Texas Medicaid Programs

  Medicaid is a jointly funded federal and state program that provides health coverage to certain groups of low-income people.  It provides medical care and supportive services to people who qualify for Medicaid under one of the programs in this chapter. Services include doctor visits, vendor drugs, nursing facility services, and long-term care. While the federal government establishes general guidelines for the program, each state determines Medicaid eligibility. 

 HHSC Medicaid for the Elderly and People with Disabilities (MEPD) staff determine eligibility. 

Below are Texas Medicaid Programs:

   Here is the difference between Medicare vs Medicaid for long-term care. 

Medicare is a federally funded only health insurance program that provides healthcare services for all Americans aged 65 and older regardless of their income or have meet a disability determined by the Social Security Administration. 

   Most people are under the assumption that Medicare covers nursing home costs. Not true. Medicare does cover (to a limited extent) some coverage for a stay in a skilled nursing facility (SNF) primarily for rehabilitation. To qualify for Medicare coverage in a skilled nursing facility you must:

• Have a hospital stay of three consecutive days.
• Require rehabilitation therapy only available at a skilled nursing facility (SNF).

Medicare coverage for a Skilled Nursing Facility includes:

• 100% coverage for the first 20 days of care.
• Afterwards there is an up to rate of $200.00 copay per-day up to the 100th day (as of 2023).*

*Note: There are some additional coverages available to people with a specific Medigap supplemental insurance that helps with the co-pay between days 21-100.

  Long-term nursing care can be a difficult subject to speak of in today’s household. The reality check: 70% of Americans will need some long-term care within their lifetime and the average stay is 3.7 years for women and 2.2 years for men. 

Cost and Coverage:

• You must pay part of the cost by using your qualifying income (e.g. social security and pension)
• Medicaid covers the remainder up-to 100% indefinitely, as long as you remain eligible.
• Keep in mind, any other health supplemental insurance will be used before Medicaid.

Medicaid for long-term care covers the following:

• Doctor’s visits
• Drugs ordered by a doctor.
• Lab and X-ray charges
• Hospital care
• Vision and hearing care
• Nursing home room and board

How will you pay the $5,000 to $7,000 per month in nursing home costs? Medicare? Private pay? Maybe. The good news: Medicaid is there to help, and there are ways to qualify.  Book with us to find out how!

 Star+Plus is a Texas Medicaid managed care program that provides long term care services and support at the recipient’s home, postponing the need for institutionalization.

Star+Plus requires an individual be placed on an interest list (known as the waiting list) for the program. The interest list is known for having a significant waiting period (in some cases years). However, if admitted into a long-term care nursing facility for thirty consecutive days, and you are approved for “normal” long-term care Medicaid, you may be able to discharge the facility and bypass the interest list.  Thus, immediately start receiving Star + Plus services at home or an assisted living facility quicker than waiting on the interest list.

The application process for Star+Plus is different than traditional long-term care Medicaid, however the eligibility criteria is the same.  To be added to the state interest list please call 1-855-937-2372 for the Department of Aging.