General Information
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
is considered to be one of the most complex laws 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 a Certified Elder Law Attorney with extensive experience
in this area.
Note: All Texas Medicaid offices can process
an application for nursing home care benefits regardless of
where the applicant resides in Texas. Hence, the Greening
Law Firm 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.
1. 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.
2. Countable Assets:
Neither available nor exempt. Countable assets are considered
for Medicaid eligibility purposes.
3. 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.
4. Exempt Assets:
Exempt assets are not counted in determining Medicaid eligibility.
Exempt assets include:
A. 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 Lien
does not attach to bona fide homestead if it passes to the
children of the owner at the time of the owner's death.
B. Motor vehicle: One motor
vehicle, regardless of age or type. Also, second vehicle
over 7 years old, except for certain luxury and antique
cars or customized vehicles (except for use by person with
a physical disability.)
C. Personal property: Exempt
except for certain valuable art/jewelry.
D. Life insurance owned by
applicant: The total combined face value of all policies
up to $2,500. Term policies are exempt.
E. Life insurance owned by
well spouse: Same criteria as for applicant; see above.
F. Burial plan for applicant.
Plan up to $2,500.00 and irrevocable plan in any amount.
G. Burial plan for well spouse.
Same criteria as for applicant (see F, above)
Note:
if applicant is married, documentation is required for BOTH
spouses.
1. Social security card, Medicare card, and
Supplemental or Medicare HMO card.
2. 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
3. "TPQY" letter obtained from
Social Security Administration to verify amount of applicant's
social security income.
4. 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.
5. 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.
6. Verification of gross monthly income from
any other source. Furnish letters directly from the providers.
7. 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.
8. Proof of citizenship. Needed only if the
applicant was born outside the U.S.
9. Copies of guardianship or power of attorney
papers.
10. Car registration or title
11. Copy of deed for any property owned,
including homestead.
12. 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.
13. Copy of most recent property tax bill
for all property, including homestead.
14. Funeral arrangements. Copies of any purchase
or agreements or any prepaid funeral contracts, cemetery or
mausoleum plots, etc. All contracts must be irrevocable.
15. 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.
16. Copies of all checks written in excess
of $500 for the past 36 months.
17. Automobile insurance policy.
18. If applicant is a veteran: VA discharge
papers, and copies of marriage certificates for all marriages.
19. Copy of income trust, if applicable.
20. Copy of personal services contract, if
applicable.
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