| Medicaid Eligibility
Nursing Facility Program |
Applying for Medicaid
Below is the Medicaid application and supporting documents. All of these forms require original signatures, and must be submitted to the facility business office. They are provided here for your convenience. You may use your computer to fill out and print the forms, or use your computer to fill out and email the form to the appropiate business office. The business office will print the forms, and have them ready for your signature. Contact the business office for the proper email address.
Nursing Home Medicaid Application
Authourization to Furnish Information
Medicaid Estate Recovery Program
Programa de Recuperación de Medicaid
Case Information Release
Statement of Intent to Return Home
Income
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Maximum gross income |
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Individual - $2,022
individual with an ineligible
spouse - $2,022
Couple - $4,044
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What counts as income |
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Social Security Benefits
Certain Veterans Benefits
Private Pensions
Interest and Dividends
Royalty & Rental Payments
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Federal Employee Annuities
Railroad Benefits
State & Local Retirement Benefits
Gifts and Contributions
Earnings and Wages
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Resources
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Maximum countable resources |
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Individual - $2,000
Couple - $3,000
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What is a resource |
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Bank Accounts & CDs
Real Property
Life Insurance Policies
Burial Funds
IRA
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Stocks & Bonds
Oil/Gas/Mineral Rights
Jewelry & Antiques
Cars & Other Vehicles
Boats & Recreational Vehicles
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What can be excluded |
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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
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Protected resources amount for
a spouse in the community |
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$21,912 Minimum - $109,660 Maximum (Excludes
value of homestead, household goods, personal
goods, one car, and burial funds)
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Other
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Medical Need - must meet medical
necessity criteria.
Risk Assessment - 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.
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Personal Needs Allowance
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Individual - total gross income
less $60 for personal needs.
Individual with a spouse in the community
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Total gross couple income less $60
for personal needs, less $2,377.50 for community
spouse, less certain amount for dependents living
with community spouse. |
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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.
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