Apr 28, 2023

What does Medicaid cover for seniors in Texas?

Manny Cominsky

If you or a senior loved one are living in Texas and are considering, or currently paying for, senior living or senior care it’s important to know what Medicaid covers for seniors in Texas, as well as how Texas seniors and their families can apply for coverage. As we’ve covered before on the blog, Medicaid is a federally funded program that is jointly funded and administered by individual states. Because each state has its own Medicaid program, it’s important to check your state’s specific eligibility requirements and application process, as well as confirm the things that your state’s Medicaid program covers. To learn more about what Texas seniors are eligible for Medicaid, how Texas seniors can apply for Medicaid, and what Texas Medicaid covers for seniors read our guide below or reach out to the Sunbound team to learn more.

Texas Medicaid overview

The Texas Medicaid program provides healthcare coverage for low-income families, elderly and disabled individuals who cannot afford healthcare services. The program is funded by both the federal and state government, and it aims to provide comprehensive and affordable healthcare services to eligible beneficiaries. 

For seniors to be eligible for the Texas Medicaid program, they must meet specific age and income requirements. Seniors must be 65 years or older and have an income at or below 100% of the Federal Poverty Level (FPL). For a single individual, this translates to an income of $1,064 per month, and for a couple, it is $1,437 per month. Additionally, seniors must meet specific asset requirements. As of 2023, the asset limit for an individual is $2,000, and for a couple, it is $3,000. The asset limit includes savings accounts, retirement accounts, and property, among others. However, certain assets, such as a primary residence, are exempt from the asset limit.

How seniors can apply for Medicaid in Texas 

Before applying for Medicaid in Texas, it’s important to consult a local senior care expert to confirm whether you are eligible, as well as to understand all the ways in which Medicaid can help pay for your or your senior loved one’s care. In addition, make sure to ask about all the methods that are available to help pay for senior care outside of Medicaid to ensure that you are finding the most effective way to fund your own or your senior loved one’s care. Once you’ve decided applying for Medicaid is the correct option, follow the steps below to learn more about the application process.

Determine if you are eligible: You can check your eligibility by visiting the Texas Health and Human Services Commission (HHSC) website or by dialing 2-1-1 in Texas or calling the Commission’s toll-free number at 877-541-7905 . 

Gather required information: Before you start your application, you will need to gather some information such as your Social Security number, proof of income, residency, and citizenship, as well as the names and addresses of your doctors and any other medical providers you see. 

Apply online: You can apply for Texas Medicaid online by visiting the YourTexasBenefits website. You will need to create an account, answer some questions, and upload any required documents. You can also check the status of your application online. 

Apply by phone: You can apply for Texas Medicaid by phone by calling the HHSC Medicaid and Managed Care hotline at 1-800-252-8263. A representative will guide you through the application process and help you provide the necessary information. 

Apply by mail: You can request a paper application by mail by calling 2-1-1 in Texas or by visiting your local HHSC office. You will need to fill out the application and mail it back along with any required documents. 

Apply in person: You can apply for Texas Medicaid in person at your local HHSC office. You will need to bring your required documents and a photo ID. An HHSC representative will help you complete the application. 

Once you have submitted your application, it may take several weeks to process. You will receive a letter from the HHSC informing you of your eligibility status. If you are eligible, you will receive a Medicaid card that you can use to access medical services. If you are not eligible, you may still be able to receive assistance through other programs.

What Texas Medicaid covers for seniors 

The Texas Medicaid program covers a wide range of healthcare services, including doctor visits, hospitalizations, laboratory tests, prescription medications, and preventive care. The program also provides coverage for dental, vision, and mental health services. The Texas Medicaid program has expanded its benefits to include telehealth services, which allows beneficiaries to receive healthcare services remotely, increasing access to care in rural areas. This can be particularly important not only for seniors who live in rural areas, but also for seniors who have trouble finding or coordinating transportation to healthcare services.

For seniors, the Texas Medicaid program provides a range of benefits for those who reside in senior living communities or assisted living facilities. These benefits include: 

Long-term care services: Medicaid provides coverage for long-term care services, such as nursing home care, personal care services, and home health care. Seniors who reside in senior living communities or assisted living facilities can receive these services through Medicaid. 

Medical equipment and supplies: Medicaid covers the cost of medical equipment and supplies, such as wheelchairs, walkers, and incontinence supplies. 

Prescription medications: Medicaid provides coverage for prescription medications, including those prescribed for chronic conditions. 

Mental health services: Medicaid covers the cost of mental health services, including counseling and therapy.

Medicaid Managed Care in Texas

Managed Care is another system that aims to improve the quality of care provided to Medicaid beneficiaries while controlling costs. In Texas, Managed Care is mandatory for most Medicaid beneficiaries, with the exception of individuals who receive long-term services and supports. The program contracts with Managed Care Organizations (MCOs) to provide healthcare services to Medicaid beneficiaries. 

The Texas Medicaid program plays a vital role in providing healthcare services to low-income families and individuals in the state. While the program faces several challenges, it continues to provide comprehensive and affordable healthcare services to eligible beneficiaries. By addressing these challenges, such as expanding Medicaid and increasing reimbursement rates for healthcare providers, the program can further improve access to care and health outcomes for Medicaid beneficiaries in Texas.

To learn more about how Sunbound can help make paying for senior living and senior care more affordable for you or your senior loved one, send us an email at info@sunboundhomes.com or request more information on Sunbound. Sunbound is the best way to pay for senior living and senior care, and we’re on a mission to make senior living and senior care more affordable for everyone.

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