Payor Services

Income

Maximum gross income

  • Individual - $1,737
  • Individual with an eligible spouse - $1,737
  • Couple - $3,474

What counts as income?

  • Social Security Benefits
  • Certain Veterans Benefits
  • Private Pensions
  • Interest and Dividends
  • Royalty & Rental Payments
  • Federal Employee Annuities
  • Railroad Benefits
  • State & Local Retirement Benefits
  • Gifts and Contributions
  • Earnings and Wages

Resources

Maximum countable resources

  • Individual - $2,000
  • Couple - $3,000

What is a resource?

  • Bank Accounts & CDs
  • Real Property
  • Life Insurance Policies
  • Burial Funds
  • IRA
  • Stocks & Bonds
  • Oil/Gas/Mineral Rights
  • Jewelry & Antiques
  • Cars & Other Vehicles
  • Boats & Recreational Vehicles

What can be excluded?

  • Homestead where the individual intends to return.
  • Life insurance if the face value is $1,500 or less.
  • Separately identifiable burial funds of $1,500 (less any excluded life insurance or irrevocable arrangement for burial).
  • Car
  • Burial spaces

Other

  • Medical Need - must meet medical necessity criteria.
  • Risk Assesment - must meet nursing facility Risk Assessment criteria.
  • Residency - must be a resident of Texas and U.S. citizen or alien with approved status (e.g., legalized or permanent resident alien).
  • Living Arrangement - must be a patient in a Medicaid-contracted long term care facility for 30 consecutive days.

Personal Needs Allowance

  • Individual - total gross income less $45 for personal needs.
  • Individual with a spouse in the community:
  • Total gross couple income less $45 for personal needs, less $2,377.50 for community spouse, less certain amount for dependents living with community spouse.
  • Couple - total gross income, less $90 for personal needs.
  • Certain incurred medical expenses are deducted if the Medicaid program does not cover direct payment for the services.