Medicaid Explained

Apply and Qualify for Texas Medicaid Nursing Home Benefits

You can qualify for financial help to pay the high cost of Texas Medicaid approved nursing homes. But, it’s important to know how Medicaid and a nursing facility work before you start working on the application. No matter how you slice it, Texas skilled nursing facilities are expensive.

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If you don’t have the money saved to pay for long term nursing home care, Medicaid is there for you and your family. If you fail to understand even the basics of Medicaid eligibility, you could find your application to the Medicaid program denied.

To get all the Medicaid nursing home benefits your family member is entitled you need to follow these critical 8 steps.

Step 1: Learn about the differences between Medicare and Medicaid.

How each agency will cover nursing home care is different. Medicare only provides a limited amount of benefit that cover nursing home care. Congress created the Medicaid program as a safety net for the elderly and people with disabilities. Medicaid nursing home benefits is part of that program. And, it’s the only government program that will cover long term nursing home care

Step 2: Learn about Medicaid’s eligibility requirements and restrictions.

The government says if you want Medicaid to help pay nursing home care, you must meet four basic tests. The four tests include:

  • The patient’s gross monthly income has to be less than $2,742.
  • The assets of the person needing care must be less than $2,000.
  • There must be a proven medical need as determined by the state
  • The patient must be in a Medicaid approved nursing home.

Step 3: Ask for a coy of the Medicaid application

Get a copy of the Medicaid application. Medicaid certified nursing homes can give you a copy. You can also get it from a local office of Texas Health and Human Services or online . The Texas Health and Human Services commission administers financial benefits for skilled nursing facilities.

Step 4: Complete the form carefully.

The Medicaid nursing home application is long and complicated. To avoid being denied Medicaid nursing home benefits, you need to fill it out accurately. Be sure you understand each question before answering it. If you make a mistake on the application, the Texas Department of Health and Human Service can deny your request. Completing the form the wrong way can delay the approval of Medicaid nursing home care benefits. With monthly costs running $6,500 and more, losing benefits can be costly.

Step 5: Confirm the patient meets income and asset restrictions

Double check that the patient is within the income and asset limits for Medicaid nursing home eligibility. Don’t make the mistake of submitting an application that will be denied. There are serious financial and emotional losses at stake. To avoid making this costly error, get professional advice on Medicaid nursing home eligibility. If you are uncertain you’ll qualify, contact a Houston Medicaid attorney for help.

Step 6: Provide documents supporting answers in the application

Be prepared to provide documentation supporting the answers in the application. The rules of gaining Medicaid nursing home eligibility are strict. You will need to be prepared to give proof that supports your answers. At a minimum you need to provide:

  • Statements for all financial assets for the current month and the three months before your application
  • All deeds proving real estate ownership
  • Current proof of income
  • The most recent awards letter from Social Security
  • Copies of all life insurance policies and annuity contracts
  • Titles to all automobiles and paperwork proving their value
  • Driver’s license
  • Medicare card
  • Social Security I.D. card
  • Proof of health insurance coverage from Medicare, Medicare supplements and group health insurance

I can’t stressed enough that having proof to support your application is key. Texas Medicaid case workers have a “document or deny” attitude toward Medicaid applications. They will deny the application if you fail to provide accurate and complete verification documents on time.

Step 7: Keep copies of all documents you send

Make copies of all paperwork that you submit. The agency loses paperwork a lot. You have a so much riding on your application being approved. Having a second set of copies means that you can easily replace any documentation that gets lost. It will cut down on frustration and keep your application on track.

Step 8: Decide how to pay the costs of skilled nursing care until Medicaid approves

Anticipate how you will pay the cost of skilled nursing care until Medicaid approves. Those costs are your responsibility until the State approves Medicaid nursing home benefits. If you can’t afford to pay the entire monthly amount due, you still have options. Some Medicaid approved nursing homes offer something called “Medicaid pending”. The “pending” status means the nursing facility will accept a payment that’s less than the full amount until you are approved. The arrangement it like a loan until your case worker determines eligibility for benefits. With Medicaid pending you are still responsible for the full fee. Once Medicaid approves the application, the nursing home sends the bill to the state and eliminate the debt.

Remember to make sure the skilled nursing facility you select is a Medicaid certified nursing home. If the nursing home is not approved for Medicaid reimbursement, nursing home residents there will not get Medicaid assistance. With the high costs of Texas skilled nursing facilities, having access to financial assistance through Medicaid can make a huge difference in providing much-needed care and support for an elderly family member.

By understanding the basics of Medicaid eligibility and following the 8 steps outlined for successful application, individuals and families can ensure that they have all the skilled nursing benefits their loved one may need. Medicaid coverage for nursing home residents covers more than the cost of nursing home services needed. Also provided are support for Medicare premiums and co-payments, personal care services and rehab services.

Medicaid can provide invaluable assistance to those who are unable to pay for long term care on their own but, the process of applying for Medicaid nursing home eligibility takes a lot of time.

You’ll have a lot of forms to fill out. The key when going through the process is to have everything in order. Take your time and be patient. By paying attention to the small details, you can save money and time.

After you send in your paperwork, it’s normal to start worrying. Many people lie awake at night, afraid that they have made a mistake. The paperwork that you have to fill out to cover nursing home cost is tedious. The rules sometimes seem like they don’t make sense. It can be tempting to ask your State of Texas Medicaid caseworker for help.

Don’t do it. That’s not what they are there for.

They are not allowed to guide you or give you advice. Their job is to decide whether the information you’ve provided meets the agency’s financial and health criteria for nursing home services. Nothing more. Even a “minor” error can cause an application to be delayed, or worse, denied. A denial means you are on the hook for all nursing home costs.

That’s why so many families turn to us for help preparing and submitting their applications. Interested?

If so, call us at 713-970- 1300. We’ll be glad to help you.