Who Is Eligible For Free Care At Home?

Who Is Eligible For Free Care At Home?

There are several public benefit programs whereby the government will pay for caregivers to come to where you reside. Many are familiar with Medicare that pays for various therapists after a hospitalization stay, but many are unaware that Medicaid has a couple of programs that pay for a caregiver to come to your residence.

The program that provides the most benefits in Texas is called the Star Plus Waiver program.

Benefits of the Star Plus Waiver program:

• The state often pays for a caregiver up to 35-40 hours per week.

• Sometimes a member of the family could be paid as the caregiver if they become employed by one of the Medicaid Managed Care agencies approved by the state.

• The rules for keeping more assets without spend-down are more generous than the nursing home Medicaid program if the applicant is married (and the other spouse does not need care). There is a formula with a higher income limit that allows the married couple to often keep far more than maximum protected resource limit which is presently $148,620 (exclusive of home, a car, personal property items, a pre-need funeral, certain IRAs, etc.). Only income such as Social Security , pension, wages and certain annuities are included in the formula (not interest, dividends, rental income, etc.).

Detriments to the Star Plus Waiver program:

• There is a wait list. During the height of Covid, this list exceeded 25,000. Presently it is a fraction of that, but it still may take 4-6 months to get to the top of the list.

• It’s becoming apparent that quality caregivers are scarce. The average employment of a caregiver employed through one of the managed care organizations approved by the state is less than 150 days. Given their low hourly pay rate which is paid by the state, it’s unlikely that will change any time soon (although there is a bill to increase salaries of caregivers). So, sometimes it is difficult to even get a caregiver.

• The transfer penalty rules are harsher. Under this program, any gift within the last 5 years prior to the application will result in a 5-year ineligibility period. In contrast, gifts under the nursing home Medicaid rules usually result in less of a penalty as it divides the amount of the gift by the average cost of a nursing home in Texas. For example, if the average cost of a nursing home was $7,000 a month and the amount of the gift within 5 years of the application was $7,000, then there would be a 1-month penalty from the month of application and from when the applicant was otherwise eligible. However, under Star Plus Waiver, the penalty for the $7,000 gift would result in 5 years of ineligibility.

• The applicant must have enough of a medical necessity for skilled care. So, for example, if you only need assistance with bathing, that would not be enough to meet the medical necessity requirement even if you met all the other requirements.

• If your income exceeds the monthly cap (presently $2,742), you have to create an income trust and the excess over the cap would need to be paid to the state for the caregivers. So, if you have a high income, you need to consider if it is still worthwhile applying. Although long-term care (nursing home) Medicaid also has an income cap, the rules are different (sometimes there can be a diversion to the nursing home applicant’s spouse). It should also be noted that an applicant for a different Medicaid program, Community Attendant Services, that generally provides less care at home (i.e., 15-20 hours per week) doesn’t have as stringent of a medical necessity requirement, but there is ineligibility if the applicant’s income exceeds the monthly income cap. Another Medicaid program that provides care at home is entitled CLASS. It has a very lengthy wait list. Each Medicaid program (there are 109 Medicaid programs in Texas) has its own rules.

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