Texas Assisted Living and In Home Care Medicaid Waiver Information and Rules for 2017

Introduction

Texas provides long-term care resources to seniors through the Texas Department of Aging and Disability Services (DADS) and the Department of Health and Human Services (HHS). DADS is in the process of merging into the Department of Health and Human Services and by September of 2017 will be abolished. Some of the services currently provided by DADS/HHS includesinformation for Texans to: 1) Live independently in their own homes, 2) Understand their state and federal benefits and their legal rights, 3) Give family caregivers the tools to do their job, 4) Provide meals at home or in group settings, 5) Qualify for assisted-living facility care, daytime programs or nursing home services, 6) Advocate for people who live in assisted-living facilities or nursing homes, 7) Guide you to the right long-term care services.

The Department of Health and Human Services also administers the Texas Medicaid waiver programs that allow seniors over the age of 65 who require a nursing home level of care but wish to remain in their own home or community the ability to receive services through the Medicaid for long-term care benefit.

Medicaid Waiver Program for Assisted Living and In Home Care

STAR+PLUS Home and Community Based Medicaid Waiver (HCBS STAR+PLUS Waiver)

STAR+PLUS is a Texas Medicaid managed care program for people who have disabilities or are age 65 or older. People in STAR+PLUS get Medicaid health-care and long-term services and support through a medical plan that they choose. Long-term services and support includes things like: Help in your home with basic daily activities; Help in making changes to your home so you can safely move around; Short-term care to provide a break for caregivers; Help with things that need to get done. Another feature of STAR+PLUS is service coordination in which a STAR+PLUS staff member works with the member, the member's family and the member's doctors and other providers to help the member get the medical and long-term services and support they need.

Services

Services include: Long-term services and supports can include: 1) Day Activity and Health Services (DAHS) and 2) Primary Home Care (PHC). Other services under the STAR+PLUS Home and Community-Based Services Waiver include: Personal assistance services; Adaptive aids; Adult foster care home services; Assisted living; Emergency response services; Home delivered meals; Medical supplies; Minor home modifications (making changes to your home so you can safely move around); Nursing services; Respite care (short-term care to provide a break for caregivers); Therapies (occupational, physical, and speech-language); and Transitional assistance services

Eligibility

  1. Health: An applicant must require a Nursing Home Level of Care.
  2. Financial: Applicant’s for the STAR+PLUS waiver must meet certain income and asset requirements to be eligible for Medicaid for long-term care for the elderly. Texas follows the special income limit rule, which means that an individual may earn a monthly income up to $2,205 (or $4,410) for a couple; and, must not have assets that exceed $2,000 for an individual (or $3,000 for a couple). The non-applicant spouse may also keep up to $120,900 in assets and receive a maximum of $3,022.50 per month for other expenses without affecting the eligibility determination.

Practical Considerations

The transition from the Community Based Alternatives (CBA) waiver to the all-encompassing STAR+PLUS program administered through the Department of Human Services because the Department of Disability and Aging Services (DADS) is being terminated makes getting information about the programs more complicated. However, because Texas is a special income limit state and allows a Miller Trust, the program is not much different than any other HCBS waiver.

Conclusion

Medicaid Planning will help for persons who have income that exceeds the special income limit, because the use of a Miller Trust, or Qualified Income Trust, can be used to make payments for care and bring the applicant’s income below the limit. A planning specialist may be able to help an applicant receive benefits earlier than they would have otherwise due to these special rules.