As older Texans approach retirement, they often begin re-evaluating their finances to see if they can afford long-term health care and other medical services. While some wealthy citizens can cover all their needs with expensive medical insurance policies – others must learn more about possible Medicaid coverage. Caregivers must also master this type of information for loved ones.
Here is a look at some of the basic questions people often ask while trying to determine if they will be fully able to meet all their future medical needs.
Key questions Texans often ask their lawyers about qualifying for Medicaid benefits
Q: Can many Texans age 65 and older qualify for Medicaid benefits?
A: Yes. However, everyone must carefully review all their assets, in advance, to avoid being
turned down for one of the various types of Medicaid services they may need.
Q: What is the Medicaid “Look Back” period?
A. Our state and federal governments are fully aware that dishonest citizens may try and “hide”
certain gifts to others before their health rapidly declines. Therefore, Texas has a five-
year “look back” period that allows government workers reviewing Medicaid applications
to “flag” questionable requests. These tend to involve gifts that were made during the five
years prior to a person applying for Medicaid coverage or benefits. If sizeable assets were
given away or sold for less than their fair market value, Medicaid can deny an application,
triggering a period of months or years during which the applicant will be ineligible for
Q: Well, doesn’t the IRS gift tax exemption always allow seniors to give annual gifts of a certain
size to family members or others?
A: No, that law was not intended to provide wealthy people with an excuse to give away
money or possessions – without possible Medicaid consequences -- during the five years
prior to applying for some Medicaid benefits. All citizens must do their part to keep the
Medicaid program solvent – and not bankrupted by any type of fraud.
Q: What types of assets are considered “countable” when the government evaluates whether
a single or married person is eligible for Medicaid benefits?
A: Countable assets include investments, stocks, bonds, credit union funds, cash, and all monies
in checking and savings accounts. Real estate properties owned -- but not lived in by the
applicant -- are also among the investigated assets.
Q: Are any types of assets considered exempt when Medicaid eligibility is being determined?
A: Yes. Here is a list of some of the most common types of properties that are not counted when adding up the value of a Medicaid applicant’s assets.
Q: Are there different Medicaid programs that provide services to the elderly? If so, do they
involve different qualifying criteria?
A: Yes. There are several Medicaid programs offering different services and their qualifying
standards can vary to some degree.
Here is a brief list of four Medicaid benefit programs.
1. The Star-Plus Waiver program. This managed care, limited enrollment program exists to
provide adult foster care, assisted living and specific in-home support services. The latter
program is designed to help seniors keep functioning in their own homes, without a
nursing home placement – which is far more expensive.
2. The Community First Choice (CFC) program. This can provide personal care and
support services in a senior’s own home (like preparing meals). In some cases, the senior
needing help may be allowed to choose a relative to provide their care.
3. Primary Home Care. Like the Community Frist Choice program, this one may also let
seniors choose their own caregivers to help provide needed services in their home.
4. Day Activity and Health Services (DAHS). This program is run like most day care
centers. It can help a home caregiver keep a regular job and know that a loved one is
safe during the day. Single seniors living on their own also can benefit from this program
that is run during normal weekday work hours. Certain medical services can also be
provided to seniors who attend.
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