02 Jan A LOOMING CRISIS: INCREASING NURSING HOME COSTS: JUSTIN CRAIN, PARTNER
Most of the nursing home residents in Texas have their stay paid for, all or in part, by Medicaid. The cost of a monthly nursing home stay in Texas can vary from city to city but the average nursing homes cost is $5,931 or more each month. If a married couple is in a nursing home, and they are paying for their care and their medicines and other necessary living expenses, they could be paying out more than $12,000 each month. An extended nursing home stay can wipe out a family’s entire life savings in a few months or a few short years. This is why so many people are interested in finding out how they can qualify for Medicaid, which pays this nursing home cost. In order to qualify for Medicaid, you must meet Medicaid’s definition of “poor”. There are other requirements as well – you must be at least 65 years old, blind or disabled, and your income and assets must be limited.
What Is Medicaid?
Title XIX of the Social Security Act, enacted by the Social Security Amendments of 1965, provided for grants to states to implement the Medicaid Program. Medicaid is a federal-state entitlement program that pays for medical services on behalf of low-income eligible persons. Medicaid is financed from federal and state funds. The Texas Health and Human Services Commission (HHSC) oversees the operations of the health and human services system, provides administrative oversight of Texas Health and Human services programs, and provides direct administration of some programs. The Texas Health and Human Services Commission oversees five agencies of the Texas health and human services system. Those five agencies are: The Health and Human Services Commission (HHSC), The Department of Aging and Disability Services (DADS), The Department of State Health Services (DSHS), The Department of Assistive and Rehabilitative Services (DARS), and The Department of Family and Protective Services (DFPS). Texas Medicaid is administered by the Texas Health and Human Services Commission and the Texas State plan is officially recognized and approved by the U.S. Department of Health and Human Services. The state plan is Texas’ agreement that it will meet the requirements of the Social Security Act and the official issuances of the U.S. Department of Health and Human Services. The vast majority of Medicaid spending for long-term care is on nursing homes. However, Medicaid is available to people who need the type of medical care available in a nursing home setting but who can be treated effectively at home or in the community without being placed in a nursing home. However, Medicaid’s resources are limited and there are long waiting lists to receive these Home and Community Based Waiver Services.
Medicaid Is Not Medicare!
Even though the names sound similar, the programs are very different. Medicare does NOT pay for long-term nursing home care. Medicare is the health insurance that most people age 65 and older have in the United States. Medicare is designed to cover the expenses that health insurance typically covers, such as doctor’s visits, hospital stays, surgery, and lab tests.
Explore available nursing home care protections or apply for emergency Medicaid assistance by scheduling a complimentary consultation with Jacob or Justin.