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Medicaid Benefits for Long-Term Care
Medicaid is a combined federal and state program that assists persons unable to pay for medical care. If an individual is eligible, Medicaid covers all necessary medical services, including long-term nursing care (for either skilled nursing care or custodial care).
With greater longevity and the high cost of care for prolonged illnesses such as Alzheimer's, more and more middle class families are being threatened with impoverishment due to nursing care costs. For those who have not been able to secure long-term care insurance, Medicaid has become an important resource for the medical and nursing home expenses associated with long-term care.
Medicaid laws are considered to be some of the most complex in the country, made even more so because each state has its own interpretation of the law and its own method of applying the law to its residents. Thus, eligibility rules vary by state.
In Texas, the assets and the income of the person to receive Medicaid are considered for eligibility purposes. Also taken into consideration are the assets of the applicant's spouse. Because this area of law is so complex and because an improperly handled application can result in denial of benefits, applicants are advised to seek counsel from an Elder Law Attorney with extensive experience in this area.
Note: Texas Medicaid offices process applications for nursing home care benefits without regard to the applicant's residence in Texas. The Greening Law Firm, P.C. assists applicants throughout the state, even those applicants who do not reside within the general vicinity of our offices.
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Definitions: Non-available, countable, income-producing, exempt assets
Types of assets for Texas Medicaid eligibility purposes are listed below.
- Non-Available Assets:
Not counted for Medicaid eligibility purposes because applicant or well spouse cannot access. Note: assets that produce income are not counted as assets, but as income.
- Countable Assets:
Neither available nor exempt. Countable assets are considered for Medicaid eligibility purposes.
- Income Producing Assets:
Produce fair market income and are considered exempt. Example: rental property. Texas Medicaid Recovery Lien will attach to these assets at the death of the applicant if they are in the applicant's name only.
- Exempt Assets:
Exempt assets are not counted in determining Medicaid eligibility. Exempt assets include:
- Homestead: Homestead of the applicant or the well spouse is exempt so long as the well spouse continues to reside there or the applicant intends to return. Note that the intent to return is not based on the actual ability to return. Texas Medicaid Recovery claims do not attach to the homestead if it passes at the time of the owner's death without going through probate.
- Motor vehicle: One motor vehicle, regardless of value. A second vehicle may be excluded under certain circumstances.
- Personal property: Exempt except for certain valuable art/jewelry.
- Life insurance: Cash value is excluded if the total combined face value of all policies is $1,500 or less. Term policies are exempt.
- Burial plan for applicant: Plan up to $1,500 if revocable, but if irrevocable, any amount.
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What Documents are required in order to Determine Medicaid Eligibility?
Note: if applicant is married, documentation is required for BOTH spouses.
- Social security card, Medicare card, and Supplemental or Medicare HMO card.
- Supplemental Health Insurance Premium Statement: If there is a community spouse, the premium statements must reflect how much is being paid by the applicant and how much is being paid by the spouse
- "TPQY" letter obtained from Social Security Administration to verify amount of applicant's social security income.
- Verification of birth dates. A birth certificate is best. If that is not available, written verification may be obtained by request from the Social Security Administration.
- Verification of pension income. This must be verified from the source. Check stubs are not sufficient. A letter must be furnished directly from the pension income provider verifying gross and net income, and any anticipated changes.
- Verification of gross monthly income from any other source. Furnish letters directly from the providers.
- Copies of insurance policies and insurance cards. Life, accident, health (including supplemental or Medicare HMO). If there is a life insurance policy, provide information from company verifying cash surrender value, if any.
- Proof of citizenship. Needed only if the applicant was born outside the U.S.
- Copies of guardianship or power of attorney papers.
- Car registration or title
- Copy of deed for any property owned, including homestead.
- For any real property sold/transferred in the last three years: (a) Copies of all transactional papers. (b) Two verifications of fair market value, which may be an appraisal or a letter from a realtor. (c) Property tax bill reflecting property's value at time of sale.
- Copy of most recent property tax bill for all property, including homestead.
- Funeral arrangements. Copies of any purchase or agreements or any prepaid funeral contracts, cemetery or mausoleum plots, etc. All contracts must be irrevocable.
- Verification of active savings accounts, checking accounts, CD's, stocks, bank accounts, annuities, etc. Statements are needed for the past 36 months. Statements are needed for all accounts that have been opened or closed in the last 36 months.
- Copies of all checks written in excess of $500 for the past 36 months.
- Automobile insurance policy.
- If applicant is a veteran: VA discharge papers, and copies of marriage certificates for all marriages.
- Copy of income trust, if applicable.
- Copy of personal services contract, if applicable.
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