DO I QUALIFY FOR MEDICAID?

There are many different services provided by the various states under the program called Medicaid. My comments are focused on Texas residents qualifying for long-term care. Many people find themselves in a nursing home ( called a skilled nursing facility in Medicaid ) suddenly after a fall, a heart attack or other serious medical crisis.

Generally, there are five requirements in order to qualify for Medicaid. First, you must be a citizen of the United States.

Second, you must be a resident of the state in which you wish to apply.

Third, and maybe the most critical is you must be “medically needy”. There are several factors involved, but essentially to meet the medical necessity requirement you must have a disease or medical disorder that requires the attention of a Registered Nurse (RN) or Licensed Vocational Nurse (LVN) on a regular basis.

Your income may not exceed the “income cap” set by statute. Currently, it is $2022.00 per month. If a Qualifying Income Trust is used (often called a Miller Trust or a QIT) then a person with more than the income cap may qualify for Medicaid.  The income placed into the Trust is deposited into a designated bank account and all of the income is paid to the nursing home (less the personal needs allowance).   There are other exceptions which are more than I can include here.

Finally, your “countable” resources may not exceed $2000.00. This one requirement is complicated enough for a book all of its own. I will write a brief article on this topic soon.

For Medicaid to begin coverage of a nursing home patient, he or she must have been in the facility for at least 30 days.

How Medicaid is applied varies from State to State. An Application is made by the patient, a facility or a family member by completing the required form and submitting it to the Texas Health & Human Services Commission.