Three Medicaid Long-Term Care Programs You Should Know

By Kelley M. Bentley –

Medicaid is a health insurance program for the elderly, disabled or indigent.  Since Medicare benefits do not provide adequate long-term care either in a nursing home or at the patient’s home, families often turn to the Medicaid program to pay for such care. Here are three long-term care Medicaid programs available in Texas:

1. Nursing Home Medicaid: Nursing home Medicaid covers the cost of institutionalization in a skilled nursing facility or intermediate care facility-intellectual disability. Nursing home Medicaid does not cover the cost of assisted living or independent living. In order to qualify, an individual must have a medical need for licensed nursing care.

In order to be eligible for nursing home Medicaid, an individual can have no more than $2,000 in countable resources and less than $2,199 of monthly income in 2016. A married couple who both need nursing home care can have no more than $3,000 in countable resources and no more than $4,398 of monthly income. If only one spouse needs nursing home care, the couple can protect a minimum of $23,844 and a maximum of $119,220. This amount may be increased, beyond the maximum, under the spousal impoverishment rules.     

2. STAR+PLUS Waiver Program: The STAR+PLUS Waiver Program helps with assisted living costs, as well as provides home-based care as an alternative to institutionalization. This program targets individuals age 21 and older who have a medical need for nursing home care but who elect home and community-based services, including assisted living, as a cost-effective alternative to institutionalization. The STAR+PLUS Waiver Program uses the same resource (asset) limit and income cap as the nursing home Medicaid program. However, unlike the nursing home Medicaid program, the STAR+PLUS Waiver Program has limited funding, restricted enrollment and a waiting list.

3. Medicare Savings Programs: The Texas Medicaid Program offers several Medicare Savings Plans, which provide supplemental coverage to eligible Medicare beneficiaries. These programs include the Qualified Medicare Beneficiaries (QMB) program and the Specified Low-Income Medicare Beneficiaries (SLMB) program. The QMB program pays the out-of-pocket Medicare cost-sharing expenses, including deductibles and co-payments. The SLMB program pays the Medicaid Part B premium.

In order to be eligible for the either the QMB or SLMB programs an individual can have no more than $7,280 in resources. For QMB, an individual can have no more than $981 per month in income. For SLMB, an individual can have no more than $1,177 per month in income.

Even though the Medicaid long-term care programs are means-tested benefits, an individual does not have to be indigent to qualify. A qualified elder law attorney can assist with eligibility, including the preservation of assets for the Medicaid recipient and his or her family.


Kelley M. Bentley is a certified elder law attorney by the National Elder Law Foundation and practices estate planning, probate, trust and elder law at Roberts Markel Weinberg Butler Hailey PC from its Fort Bend office.