Medicaid

Medicaid

Medicaid is a cooperative federal-state program designed to provide assistance to low-income people. It has become the major funding source for long term care. Medicaid is administered by the states under broad federal guidelines. Reimbursement rates per day of care are also set by the states.

Eligibility -- Medicaid will pay for nursing facility care to those who meet a state-determined poverty level, provided the nursing facility is "certified," meaning it meets a stringent set of government standards.

Benefits -- Medicaid will pay for care in a nursing facility (NF). The amount paid is determined by the State of Texas and covers room, board, and nursing care. Medicaid will determine the amount to be paid by the resident/responsible party.

How to Apply for Medicaid -- Contact your local Texas Department of Human Services for an application. Because Medicaid is based on financial need, you will be asked for information such as residence, family composition, income, real and personal property, and medical expenses. You will also need to be sure that the nursing facility which will be receiving payment is Medicaid "certified."

Risk of Impoverishment -- Spouses of nursing facility residents are protected from what is termed "spousal impoverishment." This refers to the required depletion of an "at-home" spouse's financial resources so that the spouse in a nursing home can qualify for Medicaid.

Beginning September 30, 1989, states were required to permit the at-home spouse to retain a "maintenance needs allowance" from the other spouse's income sufficient to bring the at-home spouse's income to 150 percent of the federal poverty level for a two-person household.

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