Medicaid in Texas: An Overview

Medicaid is a program that provides free or low-cost healthcare coverage to low-income Americans. Each state administers its own Medicaid program with federal funding if certain criteria are met; Medicaid is slightly different in each state.

Services provided by Medicaid in Texas include:

-Inpatient and outpatient hospital and clinic services

-Emergency hospital services

-X-rays and laboratory fees

-Physician services

-Prescription medication

-Long-term care services, including home health care, hospice care, adult day care, assisted living, and skilled nursing care.

Not everyone is eligible for Medicaid. In Texas, the eligibility requirements include being a resident of Texas, being a legal US citizen or resident; being either disabled or over the age of 65; and meeting specific income limits. To qualify, applicants have to show pay stubs or other documentation to prove their monthly household income; Social Security number for everyone in the house above six months of age; proof of residence; and other documentation detailing bank records and other assets owned.

Texas runs a sub-program to expand benefits to people who don’t meet strict Medicaid income limit requirements, but who still can’t afford insurance. This program is called the Medicaid Buy-In program, which allows some people who make too much for traditional Medicaid to pay a monthly premium for the benefits; the premium is set according to the insured’s income.

Medicaid also provides long-term care in Texas for those who need help with activities of daily living, including bathing, dressing, cooking, chores around the house, errands, and medication reminders. There are also the Community Based Alternatives (CBA) and Consolidated Waiver Program (CWP)—these programs are for adults who require nursing-home level care in the home. The CWP program is available for people with developmental or physical disabilities, and serves only those in Bexar County.

Other programs include the Community Living Assistance and Support Services (CLASS) program, Home and Community Services (HCS), Medically Dependent Children’s Program (MDCP), and the Deaf Blind Multiple Disabilities Services (DBMD) for people with various types of disabilities.

Want to learn more about Medicaid in Texas and how it provides long-term care and medical coverage to those who need it? Check out our Texas LTC Partnership Training course.

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