Individual Gross Income Limit = $2,901.00/month for a single person applying
This is the monthly income figure that determines income eligibility for Medicaid benefits for nursing home and waiver/HCBS. Level of Care is nursing home. If an individual’s income is less than this amount, then they are income eligible. If an individual’s income is greater than this amount, then they have excess income and may be ineligible for benefits and may consider a Qualified Income Trust.
Individual Resource Allowance = $2,000.00 for a single person applying
This is the maximum amount of assets a single person may own and still qualify for Medicaid benefits.
Couples Gross Income Limit = $5,802.00/month for both married spouses applying; and $2,901.00/month for one married spouse applying.
This is the monthly income figure that determines income eligibility for Medicaid benefits for nursing home and waiver/HCBS. Level of Care is nursing home. If a couple’s income is less than this amount, then they are income eligible. If their income is greater than this amount, then they have excess income and may be ineligible for benefits and may consider a Qualified Income Trust.
Couples Resource Allowance = $3,000.00 for both married spouses applying; and $2,000.00 for one spouse applying; and $157,920.00 for the non-applicant spouse.
This is the maximum amount of assets a couple may own and still have both spouses qualify for Medicaid benefits. If one spouse has received benefits for more than one year and then the other spouse moves to a nursing home and applies for Medicaid, then different rules may apply.
Maximum Homestead Equity = $730,000.00.
This is the maximum value of equity allowed for a homestead to qualify as a protected resource.
Minimum Monthly Needs Allowance (MMNA) = $3,948.00/month.
This is the minimum monthly income amount that the spouse at home may keep. If both spouses combined income is lower than this amount, then the spouse at home keeps all the income.
Community Spouse Resource Allowance (CSRA) = $31,584.00 – $157,920.00.
The community spouse (the non-applicant spouse) can retain 50% of the couples’ assets, up to a maximum of $157,920.00. If a couple’s combined total assets are below the minimum amount of $31,584.00 then the spouse at home keeps all the assets. This can be higher depending on the couple’s income conditions.
Monthly Personal Needs Allowance (PNA) = $75.00/month.
This is the monthly amount that a Medicaid recipient may keep for personal items which Medicaid does not cover (haircuts, snacks, prescription co-pays, etc.) An additional amount may be available for veterans.
Penalty Divisor = $242.13/day or $7,339.00/month.
This figure, based on the statewide average of daily nursing home costs, is used to determine the length of time an individual or couple is ineligible for Medicaid benefits because of uncompensated transfers or gifts they have made.
Here is a free Medicaid Eligiblity Test for seniors offered by the American Council on Aging American Council on Aging that you may use to help determine whether you are eligible for Medicaid benefits.
For more information on Medicaid Rules for the State of Texas, please visit Texas Medicaid Handbook.
Please Note: This information is not intended to provide legal advice nor does it intend to represent the whole of Texas Medicaid rules and regulations. This information may or may not be applicable to your specific circumstances or accurate and any questions regarding your specific circumstances should be addressed by an attorney who practices in this area.