Medicaid ExplainedApply 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 nursing homes work before you start working on the application. No matter how you slice it, Texas nursing homes are expensive. If you don’t have the money saved to pay for long term nursing 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 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. The services offered are different. Medicare only provides a limited amount of benefit for 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 pays for 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 $2,532.
  • 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:
Get a copy of the Medicaid application. Medicaid-approved nursing homes can give you a copy. You can also get it from a local office of the Texas Health and Human Services Commission or online . The Texas Health and Human Services commission administers financial benefits for nursing home care.

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 state can deny your request. Completing the form the wrong way can delay the approval of Medicaid nursing home benefits. With monthly costs running $6,500 and more, losing benefits can be costly.

Step 5:
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:
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:
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:
Anticipate how you will pay nursing home fees until Medicaid approves. Those costs are your responsibility until the State approves the 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.

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 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. Nothing more. Even a “minor” error can cause an application to be delayed, or worse, denied.

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

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