicant must be in a Medicaid-certified facility and in a Medicaid or dually certified (Medicare and Medicaid) bed for at least 30 consecutive days.
Qualified Income Trust
The Qualified Income Trust (QIT), also known as a Miller trust is a useful tool to solve difficult circumstances created by Texas Medicaid laws. Texas Medicaid rules place an income cap on applicants. This income cap, while periodically adjusted for inflation, is not large enough to cover the average cost of a nursing home in Texas. As a result, many people have too much income to qualify for Medicaid coverage but have nowhere near the assets to pay for nursing home care on their own. The solution to this problem is the QIT.
The QIT legally funnels income that would otherwise have disqualified a Medicaid applicant. The income running through the trust is not counted against the Medicaid income limitation.
The QIT must satisfy certain requirements in order for the income it receives to not be counted for eligibility purposes. A Board Certified Texas attorney can review the trust to determine if the following QIT requirements have been satisfied:
- The trust must be irrevocable.
- The trust must contain only a person’s income. An exception to this requirement is that a nominal amount may be used to open the trust’s bank account.
- The trust must receive any or all of an applicant’s income which would otherwise cause an individual to be income ineligible.
- The trust must include language that upon the death of the Medicaid recipient any remaining trust funds are to be delivered to the State of Texas, up to the full amount of Medicaid resources that were provided.
- The trust needs to provide instruction as to how trust funds are to be distributed:
– a monthly personal needs allowance to the beneficiary ($60 for an individual recipient and $120 for a married couple both of whom are receiving Medicaid institutional
– a monthly spousal minimum monthly need allowance, if applicable; and
– the cost of medical assistance provided to the beneficiary that is not otherwise covered by Medicaid any remaining amounts are to be paid to the nursing home.
A QIT is a special type of trust for seniors in need of long-term care whose income exceeds Medicaid caps. A trust allows a third party (trustee) to hold assets on behalf of a beneficiary.
Avoiding Medicaid Recovery Claim
Medicaid has the right to recover any funds it has spent on behalf of a Medicaid Recipient. In Texas, Medicaid recovery claims are limited to probate assets of the deceased Medicaid recipient.
To understand the difference between probate and non-probate assets, read more about our Probate and Estate Administration Services.
Proper Estate Planning can help avoid Medicaid Recovery Claim and allow for more assets to be distributed to spouses, family members, and other intended beneficiaries.
Texas is one of a few states that offer deeds that transfer ownership interests in real estate upon the death of the owners.
From a Medicaid perspective in Texas, after the death of a Medicaid recipient, the state may seek to recover funds it used to pay for the recipient’s care. The state’s Medicaid recovery efforts are limited to the recipient’s probate estate. Ladybird Deeds transfer ownership at death, so any real estate conveyed by this deed isn’t part of the Medicaid recipient’s probate estate and is not subject to recovery by Medicaid.
Calculating Nursing Home Co-Payment
The Medicaid program requires recipients of Medicaid nursing home care to contribute to the cost of their care. This is often referred to as the copayment or applied income amount. There is a certain formula used to determine the shared amount owed by the Medicaid recipient. The formula varies depending on whether the recipient is single, married, or whether both spouses are receiving Medicaid assistance.
Calculating financials for long-term care is important for both individuals and families to understand. Medicaid is considered a last resort – it is not a supplementary program to free up income for other uses. The mission of the Medicaid Program is to help improve the health of Texans by:
- A proactive approach to care
- Quality of care
- Medical home/nursing home services
- Healthcare services
If you have more questions on long-term care planning, elder care planning, Medicaid eligibility, nursing home costs, and how to afford life after retirement please contact Holman Law today and schedule a free consultation.
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