LONGVIEW, Texas — There are five basic requirements that must be satisfied in order for an individual to qualify for Medicaid services for long term care needs. Some of these requirements are black and white, and others can be gray.
The five basic requirements are:
- Nationality and Residency: the individual applying for Medicaid must be a U.S. citizen or an alien with a qualified alien status. You must also be a resident of the state when you apply for Medicaid. So, if you are in a long term care facility in Texas, you will meet the state requirement.
- Medicaid Facility and Availability: To apply for Medicaid, the applicant must be a resident of a Medicaid certified facility, and the facility must have available “Medicaid bed.”
- Medical Necessity: An applicant must have a medical necessity for nursing home care. In other words, the applicant must be in a sufficiently serious condition such that he or she requires the care and services of licensed nurses in an institutional setting. In other words, the care needed is such that an untrained individual could not properly provide the care and r. Additionally, the need for these services must be properly documented and ordered by a physician.
- Income: In 2020, the monthly income cap for an individual applying for Medicaid is $2,349. If an individual is married and only one of the two spouses is applying for Medicaid, only the income of the spouse seeking Medicaid is counted for eligibility. There are other limit calculations taken into account for married couples. Additionally, if an individual is over the monthly income limit, a Qualified Income Trust, or a QIT or Miller Trust, may be used to qualify for Medicaid even though you are above the income limit.
- Assets / Resources: An individual applying for Medicaid can only have a certain amount in assets. The amount of assets that one may have depends on whether the individual is single or married, or has a spouse who is also applying for Medicaid. There are countable and non-countable assets. Non-countable assets include your primary residence, one car, a pre-paid funeral. There are also others that are case specific.
Countable assets are different. For a single individual, the person can have no more than $2,000 in countable assets. The countable resource amount for a married applicant is much greater, but varies and is subject to certain requirements and calculations.
Every potential Medicaid applicant’s situation is different, and different factors impact qualification. However, no matter what your situation is, don’t automatically assume that you do not or cannot qualify for Medicaid assistance for long term care. Come talk to me before you spend your life savings unnecessarily.