Medicaid

Medicaid Information

Navigating the ever changing landscape of Medicaid benefits and eligibility requirements can be daunting. Early intervention is one of the most important parts of any thorough estate planning process. This allows us to give our clients peace of mind and a confidence in their financial security during their old age. As life experience continues to increase, more people are likely to develop chronic illnesses. Most would prefer that they dictate how their assets are used for them instead of through guardianship proceedings- so, planning is often best done while there is still compacity.

Medicaid eligibility is bogged down with rules and regulations. Did you know there are 109 different kinds of Medicaid programs (each with their own rules) in Texas? Each year is upon us and will bring another set of changes, including those brought on by the Affordable Care Act.

Michael B. Cohen and Associates are uniquely qualified in the arena of Medicaid Planning, and we are able to prepare entire estate plans including the instruments to preserve or achieve Medicaid eligibility. We will also review any current cases to look at changes that could be made to your estate plan in order to save a significant portion of your assets. Our trusted Elder Care attorneys are able to provide legal counsel and advice in all legal matters relating to estate planning and Medicaid eligibility.

Our firm assists individuals and families with their estate planning needs, including Medicaid applications, Qualified Income Trusts (QITs), Special Needs Trusts, Asset Protection, and saving homesteads from the Medicaid Estate Recovery Program. Michael B. Cohen has been practicing elder law in Dallas longer than any other attorney – over 20 years.

Medicaid Income Limits in Texas

One of the most common questions an elder law attorney receives is, “What is the income limit to be able to receive Medicaid benefits?” However, there are 109 Medicaid programs (besides any Federal program) that have various eligibility requirements. The following addresses the income limits for the most common Medicaid programs:

Long-Term Care Medicaid: Since Americans are living longer, many need nursing home care. The average cost of nursing home care in Texas is approximately $7500 per month. Yet, many have inadequate income, resources, or insurance to pay for that care. Long-term care Medicaid helps pay for nursing home care. The monthly income cap for long-term care Medicaid in 2024 is $2829. However, if the gross income exceeds that limit, the applicant can create a Qualified Income Trust and still be eligible. If a married couple both apply for long-term care Medicaid, the cap is doubled. It should be mentioned that if the applicant lacks mental capacity to sign a trust, a power of attorney could be used to establish the same – but only if the power of attorney grants that authority. The Texas statutory power of attorney is inadequate.
Star+ Plus Medicaid: Star+ Plus is a Texas Medicaid-managed care program for adults who have disabilities or are age 65 or older. Star+ Plus was developed as an option to live in the community (i.e., at home) instead of a nursing home. Although it doesn’t provide 24/7 care coverage, many prefer to stay home with fewer hours of care coverage. Similar to long-term care Medicaid, it also has a monthly income cap in 2024 of $2829. If the gross monthly income of the applicant exceeds the $2829 cap, a Qualified Income Trust can be used to obtain income eligibility. Since the applicant is living in the community (if at home), the applicant can keep their income up to the cap. Star+ Plus Medicaid usually covers around 35-40 hours per week of caregiver services plus drug coverage.
Community Attendant Services (CAS): This is a Medicaid program for personal care services for those with health issues that cause them to have problems performing activities of daily living such as transferring from bed to chair, mobility, eating, toileting, and bathing. Since this requires less care, the coverage is also less – typically around 10-20 hours per week. Although the monthly income cap is also $2829, a Qualified Income Trust cannot be used to qualify for this program.
Supplemental Security Income (SSI): This program is a needs-based program for people with limited income and resources. Typically, it is for those who are disabled prior to age 65 (although someone over 65 or blind could also qualify). If you are eligible for SSI (not to be confused with Social Security, which is a benefits program based on earnings and not on need), then you automatically qualify for Medicaid, which is particularly important for costly drugs. Unlike the other programs, the government can pay the recipient monthly income. The maximum monthly income in 2024 for an individual to be paid by the government is $943. A Qualified Income Trust cannot be used to obtain Medicaid eligibility if the income of the applicant is too great.
Qualified Medicare Beneficiary (QMB): This program helps Medicare beneficiaries pay Part B premiums and Part A and B cost-sharing amounts such as coinsurance and deductibles covered by Parts A and B. Application is made to Texas Health and Human Services, which runs Texas Medicaid programs. The monthly income limit in 2024 is $1255 ($1704 for a couple).
Specified Low-Income Medicare Beneficiary (SLMB): Unlike QMB, SLMB only pays the monthly Part B premium. The program helps those with limited income (presently $1255.01 to $1506 per month for individuals and $1704.01 to $2044 for couples) and resources pay for prescription drugs by lowering the cost of premiums. At this time, participants pay no more than $11.20 for each drug covered by their drug plan. QMB and SLMB are part of Medicare savings programs.

There are numerous other Medicaid programs ranging from assistance for children of families with low income to breast cancer Medicaid.

For more information on Medicaid, estate planning, or other public benefits, or to plan your estate whether for Medicaid benefits or otherwise, please call us at our Dallas office at (214) 720-0102 or click here to attend one of our free Estate Planning Essentials workshops. Our workshops are simple to attend and come with no obligation.