The meanings of the various words or amounts may vary in other states than in Texas. Most of the amounts discussed also vary by year.
CMS Centers for Medicare and Medicaid Services. This is the federal agency that supervises these programs. There is no such thing as a local Medicare office. Sign-ups for Medicare go through the Social Security office initially. After signing up all contact goes through private companies hired by CMS to manage claims.
Medicaid is a joint State-Federal program. CMS signs a contract with each State under which that State administers the various Medicaid programs. The benefits and rules can vary within limits from State to State.
CSRA–Community Spouse Resource Allowance This amount is modified annually for inflation. This is related to the MMMNA.
CS–Community Spouse: the spouse who still lives outside a nursing home
Countable Resources when HHSC is reviewing an application it looks only at those assets that are countable under Federal law. Some assets are excluded and not countable. More detail is included elsewhere, but typically the homestead, burial plots, household furnishings and one vehicle for each spouse are excluded. A nursing home patient is limited to $2,000.00 of countable assets.
HHSC, or Texas Health and Human Services Commission, the State agency that manages Texas Medicaid programs
IS–Institutionalized Spouse: the spouse who requires skilled nursing care in a skilled nursing facility
Income Cap: This is the maximum amount of income permitted in Texas for an applicant for Medicaid
Institutionalized means that a patient has been in a hospital and/or a skilled nursing facility for thirty days.
Personal Needs Allowance The amount allowed to a patient receiving Medicaid services in a skilled nursing facility for personal needs not otherwise provided under Medicaid. Typically this is used to pay for haircuts, clothing, snacks or whatever other item or service that amount can purchase. Currently, this amount is $60.00 for persons in a nursing home. There is also a Personal Needs Allowance for some home care programs.
MMMNA–maximum monthly maintenance needs allowance is also called the spousal monthly allowance. In 2019 this amount is $3,0160.50. If a community spouse has less than this amount of income in his or her name, income from the patient can be allocated to the community spouse after certification.
MAPT–Medicaid Asset Protection Trust, used to protect assets from the forced sale or spend down when a patient enters a nursing home and applies for Medicaid-long term care. It must be created more than sixty months before a Medicaid Application and before age 65. Under federal law, a person may set up a self-funded supplemental needs trust prior to the age of 65. Upon reaching the age of 65 self-funding of an SNT is a disqualifying transfer.
PRA-Protected Resource Amount the amount a community spouse is allowed to protect from spend-down. There are both minimum and maximum amounts. This is a very complicated area of law in which the patient is allowed to set aside more assets or income under certain circumstances.
Snapshot– HHSC determines the eligibility of an applicant based on all countable resources owned by a married couple as of 12:01 on the first day of each month after an applicant has been “institutionalized” for thirty days. This is the snapshot assessment. Part of this computation uses the assets or more correctly “countable resources” owned by a person or married couple as of the first time a patient was institutionalized for thirty days. A second assessment is made on the application as stated above. The first institutionalization could be ten years before the application or whenever it occurred.
SNF–Skilled nursing facility, otherwise known as a nursing home or rehab facility
SNT–special needs trust or supplemental needs trust. A complicated trust created to hold assets so that a person is not disqualified from either disability benefits under Social Security or from Medicaid benefits. There are both self-funded versions and versions funded by someone other than a person needing disability benefits (considered third-party trusts)
Spend down this is the process of spending assets for care until a patient meets the required maximum amount of assets to qualify for Medicaid. Most transfers for less than fair market value are considered to disqualify a patient from Medicaid coverage. There are some transfers that do not disqualify.
Spousal Impoverishment Rules the rules under which the community spouse is forced to spend down assets in order to qualify the patient for Medicaid.