Medicaid provides health-care services for low-income individuals. In Texas, Medicaid pays for some long-term care services at home and in the community. However, you must qualify for Medicaid. Your eligibility will be determined by your need for long-term care services and your income and other financial resources, which must be at or below set limits.
Qualifying for Medicaid can be difficult.
To qualify for long-term care through Medicaid you must meet strict demands.
- You must meet Medicaid income eligibility based on “countable income” limits. In 2009, the monthly income limit for a single person was $2,022, and $4,044 for a couple. What’s considered countable income varies depending on your personal circumstances.
- You must have no more than $2,000 in “countable resources” for a single person, or no more than $3,000 for a couple.
- You cannot have home equity in excess of $500,000.
- Neither you nor your spouse can transfer income or assets in order to qualify for Medicaid without incurring a penalty. You also cannot have transferred any resources in the 48-month period prior to your application.
- The block of time these transfers are prohibited is called the “look-back period.” By January 2011, the look-back period will increase to 60 months.
- You must have a “medical necessity”—a medical condition that requires the type of care provided in a long-term care facility, such as a nursing home. If you qualify, there is usually no wait for these facility-based services.
- The medical necessity designation also allows you to receive wide-ranging home- and community-based services, but because demand for these services is high, these services may not be immediately available.
You have to spend down your assets.
In essence, you will likely have to “spend down” your countable resources if you hope to qualify for Medicaid long-term care services. This includes your savings and other resources that can be converted to cash. If you qualify but still have income, Medicaid may also require that you pay a monthly co-payment to your long-term care facility or service provider. Any additional expenses Medicaid pays for your care may be recovered from your estate. For anyone who has worked and saved for the future, accessing long-term care through Medicaid can be challenging and financially draining.
Medicaid is a payer of last resort. This means that If you qualify for Medicaid but have other health-care coverage, long-term care coverage, or another party is liable for your medical expenses, those sources will have to pay first before Medicaid pays your long-term care claims.