Texas and Arkansas Elder Law Attorney Explains How to Qualify for MEPD
Few Americans ever anticipate losing their independence. However, long-term care can eventually become a matter of practical necessity—one often prompted by advanced age or mounting disability, but which can also easily be triggered by an unexpected medical emergency. Even in Texas, a state that takes great pride in both its prosperity and self-sufficiency, paying for an extended stay in an assisted living facility or nursing home typically costs much more than most retirees can spend.
For years, Ross & Shoalmire Elder Law Attorneys have helped Texas families obtain the support they need without breaking the bank. Our experienced team of Medicaid Planning Lawyers could help you explore new strategies to ensure your long-term care coverage eligibility while retaining control over your financial future. Texas Medicaid for the Elderly and People with Disabilities (MEPD) may be one of those options.
Challenges of Obtaining Affordable Long-Term Care
In the past, long-term care was a term used to allude to nursing homes and assisted living facilities. Today, though, it refers to a wider variety of support services that help people retain their independence while protecting their physical health. These services include:
- Home care. This refers to circumstances when support is provided by family members, friends, or a for-profit company. Home care often helps senior citizens age in place, enjoying the comfort of familiar surroundings while still receiving much-needed assistance with daily chores and tasks.
- Daytime programs. Occasionally termed “adult daycares,” these services allow older adults to socialize and interact with peers in secure environments staffed by medical professionals. Many daytime programs help manage medication and meet participants’ nutritional needs.
- Residential facilities. These are assisted living and nursing homes. Assisted living facilities frequently offer apartment-like accommodation, whereas nursing homes are designed for senior citizens with more serious health concerns who may not be able to perform routine tasks without assistance.
Although Texas offers some subsidies for home care and daytime programs, greater needs often correlate with escalating expenses. Unfortunately, the costs of more intensive care can be unaffordable for working families and retirees with significant savings. According to the state’s Department of Health and Human Services (DHHS), an extended stay in a nursing home averages between $3,000 and $4,000 per month. In some areas, averages are higher, exceeding $7,000 monthly for a private room or $5,500 monthly for a shared room.
While paying for long-term care might seem like an impossible expectation, depending on your family’s circumstances, you could be entitled to relief through a federally funded or state-subsidized program.
Overview of Medicaid, Medicare, and Long-Term Care in Texas
Medicaid and Medicare are government programs that can help Texans cover health care costs. However, as oft-conflated as they may be, Medicaid and Medicare have different enrollment criteria, benefits, and drawbacks.
Medicare, for instance, is federally funded health insurance available to senior citizens and younger adults with qualifying disabilities. It can help pay hospital bills and cover the costs of routine but doesn’t typically offer any assistance for long-term care. Medicaid, in contrast, can be applied to long-term care—but only for applicants whose income falls below a certain threshold.
Medicare
Medicare is a U.S. government-sponsored program that helps cover medical costs for Americans over 65, and for Americans under 65 with qualifying disabilities and medical conditions. Its benefits include:
- Hospitalization coverage
- Medical insurance
- Structured insurance plans that provide different benefit tiers
- Prescription drug coverage
Some Medicare plans are subject to income limits, but most only require that applicants meet age-related criteria to enroll. However, Medicare doesn’t typically offer any assistance with long-term care—meaning that its recipients are expected to pay out-of-pocket for any stay in an assisted living facility or nursing home.
Medicaid
Medicaid is administered jointly by the U.S. government and the Texas Department of Health and Human Services. Medicaid covers:
- Regular checkups with the doctor
- Medical services and vaccinations
- X-rays and laboratory tests
- Vision and hearing care
- Medical specialist care and mental health treatment
A subset of Texas Medicaid is Medicaid for the Elderly and People with Disabilities (MEPD), which can also assist with costs incurred by long-term care and related support services.
Texas Medicaid for the Elderly and People with Disabilities
MEPD covers most forms of long-term care and support. Services include, but aren’t limited to:
- Home care, personal care, and other “aging in place” initiatives
- Transportation assistance for the elderly or disabled parents of minor children
- Nursing home care
- Mental health hospitalizations
- Varied care programs for adults with intellectual disabilities
Texans who qualify for MEPD benefits must typically enroll in a STAR+PLUS plan, with different regional plans available.
Texas Medicaid and Its Options for the Elderly and Disabled
The Texas Department of Health and Human Services (DHHS) administers the state’s Medicaid program.
Although the DHHS offers full nursing home coverage for eligible Medicaid recipients, the state prefers redirecting senior citizens to more comfortable and cost-effective options. Here are some of Texas’s MEPD-covered programs.
Primary Home Care
The Texas Primary Home Care program, or PHC, provides seniors and adults with disabilities with access to in-home attendant services. In-home attendants help with a wide range of tasks, including bathing, dressing, grooming, using the toilet, and cleaning the house.
In most cases, senior citizens eligible for PHC are afforded some flexibility in choosing a provider: their attendant can be sourced from a professional agency, or they can hire a relative or friend to act as a care attendant.
Day Activity and Health Services
The Lone Star State’s Day Activity and Health Services program, or DAHS, is a form of “adult daycare.” Daycares are intended as a cost-effective and more independent alternative to nursing homes, with most catering to senior citizens diagnosed with limiting conditions like dementia and Alzheimer’s disease.
Most Texas adult daycares provide services including:
- Meals and snacks
- Professional supervision
- Medication management
- Personal care assistance with toileting and other tasks
Anyone who meets the basic eligibility requirements for MEPD and DAHS is guaranteed to receive benefits. These requirements include continuing to reside in one’s home or in the home of a friend or family member.
Community First Choice
Texas’s Community First Choice program, or CFC, is another alternative to conventional nursing home facilities. The benefits are similar to those offered by home care and include both personal care assistance and homemaker services. Enrollment is only open to qualifying adults residing in their home or with a family member.
Program of All-Inclusive Care for the Elderly
The Program of All-Inclusive Care for the Elderly, or PACE, provides additional services to “people who are frail [or] elderly” and qualify for placement in a nursing home. PACE helps senior citizens receive nursing home-like services without leaving the comforts of their home, or helps ease the transition to a professionally managed off-site facility.
How Ross & Shoalmire Helps Protect Your Rights Without Sacrificing Your Life Savings
Texas Medicaid can help families pay for high-quality care at home, in an assisted living facility, or in a nursing home. However, the federal government sets Medicaid’s base requirements—and only provides Medicaid benefits for low-income applicants.
In Texas, the annual household income limits for Medicaid eligibility as of 2024 are:
- For a 1-person household, the maximum annual income level is $28,869.
- For a 2-person household, the maximum annual income level is $39,046.
- For a 3-person household, the maximum annual income level is $49,223.
- For a 4-person household, the maximum annual income level is $59,400.
The state’s use of the term “income” can be somewhat confusing. The DHHS looks at factors beyond a paycheck or Social Security disbursement in assessing a Medicaid applicant's income. Income is defined as any profit-generating asset, property, or service that a Medicaid applicant can use to meet their basic needs for food and shelter. This definition encompasses employment-based earnings, pension payments, and even IRA withdrawals.
The state also counts assets, ranging from cash, stocks, and bonds to investment real estate. Although some assets—such as a personal car, and an applicant’s primary residence—are considered “non-countable,” many middle-class families are forced to choose between Medicaid benefits and their life savings.
But you don’t have to navigate this red tape alone. Our trustworthy and experienced Medicaid Planning Attorneys provide a range of valuable services to help you navigate the complexities of the Medicaid system.
