What do Medicaid nursing home benefits cover?
There are approximately 42 Medicaid programs in Texas. It is important to understand that each program has its own eligibility criteria and benefits. If the Medicaid applicant in a Medicaid certified nursing home meets the functional and financial eligibility criteria, Medicaid will cover most of the medical and support needs of the person. As the payer of last resort, Medicaid only begins to pay once other healthcare coverage, long-term care coverage, or other coverage is exhausted.
Nursing home Medicaid does not pay for dental care. If a Medicaid nursing home recipient needs a noncovered medical service such as dental care, and the medical service is not paid for through Medicare or private health insurance, the Medicaid recipient can pay for the care and submit a copy of the paid invoice to HHSC. Provided the medical service is medically necessary, HHSC will reduce the Medicaid recipient’s copayment and pay the nursing home the difference. It is a good idea to check with the HHSC caseworker and billing office prior to paying out of pocket for a noncovered medical service.
Other Frequently Asked Questions
- Can a family member be paid for services provided to the Medicaid applicant?
- Can I gift or transfer assets for less than fair value and receive Medicaid nursing home benefits?
- Does Medicare cover nursing home care?
- How is medical necessity determined for Medicaid nursing home care?
- How is the Medicaid applicant’s home protected against the Medicaid Estate Recovery Program (MERP)?
- How much is the Medicaid copayment to the nursing home?
- I thought you could gift a certain amount each year without penalty?
- What are some strategies to getting under the Medicaid resource limit?
- What are the basic eligibility requirements for long-term care Medicaid in Texas?
- What do Medicaid nursing home benefits cover?
- What if medical necessity is denied?
- What is a Medicaid transfer penalty and how is the penalty calculated?
- What is a Qualified Income Trust (QIT)?
- What resources are excluded for purposes of determining Medicaid eligibility?