Medicaid eligibility

Medicaid Eligibility
What are the Basic Medicaid Eligibility Requirements?


The national average for long-term care costs in a nursing home is $6,360 a month. In Texas, the average cost for a semi-private room in a nursing home is over $57,000 a year and a private room can exceed $8,000 a month.

If you have a loved one that is or about to be in a Nursing Home, you are probably asking yourself, “How can I possibly afford this?”

Many people are surprised to learn that Medicare and private health insurance do not cover long-term care in a nursing home. And although many aging seniors have VA benefits, it is rarely enough to cover most nursing home bills. Many families have to spend their entire life savings just to pay for long-term care.

It doesn’t have to be that way! Unlike Medicare, Medicaid does pay for long-term care for those who qualify. It is the single largest third-party payor for long-term care, paying over 62% of all long term care costs in the U.S.

A person applying for Medicaid must meet two sets of requirements to qualify – Financial and Non-Financial

The Non-Financial Requirements are:

  • You must be a U.S. Citizen or lawful alien,
  • You must be a Texas resident and plan to remain in Texas,
  • You must reside in a nursing home for at least 30 days, and
  • You must have a “medical necessity” for long-term care in a nursing home.

In addition, the applicant must satisfy the Financial Requirements. These rules set caps on the applicant’s income and assets. The applicant must be below the income cap and asset cap in order to qualify. Both caps change every year.

For the year 2020, the income cap is $2,349 per month and the asset cap is $2,000 for single applicants. If the applicant is married, the asset cap is still $2,000, but their spouse may keep up to half of their combined assets up to $128,640 without disqualifying the applicant.

Medicaid eligibility

You may be saying to yourself, “My loved one has way more than that. They own a home, two cars, and have retirement accounts. How can they ever qualify for Medicaid?”

Medicaid’s rules are extremely complex and have numerous exemptions. It is possible to keep all or a majority of your assets and still qualify. With help from the Michels Law Firm, your loved one can qualify for Medicaid even if they are above the Financial Requirements.

Don’t let long-term care cost your loved one their entire life savings. Contact The Michels Law Firm to speak with an experienced Elder Law Attorney.