How to Know if patient needs Medicaid for Assisted Living Facilities

Assisted living facilities are not cheap, but they are often necessary for people with memory problems such as dementia or Alzheimer’s. Fortunately, there are medical insurances (both private and public) such as Medicaid that may help with the bills. Medicaid provides health coverage to over 72 million Americans. In the state of Texas, around 14% of the population uses it as their health insurance. In order to assess if you are qualified for Medicaid when it comes to assisted living facilities, then you should check their rules for eligibility:

• Automatic qualification

Some people are automatically qualified for Medicaid insurance, such as SSI beneficiaries and people registered in the TANF or the Texas Temporary Assistance to Needy Families. Those who are also disabled, blind and/or aged 65 and older are qualified, if they are within the limits provided for income and resource.

• Income limits

For single people who plan to enter the assisted living facilities, must have a monthly income that is no higher than $2,000. If you are in a married relationship and you both are entering the facility, then your combined income must be lower than $4,000 per month. You should double check with your state, as the income and asset limit may change.

• Resource limits

This includes assets such as land, cars, money etc. If single, then the limit is $2,000, but if in a married relationship (and both wish to apply) then the limit is $3,000. Note that there are some exclusions to the resource limits.

• Medically necessary

A doctor must prove that staying in a nursing home or an assisted living facility is medically necessary for the patient.

Other Options

There are programs in Texas that help those who can prove that they are medically qualified but do not meet the other requirement. Try applying to the CBA Medicaid or the STAR PLUS Medicaid Waiver Services. This is not available in all parts of Texas, so it is advisable to ask the local Texas Department of Aging and Disability Services office for more information on the Medicaid and other programs.