Elderly Mother With Her CaregiverYour elderly mother needs help with things like bathing, food preparation, and taking medications, but she does not need the full-time, costly care provided by a nursing home. While an assisted living facility or an in-home healthcare provider would be the best solution for her, she has limited financial resources, and you don’t know if she can afford it. You know she can qualify financially for Medicaid, but you’re wondering if she can use Medicaid benefits to pay for a lower level of care. We have the answers you need.

Qualifying for Medicaid

In order to qualify for Medicaid to pay for a skilled nursing facility, you first have to meet certain financial requirements, including the following:

  • Your income is limited, meaning you earn less than $2,349 as an individual or $4,698 as a couple (in 2020).
  • You have less than $2,000 in other financial resources, including savings accounts, personal property, retirement funds, and land.

If you worked with an estate planning attorney at least five years ago to protect your assets in a trust, you can also meet the financial requirements for Medicaid while preserving some of your wealth for your heirs.

In addition to meeting the financial limitations, you will have to show that the nursing home is “medically necessary.” This requirement is met by having your doctor provide documentation of your condition and your inability to care for yourself. So what happens when you don’t need this level of care but need help that you can’t afford?

Medicaid for Assisted Living

Assisted living facilities offer residents regular meals and assistance with vital daily tasks but are not considered skilled nursing facilities. In general, Texas Medicaid will not pay for assisted living because it does not meet their criteria for critical care. However, if you are eligible for Medicaid and can show that a nursing home is medically necessary, you could qualify for the STAR+PLUS program, which pays for assisted living for people who would otherwise have to be in a nursing home. In other words, your care needs have to be extreme enough to require a nursing home but manageable in another setting. Enrollment in this program is limited, but it is a viable option for some people with physical challenges.

In addition, if you are living in a continuous care facility that combines independent living, assisted living, and skilled nursing care, and you are at the assisted living level, it may be possible to use Medicaid to pay for some of your care.

Paying for In-Home Care

Medicaid will cover home health services if your doctor writes an order for in-home nursing or therapy care, but the coverage is generally temporary. Medicaid will review your care plan every 60 days. If you otherwise qualify for Medicaid and you need assistance with one or more tasks for daily living—such as bathing, dressing, eating, getting exercise, and getting out of bed—you might qualify for Primary Home Care (PHC), which provides in-home long-term care services for those with financial need. You will have to apply for the program and meet with a representative to discuss your limitations and what kinds of services you need.

Our Elder Law Attorney Team Can Help You Understand Your Options

Elder care issues often arise with no notice. A previously independent senior can suddenly have a bad fall and wind up in the hospital. As their spouse or adult child, you could find yourself scrambling to find a place for them when they are released from the hospital. The biggest question is often, “How will they pay for it?” At Ross & Shoalmire, PLLC, we know what your options are in Texas, and we can talk you through them to find the right fit.

As part of your routine estate planning over the years, you and your attorney might have discussed the possibility of needing long-term care one day, and you might have a plan in place. If you are like most people, though, you probably don’t have a plan. At Ross & Shoalmire, our Elder Law attorneys are always looking ahead so that our clients are prepared for whatever might happen down the road. Contact us to talk about a long-term care plan today.

Are You Looking for an Elder Law Attorney in Texarkana, TX?

If you are looking for elder law assistance, you need to speak with an experienced elder law attorney as soon as possible. Contact us online or call our Texarkana office directly at 903.223.5653. We also have offices in Tyler, Paris, Longview as well as Magnolia, AR!