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Medicaid Frequently Asked Questions Health coverage is necessary. Few people can afford to pay all of their medical expenses themselves. But what if your employer doesn't offer coverage or the coverage is too expensive? What if you're elderly, have a disability, or don't have a job? Many Texans are helped by the state's Medicaid program. The Social Security Administration determines ongoing Medicaid eligibility for people who receive Supplemental Security Income (SSI), while the Health and Human Services Commission (HHSC) determines eligibility for everyone else. This includes coverage of unpaid or reimbursable medical bills during certain months before an SSI application. Then the Texas Health and Human Services Commission oversees your benefits. Read on to learn how you can receive help if you qualify.
Where do I apply for Medicaid?Visit your local Medicaid office, click here to find the office nearest you. If you have questions, you can call the toll-free Medicaid Hotline at 1-800-252-8263 between 7:30 a.m. and 5:30 p.m., Monday through Friday. What is Medicaid?You can think of Medicaid as a type of health insurance for low-income families, children, and people who are elderly or have a disability. But unlike regular health insurance, you don't have to pay for it, and most services are free. There are two types of Medicaid in Texas: traditional and STAR. People in both programs get the same benefits. Under the traditional program, you get medical care from any doctor or provider who accepts Medicaid. Under the STAR program, you have one provider who takes care of you. Your caseworker will let you know which one you'll receive. Who's eligible for Medicaid?People who receive Temporary Assistance for Needy Families (TANF), Refugee Cash Assistance, and SSI automatically get Medicaid. (TANF is sometimes called welfare, and SSI is available to people who are elderly, blind, or have a disability.) Other people also may qualify based on their income and resources.
Different eligibility requirements apply to each group. Please contact your local Eligibility office for specific information. How does Medicaid work?Each month you'll get a Medicaid ID card. It's very important that you keep it in a safe place. You'll have to show that card each time you visit the doctor or get a prescription filled. You won't receive a monthly ID card if your only benefit is payment of all or part of your Medicare Part B premium. Medicaid pays for most services, but not for everything. To make sure that you receive your benefits, follow these rules.
What's covered?In most cases, Medicaid pays for doctors' services, laboratory and X-ray charges, medicines, nursing facility and hospital services, family planning, eyeglasses, hearing aids, ambulance, podiatry, chiropractic, maternity, nurse midwife, and other health care services. People who are elderly or have a disability who need help with daily activities may be able to receive services in their homes. The state also offers some non-Medicaid community care services. Medicaid often pays for regular checkups, especially for children. In some cases, children may even get to see a dentist. Your Medicaid ID card will tell you what services you can receive, and when regular check-ups are scheduled. What are the minimum qualifications?Medicaid is available to qualifying Texans of all ages and abilities. There are separate programs for families and children and for people who are elderly or have a disability. In general, you must:
How do my assets, such as my home and bank accounts, and my income affect whether I can receive Medicaid?The amount of assets and income you're allowed depends on the category you apply under. Contact your local Eligibility office for more information. You'll need to provide proof of income and assets when you apply. In most cases, a homestead is not counted as an asset. I have several unpaid medical bills. Will Medicaid pay for them if I'm eligible for coverage?Coverage usually begins on the first day of the month in which you applied for benefits. Sometimes Medicaid pays unpaid bills as far back as three months before you applied for coverage or you began receiving SSI benefits. Can I get Medicaid coverage if I already have health insurance?Yes, but your other insurer must pay first. Medicaid may pay for things not covered by your other policy. Can I work and still be eligible for Medicaid?Yes, certain earnings may not be counted. If you meet the other requirements, it doesn't matter if your income is from a job or another source. If you are elderly or have a disability, plus one half of the remainder of certain earnings, won't be counted when eligibility is determined. I was told I make too much money for regular coverage, but that my child might qualify for spend down. What does that mean?Spend down is another name for the Medically Needy Program. You can be reimbursed for unpaid medical bills if, by paying them, your income would be low enough to qualify you for Medicaid coverage. For example, a family of four with an income of ,000 a month would be covered if their medical expenses were at least 2 a month. Doctor visits, prescriptions, past medical bills, and medical insurance charges are covered. If you have other insurance it must pay first. Only the amount that it doesn't pay may be counted. This program is for children and pregnant women only. My family doesn't qualify for Medicaid, but we can't afford insurance. Is there any help available for us?The Children's Health Insurance Program (CHIP) offers low-cost insurance for families like yours. The phone number is 1-800-647-6558. I'm covered by Medicare, but I have a hard time paying my share of the costs. Can Medicaid help with my out-of-pocket expenses?Texas has several Medicare savings programs that may help people who are eligible for Medicare Part A. Different income and resource limits apply to each. Do I have to be broke to qualify for long-term care Medicaid?No. You can have some income and other resources and still be eligible for Medicaid. Income sources include earnings or wages, Social Security, certain veterans benefits, private pension and retirement benefits; interest or dividend income; royalty or rental income (after expenses); gifts or contributions; and civil service annuities. Resources include financial accounts; stocks and bonds; real property, such as land; a car; life insurance policies; burial funds; and personal property such as jewelry, antiques, and coin collections. Some resources are protected. They generally include your homestead, household goods, personal effects, a car, and certain burial funds and burial space items. If I have a job, can I still qualify for long-term care Medicaid?That depends on how much you earn at your job. Having a job may not disqualify you, but the amount of money you can earn and still be eligible for Medicaid is low. A Medicaid eligibility worker can tell you whether your job makes you ineligible for Medicaid. Do I have to sell my house before I can qualify for long-term care Medicaid assistance?No. Some resources are protected. Protected resources generally include your homestead, household goods, personal effects, a car, and certain burial funds and burial space items. If I need long-term care Medicaid assistance, what will happen to my spouse?Spouses can usually keep some amount of protected resources if they continue to live in their home or community. The resources a spouse may keep include a homestead, household goods, personal effects, and a car. What other requirements must I meet for long-term care Medicaid eligibility?
If I qualify for Medicaid, do I have to pay anything for long-term care for me or my spouse?It's possible that you may be required to contribute some of your income toward the cost of care. Only a long-term care Medicaid eligibility worker who knows the details of your situation can tell you for sure whether or not you will have to contribute to the cost of care. My mother can't really take care of herself anymore, but she won't even consider a nursing home. Does Medicaid provide any way for people to get help so they can stay in their homes?There are a number of Medicaid-funded home and community services for qualifying people of all ages. Some programs are available on a first-come, first-served basis.
If I don't qualify for Medicaid, can I still get help with any long-term care services?Yes. Even if you are not eligible for Medicaid, you may still qualify to receive a number of the community-based services. Community care services are provided on a first-come, first-served basis at little or no cost to you. Contact your local Eligibility office for more information. |