Texas House Bill 54 and Medicaid Income limits
New changes to nursing home cost
Texas Medicaid Long-Term Care Eligibility for Seniors
Income limits of a beneficiary’s monthly income ($2,742) , with the exception of a Personal Needs Allowance of $75 (increase effective 9/1/2023 pursuant to HB 54), Medicare premiums, and possibly an income allowance for a non-applicant spouse (stay at home spouse eligible for a minimum of $3,715.50 monthly income) applicant’s remaining income must go towards nursing home costs.
Applicant eligible for resource limit of $2,000 and spouse or non-applicant eligible for resource limit of $148,620 plus exempt items.
Treatment of Income for a Couple
When only one spouse of a married couple applies for Institutional Medicaid or a Medicaid Waiver, only the income of the applicant is counted. This means the income of the non-applicant spouse is disregarded and does not impact the income eligibility of their applicant spouse. The non-applicant spouse, however, may be entitled to a Monthly Maintenance Needs Allowance (MMNA) from their applicant spouse to prevent spousal impoverishment. In 2023, the MMNA in TX is $3,715.50 / month. If a non-applicant spouse has monthly income under this amount, income can be transferred to them from their applicant spouse, bringing their income up to this level. A non-applicant spouse who already has an income of $3,715.50 / month or more is not entitled to a MMNA / spousal income allowance.
WHAT YOU NEED TO KNOW ~
Elder Law Answers
People who are older and require help with basic tasks of living – bathing, dressing, personal care, housekeeping or preparing meals – are candidates for long-term care services. Current estimates state that as many as 70 percent of people turning 65 can expect to use some form of long-term care during their lives.
Why Would I Need Long-term Care?
Reasons for needing long-term care include:
Age. The older you are, the more likely you will need long-term care.
Gender. Women outlive men by about 5 years on average and so they are more likely to live at home when they are older.
Disability. Having an accident or chronic illness that causes a disability. 69 percent of people age 90 or more have a disability.
Health status. A chronic condition such as diabetes or high blood pressure makes you more likely to need care.
Living arrangements. If you live alone, you’re more likely to need paid care than if you’re married or living with a partner.
Where can I get Long-term Care Services?
If you have a medical issue or a disability, many long-term care options are available to you. You can get services in:
Your own home.
A daytime program in your community.
A residential setting, such as a nursing home or assisted living facility.
In Your Own Home
Given the choice, most people would prefer to live in their own home or with their family. By getting help with everyday tasks, this often can happen. Some types of services you may be able to get at home are:
Personal care services — Help with housekeeping, cooking meals or personal care tasks, such as bathing and dressing.
Medical services — Provides medical supplies or equipment to help you be independent. These might include reachers to help you get things off high shelves or a scooter to help you move around. You also might get nursing care in your home.
Transportation services — Rides to medical appointments if you do not have a car or can't drive.
Caregiver services — Provides a break and other help for family members who help take care of you.
A Daytime Program in Your Community
Whether you live alone or stay by yourself when your family goes to work, you do not have to be lonely. If you go to a daytime program, also called adult day care, you can have fun, learn and be with others. You also may get help with some tasks, such as taking medicine.
In a Residential Facility
Sometimes it’s not possible to live by yourself or with your family. In those cases, assisted living or a nursing home might be right for you. These facilities are professionally staffed businesses that provide different levels of care, depending on what you need.
Assisted Living Facility
If you choose to live in assisted living facility, you will usually have your own room or apartment. You can bring your things with you to make it feel like home. You will usually eat with others. Services might include:
Help bathing or getting dressed.
Someone to make sure you get your medicine.
Employees checking on you to make sure you are doing OK.
Nursing Home
If your doctor says you need full-time care from a nurse, a nursing home may be right for you. Nursing homes are the highest level of care most people will receive outside of a hospital. This type of care is sometimes called custodial care. In additional to a high level of medical care, residents get help getting into and out of bed and with feeding, bathing and dressing and other activities.
The cost of a nursing home in Texas ranges from $3,000 to $4,000 a month (University of Texas). If you do not have much income or other resources, Medicaid may pay for a nursing home. You can talk to a Texas Health and Human Services employee about Medicaid. You will have to live in a nursing home for 30 consecutive days before you can apply for services.