Health Care Coverage: People 65 Years or Older/People Who Have a Disability
A person who is 65 years or older, or a person who has a disability, may receive Medicaid assistance if he or she meets income and resource limits set by the program.
The amount of resources that a person owns is considered when deciding if he or she can receive Medicaid. Resources can include bank accounts, certificates of deposit, property, cash value of most life insurance, stocks and bonds. Resources do not usually include the value of a person’s home, vehicle, limited burial fund or personal belongings.
To find out if your income and resources are within the limits for this program, you can fill out a self-screening questionnaire at www.YourTexasBenefits.com. You can also meet with an HHSC staff person at an office near you. (To find an office, go to www.YourTexasBenefits.com, and then click on “Find an office.” You also can call toll-free 2-1-1.)
Medicaid for Long-Term Care
A person who needs 30 or more days of continuous, long-term care may be able to receive Medicaid if income and resource limits set for the program are met. Medicaid may also pay for medical services that were received three months before the person applied for assistance.
A person who receives Medicaid for long-term care must pay a portion of the cost by using all of his or her income, except for a small monthly allowance for personal needs and certain deductions such as health insurance premiums.
Long-term care services can be provided through community programs while the person is living at home or while the person is living in a long-term care facility, such as a nursing facility, institution for mental diseases or facility for the mentally retarded.
The benefit period for long-term Medicaid services is usually one year. Before the end of the benefit period, a renewal application will be sent to that person, or his or her authorized representative.
Medicaid for people who receive Supplemental Security Income
A person who receives Supplemental Security Income (SSI) automatically receives Medicaid. HHSC sends information about Medicaid services to people receiving Supplemental Security Income.
If a person receiving Supplemental Security Income needs help paying for medical services that were received three months before applying for Supplemental Security Income, he or she must complete a Medicaid application to request this help. Income and resource limits set by this program must be met.
To learn more about how to apply for Supplemental Security Income, visit the U.S. Social Security Administration’s website or call the toll-free number, 1-800-772-1213.
Medicare Savings Programs
Medicare Savings Programs are for people who receive Medicare and need help paying for Medicare premiums, co-insurance and deductibles. If a person meets income and resource requirements set by the program, Medicaid will help pay for some Medicare costs.
Income limits range from $908 to $1,815 for a person and $1,226 to $2,452 for a couple. The amount of resources a person owns is also considered and can include bank accounts, certificates of deposit, property, cash value of most life insurance, stocks and bonds. Resources usually do not include the value of a person’s home, vehicle, limited burial funds or personal belongings.
People who receive Medicare and are interested in applying for a Medicare Savings Program must complete a HHSC Medicaid application.
The benefit period for Medicare Savings Programs is usually one year. Before the end of the benefit period, a renewal application will be sent to that person, or his or her authorized representative.
For more information about Medicare, visit the U.S. Department of Health and Human Services website and the Centers for Medicare & Medicaid Services website.
Medicaid Buy-In for Adults
The Medicaid Buy-In program offers all Medicaid health-care services, including community-based services. Some people must pay a monthly fee to be in this program.
This program is for people who:
- Have a physical, intellectual, developmental, or mental disability.
- Are working.
- Live in Texas.
- Don’t live all the time in a nursing home, state hospital, or intermediate care facility for people with intellectual disabilities.
People in this program can make more money (income) and own more things (assets) than allowed by other Medicaid programs. Retirement accounts and money set aside for health care and work expenses are not counted as income or assets.
Medicaid Buy-In for Children
This program is for families who have a child with a disability, but earn too much money to get traditional Medicaid. Through this program, families can “buy-in” into Medicaid coverage by making monthly payments.
To be in this program the child must:
- Be age 18 or younger.
- Not be married.
- Meet the same rules for a disability that are used to get Supplemental Security Income (SSI). The child doesn’t have to get SSI.
- Live in Texas.
- Be a U.S. citizen or legal resident.
The benefit period for this program is usually one year. Before the end of the benefit period, a renewal application will be sent to the family.